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Politicians, Clinicians, Managers: Who’s to blame, who cares?

11-June-2013 0:00
in General
by Dr. Megan Joffe

Who's to blame?  And who actually cares?


The recent political fracas following the Keogh review, while interesting to observe, deflects attention from how political behaviour impacts the front line.  Clinicians and managers are guided by how the politicians position the NHS and what their strategy for it is. In this context people on the frontline have much less freedom than some would assert, to deliver care they consider the best.  While this view is in no way meant to excuse poor care there is a feeling – increasingly prevalent - that good clinicians who want to do their best to manage the service are feeling increasingly demotivated to take on leadership roles. They are given responsibility with little authority, and very little, if any, resources. They are required to do more with less. Notwithstanding advances in medical technology and care, the pressure to reduce costs, to centralise/decentralise, to merge/de-merge, to change plans all the time being challenged to deliver excellent care is wearing.  The signs of learned helplessness are gaining momentum – a feeling that whatever you do will be criticised, that it is never enough; and that you are powerless to effect any meaningful change in the area that you are responsible for. In this context clinical leadership requires resilience and a thick skin. It is to their credit that clinical leaders continue to care deeply about their patients but are less and less interested in leadership roles that seem to be a relentless battle with little reward. Those that do take on leadership roles should be commended and supported. Indeed today’s news (24/7/2013) with a focus on difficulties in resourcing A&E departments suggests that maybe some politicians will listen to people on the ground and take their concerns seriously – the real support will come when money is made available to pay for the extra resources that are needed although of course they may have to rob Peter to pay Paul.

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