Casualties of dramatic changes to their system

A new report has found attitudes in the NHS are far from healthy

As any regular viewer of television's Casualty knows, the NHS is not a particularly happy place at present. Tussles over funding, beds and staff shortages take nearly as heavy a toll on individuals' lives as their complex romantic liaisons.

Defenders of the management changes in the health service have suggested that the BBC has rather over-egged the pudding in the interests of dramatic effect. But a recent report from Imperial College, London's management school would appear to suggest that artistic licence has not been carried too far.

Medical staff and directors are "less certain of their career paths" because of recent changes. The NHS is reflecting the private sector as individuals are encouraged to take responsibility for their own career development, says the report Managing in the NHS: A Study of Senior Executives.

It finds that a "significant minority" of those with a medical background that are affected by changes feel so threatened that they want to move out of management. They want to return to full-time clinical work because they feel their jobs are not adequately supported or defined. A third of respondents with backgrounds in nursing said they wanted to leave the NHS because they thought their advancement could be blocked by changes.

At the same time, the report team, led by Diana Winstanley, director of the health management programme at Imperial College, has found that some people in the NHS - particularly finance and human resources directors of trusts - see new opportunities through a broadening of their responsibilities and their roles. It suggests that the trusts and local-level purchasers can act as information centres to help individuals with career opportunities and training. The challenge, it says, is for the trusts to break down barriers between purchasers and providers that might prevent people moving from one side to another.

One way of overcoming these barriers is to construct management development programmes that bring together people from different disciplines, backgrounds and parts of the healthcare sector. The report, based on a survey of 271 people with clinical and managerial backgrounds in 21 health service organisations, highlights that it is essential to have a close partnership between course providers and different parts of the health service if training is to be of useful and relevant.

Dr Winstanley says: "There will always be a huge requirement for people with specialisms in medicine and health, but there is now also a premium for managers who are able to demonstrate strategic thinking, engage in service evaluation and development, organise and motivate their own team and network and teamwork across organisational and disciplinary boundaries."

No wonder the cast of Casualty looks so stressed every Saturday evening.


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