At the time of its launch in 1948, the United Kingdom National Health Service (NHS) was divided into three sectors to manage the service; the first was tasked with managing hospital services, the second looked after family doctors, dentists, opticians and pharmacists while the final section, was tasked with the local authority health services, including community nursing and health visits.
As with any other organisation the NHS since 1948 has undergone enormous changes within its structure from the shop floor up to the board of directors necessitated by changes in the social, economic and political climate in which it operates. The NHS is constantly trying to adapt to incorporate the most effective treatments for the community whilst also attempting to reduce or minimise expense and is regularly criticised in the press for its inefficiencies.
Being one of the largest organisations in the world the NHS is naturally difficult to manage, so how can the senior management within the NHS ensure that they provide a service which is “ever a more efficient, rational and controlled [while] at the same time caring and people centred”? (University of Leicester, 2007) Question 1 How do you understand the problem of management in the United Kingdom National Health Service? What organisational factors have contributed to these problems?
The basic challenges faced by management in the NHS today are much the same as they were at the time of it’s creation, and are seen in nearly every organisation across the world and in every industry; accurate forecasting of expenditure, resource allocation, funding, increased costs and perhaps most importantly, customer satisfaction; and while the NHS doesn’t have shareholders as such to be answerable to, it does have to justify its performance to both the government and the taxpayer. Financial Structure
One of the biggest problems faced by the NHS is the same as with any other business, cost, and how to keep it under control. As a public service it is funded by the taxpayer, catering to all UK residents and as such there are finite resources available to treat an ever increasing population and infinite demand for those services offered. The resulting ‘reverse’ funding structure of the NHS also puts the use of new technologies or treatments available in the sector out of reach until they have been reviewed, approved and budgeted.
In most other businesses, department heads would draw up a budget which would be sent to top management for approval, i. e. ‘bottom up’. The NHS however has a ‘top down’ funding structure whereby management are allocated funds which they then have to work to regardless of their forecasted expenditure. This means that as technology in the sector develops and treatments become less invasive and traumatic, with a more positive outcome for the patients, the demand and therefore expense increases further still as the patients’ expectations also increase.
(http://www. nhshistory. net/introduction. htm). This is due to the fact that although advances in treatments may lead to a reduction in unit cost, the overall cost of treatment will still increase as so too does demand. Coupled along with additional demand, testing, certification and training costs all need to be factored into the equation. This is a fundamental problem with the NHS which will not be solved unless the basic method of funding is altered. Motivation Another problem of management in the NHS is the motivation of its staff.
Although it can often be easy to ‘point the finger’ and blame underperformance on morale, the ‘stream of initiatives and targets’ issued by the Department of Health as described in the text are designed to address the “major and obvious defects of the NHS”; (http://www. nhshistory. net/introduc-tion. htm) however these have been seen by some managers in the NHS as a hindrance, ‘distracting all from important tasks’. This also has the effect of creating a sense of instability and a feeling of insecurity among the workforce having a detrimental effect on their level of motivation and therefore their ability to deliver satisfactory results.
As suggested by the Hawthorne studies, if the staff are motivated then they will be more productive and this will reflect in the standard of work which they deliver, in this case, the number of patients treated and the level of satisfactory outcomes as well as the satisfaction of those patients with the service which they receive. This highlights the importance of good management within the organisation, after all the aim of the NHS is to improve peoples’ health.
However, the fact that the NHS has been so openly criticised in the press in recent years reflects poorly on the management directing it, resulting in the management losing confidence in their management abilities. Further examples are shown in the text displaying the way management feel they are perceived both by the public and by government ministers; “I think that the public doesn’t have a very good opinion of us, I think the media portray us very badly – that there’s far to many of us. ” (University of Leicester, 2007) The public associate the NHS with clinicians, not managers.
As managers operate behind the scenes planning and organising the resources, the public has limited knowledge of their role. This lack of understanding leads to the public feeling that there are too many, particularly when presented with statistics regarding the number of managers at Leeds General Infirmary and St James hospital. However as stated in the text, the standard of management in healthcare can have a greater impact on mortality rates than the ratio of doctors to patient beds, so the seemingly high number of managers can perhaps be justified.
The managers however must not be neglected in order for the front line doctors and nurses and many support staff to feel motivated as management are the motivators and as such must be motivated themselves. Unfortunately the middle management in the NHS are seen as having a somewhat “uncomfortable position” (University of Leicester, 2007), the policies designed by government ministers to improve the service’s cost effectiveness eventually have to be introduced and implemented by the middle management; they may feel they have a thankless task.