Annex A > Chapter 8 - Management and Culture of the UBH and the UBHT > The scope of this chapter > Dr Roylance's overview
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Dr Roylance's overview
3 Dr Roylance told the Inquiry that, over a period of years, there had been successive management changes designed, in his view, to address the mismatch between resources and demand in the NHS. He saw the introduction of general management to the NHS in the mid-1980s as one such change. In summarising his view of the changes over time, Dr Roylance said:
`The National Health Service is characterised by an accelerating gap between what is possible and what is affordable. Unless that fundamental issue is accepted and understood, nothing else makes a lot of sense.
`Over time, various initiatives to bridge that gap have been instituted. They include first of all, increased funding, and if there were time, I would demonstrate that the more money that is put into the Health Service, the bigger is the shortfall between what is considered possible and what is affordable.
`So although we all welcome increased funding, it will not bridge the gap.
`Then there was "Let us manage the Health Service (the Griffiths Report and so on) and make it more efficient, more effective and more business-like". As we have all seen, there is a tendency for that to divert money from healthcare into management. If you have what I call "professional managers" invited into the Health Service, it is not surprising that the amount of management is increased. In my judgment, in many Trusts, they are mostly managing management and not healthcare.
`Then there is the pious hope that evidence-based medicine would solve the problem and bridge the gap. That was fairly recent, five, six, seven years ago. In my view, all that does is sharpen the argument for more resources, because although there may be a slight delay, it will justify enormous expenditure on new developments.
`There is the view, the very proper view, that the gap might be substantially reduced by health promotion ... in my personal belief, until you separate health promotion - perhaps give it to local authorities as a responsibility - and recognise the Health Service as a disease service, you will not make any progress there ...
`Could I say that the last initiative - this is part of the background of management - was what I would describe as "concealment" of the shortfall. That is by the GP fund-holding system, where you give the GP the money and he does not send anyone to hospital until he can pay for it ...
`... a Chief Executive in a teaching hospital trust is constantly assailed with demands for more funds. These are not expressed in gentle terms ... there are aggressive demands that patients are dying, the service is unacceptable. This comes in all the time.
`In my last year as Chief Executive, the novel idea of clinical governance came in. It was a new idea and it followed the previous corporate governance which crudely could be said, "You must not put your hand in the till", but clinical governance was a very new concept that the managing authority, the trust and the Chief Executives, should be responsible for the quality of clinical care.' [1]
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