Final Report > Chapter 12: Responses to Concerns and Actions Taken, and Whether Such Actions were Appropriate and Prompt > Responses within the UBH/T > Clinicians as managers

Clinicians as managers

44 We interrupt our commentary at this point because our observations concerning Mr Wisheart go beyond Mr Wisheart to all those who found themselves as clinicians in positions of management. While, as we have said, the Griffiths Report called for the involvement of clinicians in management, to which Dr Roylance responded positively, no thought or attention seem to have been given to the fact that management requires particular skills and training. Merely being a senior clinician does not mean that the clinician has these skills. They must be acquired and clinicians must be given the time and opportunity to acquire them. It is clear that a number of the Inquiry's observations about the way in which concerns raised about the PCS service were handled at the BRI have arisen out of decisions taken by clinicians on the borderline between managerial and clinical loyalties and practice. For example, Mr Wisheart, as a clinician, may have thought it inappropriate to intervene in Mr Dhasmana's decision to operate on Joshua Loveday because of a long-standing tradition that one consultant does not interfere in the clinical judgment of another. But, as Mr Dhasmana's Medical Director, he had a duty to do so. Mr Dhasmana, as a clinician, decided to operate but, as the manager of the surgical team, Mr Dhasmana had a responsibility to consider the impact which the calling of an extraordinary meeting to discuss Joshua's operation would have on the team and to reconsider the decision. All the tasks to be performed in any hospital should be carried out by those who have both the necessary skills and resources, with clear lines of accountability to ensure that a good job is done. This should be self-evident. Clinicians at the UBH/T, at the time in question, were being asked to undertake managerial responsibility for which they were untrained, unprepared, and under-resourced. To choose one example, it was instructive to hear Mr Baird describe how his duties as Clinical Director of Surgery occupied `five or ten minutes' [45] of his time twice a day. This may be understandable, given the other range of duties he had, but it is not a recipe for good management.

45 In the future, if, as we argue in Section Two, all who work for the NHS are collectively categorised and come to see themselves as healthcare professionals (albeit with differing responsibilities), the dividing line between the managerial and the clinical may be less clear cut. All managers will be seen as caring for patients. All clinicians will be seen to be carrying out managerial tasks, even if only within their own clinical teams. To do this effectively, clinicians will need to be supported by training and resources, and especially an adequate allocation of time.

Footnotes

[45] T 29 p.62 Mr Baird