Final Report > Chapter 15: The Culture and Management at the UBH/T > Strategic vision
<< previous | next >>
Strategic vision
9 From 1990 onwards Dr Roylance's delegation, as DGM and then Chief Executive, of large areas of responsibility to the clinical directors was accompanied by a reluctance to develop corporate responsibilities or priorities. Moreover, overall strategic vision or direction was lacking at Board level. The Trust's non-executive directors and even Mr Peter Durie, the Chair until 1994, were not encouraged by Dr Roylance to develop this approach. In Dr Roylance's view, with the creation of trusts, planning had passed from the Trust and the Board to the various purchasers of healthcare services, particularly the Bristol and Weston District Health Authority (B&WDHA), later Bristol and District Health Authority (B&DHA). He told the Inquiry that: `... the people who decided [what] the pattern of cardiac services should be ... were the purchasing health authorities not the providers, not the Trust Board'. [11]
10 In our view, this was far too rigid and literal an approach to the idea of the purchaser-provider split. It effectively absolved the Trust from any strategic responsibility and cast it in an entirely reactive role. By its own logic, of course, it would leave the provider high and dry if the purchaser's priorities changed, albeit that the Department of Health's (DoH's) guidance or policy at the time was for the maintenance of a `steady state'. Crucially, in the context of the concerns of our Inquiry, this approach militated against the identification of clear goals for the development of cardiac services. In particular, it left unresolved a central problem: the determination of the priority to be given to paediatric, as distinct from adult, patients needing cardiac surgical services.
<< previous | next >> | back to top
Footnotes