Final Report > Chapter 15: The Culture and Management at the UBH/T > Delegation and accountability
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Delegation and accountability
15 Mr Hugh Ross, Chief Executive of the UBHT from October 1995, told us that when he succeeded Dr Roylance he found that: `there were not sufficient mechanisms and information systems in place for me to assure myself that all of the Directorates were operating in a proper manner'. [18] Mr Stephen Boardman, Director of Corporate Development, UBHT, 1991-1992, put it more bluntly: `Dr Roylance did not appear to have control over the Clinical Directorates'. [19] Dr Roylance's view was that it was his role to recognise and go along with the culture of consultants, which he characterised as being grounded in clinical freedom. He saw it as his role to free them to do their job. He told the Inquiry that he was not in the business of `herding cats'. [20] Clinicians at the bedside were to make decisions and it was not for management to interfere. [21]
16 The degree of delegation operated by Dr Roylance would be a matter for concern in any large institution, if there were no appropriate systems for accountability and review in place. But, in the UBHT, the potential for problems to develop and remain unresolved, arising from this system of management was compounded by the culture of management which prevailed. Power was concentrated in the hands of the Chief Executive and his close colleagues. Mr Wisheart, at various times, was Medical Director, a Clinical Director and Chair of the Hospital Medical Committee (HMC), and in 1992 he held all of these positions. Mrs Margaret Maisey, the Director of Operations, as we have seen, combined this role with that of Nurse Adviser to the detriment of the duties associated with the latter. In Mr Wisheart's case, the extent of the responsibilities held makes it difficult to see how the roles could all be performed adequately. He was also carrying out heart surgery on adults and on children. Dr Roylance made the final decision on who became a clinical director, from among senior clinicians with whom he had worked for some years. [22] The scene was set for the development of the `club culture' expressly encouraged by Dr Roylance. Mr Boardman [23] told the Inquiry that a career depended on someone's `fit' within the `club', rather than performance, and that any challenge to policy was perceived as disloyalty. This approach was neither conducive to self-assessment or reflective criticism in some nor confidence in others. Indeed, we heard of a culture of fear. [24] Dr Susan Dopson [25] reported Dr Roylance as saying to her: `I have enormous power which I'm not prepared to use except in very specific situations ... I can hire and fire anybody, I don't need to ask anybody's permission for anything.'
17 The managerial culture at the UBHT was one which took too great a pride in and placed too great a reliance on its `oral culture'. Claiming to avoid unnecessary paperwork, communication was oral rather than written. In the circumstances, this only added to the uncertainty and insecurity in decision-making, as those who were outside the `club' found it hard to discover what was going on and those to whom responsibility was delegated sought to read the minds of the senior executives.
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Footnotes
[19] WIT 0079 0281 Mr Boardman
[23] WIT 0079 0014 Mr Boardman
[24] WIT 0089 0025 Mrs Ferris referring to Mrs Maisey
[25] Dr Dopson is a university lecturer in management studies and a Fellow in organisational behaviour, Templeton College, Oxford