Final Report > Chapter 5: Management in Bristol > General management
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General management
2 General management, which we described earlier in Chapter 4: The Changing NHS 1984 - 1995, was introduced in Bristol during 1985. Dr John Roylance was appointed District General Manager (DGM) of Bristol & Weston District Health Authority (B&WDHA) with effect from 1 April 1985. The appointment of a doctor to this role was rare at the time. In 1986, only 15 out of 188 DGMs had a medical background. The DGM was `directly and visibly responsible' [2] for the management of the district. He was the overall budget-holder and was responsible for the development of policies and for monitoring their implementation. Thus, the influence of Dr Roylance on the delivery of health services to the South West Region from 1984 to 1995 was very great.
3 Dr Roylance saw his role as:
`... getting rid of functional management, nurses being managed by nurses, physiotherapists by physiotherapists, administrators by administrators. It could be said at that time when I took up the District General Management role there were about 9 different health services in the District coming together only at District level. In introducing the General Management function, it was expressly required to delegate operational management decisions as near to the bedside as possible.' [3]
4 Dr Roylance said that until general management was introduced, the exercise of clinical freedom was pursued entirely independently of any consideration of resources. Management had to use: `... quite crude measures to try and prevent the major overspending of a service, things like closing operating theatres, closing wards ...' [4]
5 In May 1985 the District approved a management structure for the health authority and its units, as shown in the chart below:
Figure 1: Management structure of the Bristol & Weston District Health Authority, May 1985 [5]
Click the image above to view full-size
6 The District was divided into two units: [6] the Central Unit and the South Unit. Each had a Unit General Manager who was directly responsible to the DGM. The Units had 11 sub units between them, each managed by general managers. The Central Unit (the general managers of which were John Watson and then Margaret Maisey from 1989-1991) had six sub units, of which the BRI was one. The BRHSC was incorporated into another unit (the Children's and Maternity Unit).
7 All of the professional, technical and administrative staff were incorporated into this system of units and sub units, with their pre-existing hierarchies remaining only as advisory structures for the general managers. There was one exception: the consultant staff retained both their previous advisory role, through the Hospital Medical Committee (HMC) advising the DGM directly, and their clinical independence. [7]
8 In addition to the management structure, there were four advisory committees which gave professional advice in their particular areas of expertise to the general managers at both unit and district level. For the most part, the professional advice at district level was channelled through the Chair of the HMC who, in turn, was given advice by the chairs of the clinical divisions, of which there was one for paediatric services and one for surgical services. [8]
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Footnotes
[2] WIT 0074 0425; from correspondence from Dr Roylance to the Regional Health Authority dated 1 May 1985
[5] WIT 0038 0067 Ms Charlwood; a document relating to the introduction of general management in the District, prepared by Dr John Roylance, dated 1985
[6] Formerly there had been seven
[7] WIT 0108 0005 Dr Roylance
[8] WIT 0074 0010 Dr Baker. Dr Ian Baker was District Medical Officer, B&WDHA, 1984-1988, Director of Public Health and Assistant General Manager (Planning), B&WDHA, 1988-1991, and has been consultant in public health medicine, B&DHA, since 1991