Final Report > Chapter 25: Competent Healthcare Professionals > Broadening the notion of competence > Education about the principles and organisation of the NHS, about how care is managed, and the skills required for management

Education about the principles and organisation of the NHS, about how care is managed, and the skills required for management

13 One of the most surprising features of the current approaches to the education of healthcare professionals, particularly in medical schools, is the relatively low priority accorded to teaching in two areas which are central to a career in the NHS. We refer to an understanding of the NHS, its values and how it operates, and to the way in which the NHS's services are managed. The consequence is that many future healthcare professionals graduate with a lamentably insufficient awareness and understanding of the organisation in which the vast majority will spend their working lives. We welcome the recognition of the problem in `The NHS Plan', in which it is proposed to provide new, joint training across professions in the principles and organisation of the NHS. [9]

14 The importance of such education and training cannot be overstated. An understanding of the values and principles on which the NHS operates has a profound bearing on such intangible but crucial factors as the future professional's sense of belonging and identity. If, for example, a doctor's or a nurse's education is geared to encouraging identification first and foremost with a professional group, the interests of which may not always coincide with those of the wider NHS, the seeds of tension and conflict are sown. If the organisation of the NHS is explained, a signal is given that it is important to the professional's life. By learning about the NHS, future healthcare professionals become aware from the outset that the NHS is a service both for the particular patient currently needing care, and for the generality of patients. This opens the way to an understanding of the challenges and dilemmas faced by those who are responsible for running and managing the service for the benefit of all and who, therefore, must serve both patient and patients.

15 As regards management, it is increasingly the case that healthcare professionals are involved in decisions about the management of services. Indeed, many individuals may take up specifically managerial roles at different points in their careers. But an understanding of management is not just about preparation for a role as a `manager'. This is because all healthcare professionals are involved in management, in the sense that any patient is exposed to a process of care, which should be a managed process involving professionals working together. Thus, we regard it is as imperative that future healthcare professionals preparing for a career in clinical care, as early as possible in their education, be made aware of what management of healthcare processes and organisations entails, the type of decisions which those specifically designated as managers must make and the skills which management requires. This should include an understanding of the management of resources, and an awareness of the choices to be made in organising and delivering services for people with widely different needs and in greatly different circumstances. To the extent that some healthcare professionals, not least hospital doctors, who are not involved in management in its usual sense, currently continue to view managers with less than outright affection, some education in management could also serve to change the relationship between the two groups.

16 Indeed, we consider that there would be considerable advantage if both medical schools and schools of nursing were to collaborate more closely within and across universities with the various centres of management and policy which teach about the health service and about public sector management. Such collaboration would strengthen the opportunities for those developing careers as healthcare professionals to learn at an early stage about the principles of management and leadership. It would also give those with a non-clinical background who are working towards a qualification in management, the opportunity to gain exposure to some of the clinical and ethical issues which they will subsequently face in a career in health service management. Indeed, after completing their initial education, there should be many more opportunities than at present for managers and clinicians to `shadow' one another for short periods, to learn about their respective roles and work pressures. This is but one of a number of possible initiatives that should be developed to help to break down the artificial and negative barriers which have grown up between managers and clinicians.

Footnotes

[9] `The NHS Plan'. London: Department of Health, 2000. Para 9.18