There is evidence that doctors like the term 'leadership' and certainly prefer it to 'management'. Leadership holds a certain mystique which is unhelpful as it may be interpreted as a skill with which only the selected few are born. If you don’t believe me ask any group of doctors under the age of 30 if they are leaders – you will only need the fingers of one hand to count!
The NHS has been given the job of saving £20 billion in four years. This is variously known as the QIPP programme or the Nicholson Challenge. It has been described as so big it can be see from outer space. Last month the Audit Commission produced their summary of the NHS financial year to remarkably little fanfare. The summary is that £4.3 billion was saved.
Over the summer I got the chance to be a medical student guinea pig for a 360° feedback tool based on the new NHS Leadership Framework. This new framework applies to all staff in the NHS and builds upon FMLM’s Medical Leadership Competency Framework, with which I am sure you are familiar.
The education and training aspect of the Health and Social Care Bill has, to some extent, been overshadowed by the much more headline-friendly changes in commissioning, the management cull and the debate surrounding competition. If you ask trainees, their overwhelming concern is the conflict of interest that will arise when training and service budgets are held by the same NHS trusts. Losing deaneries means that there will be no regional bodies to hold trusts to account when, as looks inevitable in the economic climate, training budgets gradually get chipped away by service demands.
The relentless call for clinical leadership to deliver better quality care whilst also cutting costs has intrigued my colleagues at the grassroots. Many frontline clinicians believe that the healthcare system is ‘creaking at the seams’, relying on the goodwill of over-worked staff and needs more investment rather than less.
The FDA (US Food and Drug Administration) decided to withdraw approval for Avastin as a treatment for advanced breast cancer recently. They heard evidence from individual women whose lives had been prolonged by Avastin. However, they were unswayed, pointing to the $88,000 per year cost. It is yet another example of the longstanding debate about value judgements in healthcare and the role of advocacy.
As the Faculty for medical leadership and management opens for business, I’m wondering where junior doctors will fit into its infrastructure.
Doctors in training are best placed to see frontline inefficiencies and often have innovative ideas for system improvement. While Fortune 500 companies actively nurture talent and sponsor their emerging leaders, the NHS (Europe’s largest employer) has traditionally expected medical leaders to evolve organically. This meant climbing the ranks to consultant followed by frantic survival of the fittest.
When they write the history of the last twenty years of the NHS, what will they say about the medical profession? Justifiably, they should make a lot of technological change and advances in treatments… but then they always do which allows the majority of us to sit back and bask in the reflected glory of the relatively small number of pioneers.
The first ever web page was published twenty years ago this month. The Linux project is also celebrating its twentieth birthday this month. These are two examples that are emblematic of how free has changed the world. They are free as in speech, but also free as in beer.