The NHS manager

There are many types of manager in today's NHS and judging from their end product it seems that something has gone terribly wrong in the land of the NHS manager. The logic of the NHS manager means that due to their inherent incompetence when they try to make things better, they inevitably make things worse; a more intelligent manager would then realise that a change of approach was required, but unfortunately the NHS manager tends to carry on digging their pit deeper and deeper by obstinately refusing to change tack. This assumes that their intentions are always benign, undoubtedly this is not the case for the cynical politically driven manager; their kind knowingly do harm in a rather amoral way. In their own eyes the NHS manager is never wrong. The NHS manager is also not helped by the fact that the NHS super managers in the Department of Health nerve centre have no intention of making the service better, they are simply the automaton enforcers of the government's will for us all, ie a cheaper shoddy health service for us all.

The NHS manager can be sub divided into a few broad categories, obviously there are no generalisations at all in this evidence based piece of research, however there is a small grain of truth in the ferret fancier's guide to NHS managers.

The common malingerers

The 'NHS University manager'- this is the born and bred NHS manager, trained in pure management with no knowledge of anything other than pure meaningless waffle; this results in a complete inability to understand what goes on in the real world, meaning that any attempts they make to affect change will be based on groundless management banter and will therefore only result in stifling the attempts of people who do the practical work on the NHS shop floor. They are named after the NHS University as this fine educational institution was an example of millions of pounds spent with precisely nothing to show for it.

The 'Impinging Nurse manager'- this is the extremely common sub type that plays a rather prominent role in stifling any possible progress that clinicians try to make on the ground. Invariably the weight of several packets of chips on their shoulders results in a complete inability to engage with anyone other than their fellow impingers, with whom they spend many hours snacking on lardy treats in expansive committee rooms that are only just large enough to permit the wobbling of their highly obstructive derrieres. Typically this nursing breed comes from a background of being rather useless at the real job of nursing, and from a enjoyment of bullying ones fellow employees; this lack of ability combined with a nasty vindictive streak results in a uniquely regressive style of management that many of us have the misfortune of experiencing first hand on many occasions. In their eyes the protocol can do no wrong, even when written in pigs faeces by a dyslexic crack-fuelled monkey.

The 'Donaldson'- this type of malodorous turncoat manager is named after our beloved CMO, Liam Donaldson. This type is medically trained but is very happy to sell out their own profession absolutely for the guarantee of honours, a nice office with a padded leather chair and a very occasional embarrassing appearance in public when the sh*t has really hit the fan thanks to some rather pitiful policy making. Personally I find this type to be particularly unpleasant, not only on the eye but also from an ethical viewpoint, as frankly this lot should know better. Unfortunately they are greedy egotists who have no care for anyone other than themselves, and this means that their management style always results in them enforcing the will of their master, the government. They care not for patients, the service or the staff on the ground; they are looking out for number one.

The 'Management Consultant'- this lot of smooth talking city slickers are particularly adept at being paid a small fortune for doing very little indeed, a quite remarkable talent. Despite invariably having no knowledge of medicine, healthcare and the NHS; the government seems to be rather fond of consulting these chaps using large wads of tax payer's cash. Despite the fact that many clinicians on the ground have been suggesting practical solutions to problems for years while going blue in the face, the government ignores this highly talented wealth of specialised knowledge and chooses to consult an overpriced source that doesn't really know that much about anything if we're honest. It's amazing how business seems to go ones way when one happens to donate a few pence to the political party in charge.

The 'Total Numpty'- this sub type of manager is the completely untrained breed of manager that can be found with remarkable ease in the NHS today. This type has very little knowledge of anything at all, they don't even have that precious managerial skill of being able to send you to sleep with a magic cloud of superwaffle. The NHS does have room for many types of incompetent who would not be able top find a job anywhere else, after all it is cheaper to pay them a low managerial wage than to fund their benefit claims. Strangely they do less damage than the more highly trained 'NHS university manager', as due to their complete ineffectiveness they can do no good, but also no harm.

Rarer manager types

Good manager - this exceptionally rare breed is trained in management but actually engages with staff on the ground, listens to constructive criticism and is able to learn from mistakes. Unfortunately these managers are often sacked for refusing to go along with destructive orders from above, while some of them become corrupted into the 'NHS university manager' sub type.

Ex doctor or nurse manager with no chip on shoulder and good intentions- this type is spotted in the NHS only very occasionally, a bit like the lesser spotted welsh warbler; these managers actually have the vision and insight to be able to save the NHS. It is therefore very sad to say that they frequently spontaneously combust thanks to the sheer frustration despair of having to engage with the more common forms of NHS manager. These noble managers have also been subjected to vicious smearing campaigns with little basis, and some have also been removed from office for not doing as they were told.

Overall this rather unique blend of the incompetent, the even more incompetent and the plain unpleasant results in one of the most dysfunctional management structures ever seen. The top down authoritarian lead of the Department of Health, under pressure from our corrupt politicians, has crafted this disastrously ineffective manure heap through many years of bullying and wrecking. The Department of Health has slowly amassed a team of incompetent bullies sculpted in its own malignant image. It results in those staff on the ground who are actually trained to care for and treat patients being obstructed by a complicated network of utter cretins. The staff on the ground cannot make sensible decisions in the interests of their patients anymore, they have become mere pawns taking part in a meaningless game of chess played by their idiotic managers, and the patient has been forgotten. We now routinely have untrained idiots making clinical decisions about patients in an overtly dangerous manner, as money is shuffled between different NHS bodies in a way that prevents patients from getting the care that they deserve; and this is all in the name of modernisation and progress. Brave new NHS indeed.