NHS targets lead to 'poor leadership' and paralysis through constraints.....

The results show that for reform agendas to work politicians and the public sector need to work together to enable local leadership to flourish. The performance audit regime and rigid rules New Labour developed to drive forward its NHS modernisation policy served to highlight the failings of 'management by targets'. There is a clear need for the public sector to respond flexibly in local circumstances while operating within a system of dictated targets and performance audits.

The study analyses the pressures that senior NHS chief executives were under 2000-2002 when the government, in response to perceptions that the Service was in crises, introduced the modernisation plan. In addition to massive investment it also led to a high number of performance targets, audits and reviews. 25 interviewees were asked about their careers, their views on the NHS and about their own leadership roles over a 31 month period.

The research shows that the lack of leadership and decision-making by senior NHS mangers was down to policy, not individuals. The reduction in local control undermined and demoralised many. Increased levels of central control increased job insecurity (in 2001 20% of NHS chief executives resigned or were sacked). Further, none of those interviewed felt that they had any real opportunity to express their views or influence policy, which prevented the effective delivery of services.
Chief executives expressed that there were unrealistic expectations for quick wins. Reports of bullying were commonplace and many felt that they were being treated as scapegoats.
Rather than being given the scope to help lead reform, chief executives were treated as little more than conduits for central policies. New Labour's reservations about the abilities of public sector managers to embrace change led to senior politicians deciding to run and to reform the system themselves. The suspicions of politicians about the abilities of public sector managers largely contributed to ineffective management.

But the friction between politicians and NHS workers is far from resolved. Last month hundreds of health workers took the fight against job cuts to Parliament in a mass lobby of MPs. Recent headlines have suggested that ministers have lost control of the NHS through mismanagement, and many failings were attributed to over emphasis on activity planning to hit targets.

The analysis of the role of chief executives shows that the popular image of the empowered, proactive leader fails to reflect the reality of senior manager's roles in pubic sector organisations.
Professor Frank Blackler, report author from LUMS, said: "A target obsessed NHS means that the health system is failing to treat its own staff with dignity. There is no substitute for the direct involvement of frontline workers in service delivery and bureaucratic discretion for NHS senior managers is crucial.

For further information please contact: Jenny Murray