Clinical freedom and management accountability.

Abstract

Administration or management? Relations between clinicians and administrators in the National Health Service have always been awkward and in some senses unsatisfactory. Doctors have acknowledged the need for adminis? trators in hospitals but have seen them as facilitators, whose role is to enable clinicians to get on with the business of seeing and treating patients. Success or failure has largely been judged by whether the patients' notes were in the outpatient clinic at the right time, the ward sisters had sufficient linen for patients' needs, and the hospital looked clean and cared for. The task of administration was to ensure that whatever policies were adopted were put into practice as smoothly, efficiently, and unobtrusively as possible. Today's problems are different and demand different solutions. The overriding concerns of all hospitals are their cash limit and getting the best possible value for money. This must be seen against a background of enormously increased organisational complexity and an ever widening range of ways in which money can profitably be spent on the care of patients. The inquiry into the management of the NHS headed by Roy Griffiths was inevitable and desirable.1 Management must be concerned with finding the best possible solution to the dilemma of matching finite resources to the rising cost of medical progress. It must identify new and imaginative ways in which things can be done, defining where the organisation is, where it wants to go, and how best to get there. The introduction of general management into the health service will be seen as a logical and beneficial step, but its impact will be crucially dependent on attracting the necessary talent. This year will be regarded as the watershed between administration and management in the health service, and few doctors can imagine the rigours that he ahead. It seems unlikely that hospitals will escape the radical action faced by troubled commercial enterprises, and the immunity that hospitals have traditionally enjoyed from finance driven intervention will be a thing of the past.