Can Gerry Robinson fix the NHS? asked the BBC. A better
question would be: can anyone fix the all-compassing managerialist ideology
that asks such stupid questions?
Sure, waiting lists were a little lower in a few specialisms after he arrived. But as John Crippen says, these reductions were small, and achieved at a cost which the programme tried to gloss over.
But these achievements in no way vindicated Sir Gerry’s claim that “the NHS just needs managing in a day to day way.”
The thing is, all the ideas for cutting lists came from the staff: consultants, nurse-consultants and (yes) junior managers. As Sir Gerry said, “the staff have the answers.” His contribution was not to bring any skill or know-how, but merely to do what anyone with a camera could do – to focus attention onto the question. As one nurse told him: “you made a difference by making us sit down and talk about it.”
In other words, the progress that was made came from empowering staff, not from bringing better management. As the hospital’s CEO said, “I’ve done little but give permission.”
But of course, one can give permission simply by getting out of the way. Which raises the question: couldn’t the NHS be better run simply by increasing the degree of worker control?
The BBC, of course, never asked this question. Nor did it ask, until very hurriedly at the end: how can we improve efficiency by changing incentives? As one consultant said, efficiency’s greater in the private sector because time is money there.
Instead, the BBC’s presumption was the purely managerial one that the NHS could be fixed if only the right man were in charge. Hence the several sly ways in which the existing CEO, Brian James, was made to look inferior to Sir Gerry, despite being – in Sir Gerry’s words – “unquestionably one of the better managers in the NHS.”
This presumption, though, is merely the fundamental attribution error. What it doesn’t realise is that, had someone like Sir Gerry become a hospital CEO, he would have become as bound by red tape and bureaucracy as Brian was. Office determines character more than character determines office.
If the NHS is to be fixed, it requires changes in power structures and incentives. The BBC’s managerialist ideology means it missed these issues.