“Autocratic top-down management” fails NHS and leads to mediocrity

“Autocratic management is a leading cause of poor NHS care, according to the compiler of a European health service league table that ranks Britain 15th.

The UK trails Slovakia and Portugal while the best performers such as the Netherlands and Switzerland pull away, according to the Euro Health Consumer Index. Treatment is Britain is mediocre and there is an “absence of real excellence” in the NHS, the report concludes. Only Ireland does worse on accessibility measures such as availability of same-day GP appointments, access to specialists and waits for routine surgery.

The findings come after a global study this week found cancer survival in Britain still lagged well behind the best in the world.

Arne Björnberg, who compiles the Euro Health Consumer Index, said: “Cancer survival rates are one of the prime examples of NHS mediocrity.”

More money is needed to improve care, according to a study that finds a strong correlation between treatment results and how much countries spend on health.

However, Professor Björnberg said that the most urgent lesson the NHS could learn from other countries was about the corrosive effects of an “autocratic top-down management culture”. He said: “As a Scandinavian what strikes you when you visit the UK is British management is extremely autocratic. Managing 1.5 million using a top-down method doesn’t work very well. If you go and ask a secretary or a receptionist anything out of the routine in Scandinavia, the most negative response would be: ‘I’ll see what I can do’. But in the UK they will say: ‘I’ll have to talk to my manager’. Subordinate staff are not allowed to use their brains in the UK and managing a professional organisation like healthcare like that is not a good idea.”

The Netherlands has consistently topped the rankings, which some have attributed to a system of competing insurance companies. However, Professor Björnberg said that the main lesson to be learnt from the Dutch was not about market forces but the need to put doctors in charge and force them to take account of patients’ views.

“If you have intelligent people and make them talk to customers frequently, that is a good idea,” he said.

“You have 1.5 million intelligent and dedicated people working for [the NHS]. Liberate the medical profession and put politicians and amateurs at arm’s length.”

[Autocratic top-down] NHS bosses dismissed the findings, preferring an index compiled by the US-based Commonwealth Fund, which ranks Britain top of 11 global health systems. The NHS scores well on measures such as equal access, but ranks tenth at keeping people alive.”

Source Times (paywall)