Editor's blog Wednesday December 1: The future NHS manager

It would be easy to think that the future NHS manager will be a GP - as Health Secretary Andrew Lansley seems to do, with his repeated confusion of prescribing and referring with commissioning.

It would also be wrong.

However, the future NHS manager won't be the previous NHS manager either.

NHS management as we know it today was invented in three stages: first by the 1983 Griffiths Report for PM Margaret Thatcher, which robustly declared that "if Florence Nightingale were carrying her lamp through the corridors of the NHS today, she would almost certainly be searching for the person in charge".

The second stage was the the  invention of the NHS trust, an autonomous organisation with its own board and management structure.

The final stage was in the last government's imposition of a statutory duty on all NHS trusts to be in financial balance in-year.

That created NHS management as we know and love it - politicised, financial-balance-driven (for now), good at restructuring, target-hitting, managing noise, managing up-up-up to Whitehall.

A recipient of top-down DH or ministerial shouting; an MP pacifier; occasionally, a barrier between blatant silliness and their organisation. A public servant.

The two most expensive things in the NHS are the right and left hands of GPs. Since they effectively commit almost all the discretionary spending, it is right that they should be much more involved in decisions via the new GP commissioning consortia.

And of course, most GPs will not want serious, hardcore involvement in management.

Analysts and persuaders
This means that from extant NHS management or from elsewhere, consortia will need two types of people: analysts and persuaders.

The analysts will be people whose function is to make the data dance: move quickly, precisely and illuminatingly. They will be very hot on comparison and variation. In ‘Strictly’ terms, these people will be the professionals: at once choreographers, teachers and partners.

The persuaders will of course have to understand the data; but they will also require the interpersonal negotiating and persuasive skills to get clinicians - individually and collectively - and organisations to change the ways they work. One tribe of persuaders will need to take on the splendidly challenging job of persuading patients and the public as well to change their behaviours, in conjunction with local authorities.

Analysts and persuaders, motivated by an unrelenting focus on patient outcomes and value for money, are the people whom consortia will need to employ or hire.

Currently, NHS CE Sir David Nicholson and team are warning the NHS of a potential £1.5 billion in redundancy costs unless PCT and SHA staff are recycled into the new system. Unwise conversations have begun about who will be transferred to whom.

If the Whitehall powers-that-be understand that analysts and persuaders are the people consortia will need to make the new system work, there should be no conflict of interest or misunderstanding.

If they do not, and are able to force staff without those skills  upon consortia, then it will all get very messy.

Analysts and persuaders. Invest in them. If you've got stakes in other people, it's time to sell.