Tuesday 25 January 2011: The future manager, sucking up, Ascension Day and Judas goats

I've written before about the two main types of managers who will flourish in the 'liberated' NHS: data geeks and persuaders.

This will be true regardless of whether these reforms happen exactly as planned; later than planned; or quite a bit differently than planned.

Healthcare systems in the developed world are all facing ageing populations and potentially a decade of sluggish economic growth as we fund the banking crisis-induced bale-out. All systems will have no choice but to get serious about a) noticing need, activity and outcome variation in a timely way (data geeks), and b) getting the clinical team and delivery infrastructure to do something about it (behavioural and economic persuaders).

I was discussing this idea yesterday with a very experienced chief executive who has done big jobs around the system, who made an excellent point in response.

His career had begun at the end of the 1970s, when the senior figures running the NHS institutions and overall system were administrators. In the period following the October 1983 publication of the Griffiths Report, modern NHS management as we understand the concept was created.

The invention of NHS management, in this person's words, saw the administrators quickly removed from the system "and people like me were sucked upwards into the vacuum of their places running the system - but with a brief to manage it; rather than to administrate. And over the next few years, there's going to be a similar turnover of the people in charge".

He's right. There will be a new generation sucked up into the new roles running consortia. But there will be some key differences.

Firstly, quite a few of them might well be clinicians.

Secondly, we do not yet have clarity whether 'any willing provider' and neo-Monitor's take on competition and economic regulation incentivises the various parts of the provision system to pull together or to pull apart.

Thirdly, consortia will exist in shadow, pathfinding form for two years of tight Stalinist controls. This will see some consortia merge to gain the advantages of scale and skills.

Ascension Day is 40 days after Easter, and commemorates Jesus' being sucked up into the clouds.

If all goes to plan, 1 April 2013 sees consortia arrive in full form. Their accountable officers might be sucked up into a liberated landscape. Equally, they might be sucked dry and scapegoated - or used as a Judas goat.