Financial pressures challenging doctor-manager relations

A new survey by the Nuffield Trust has suggested that relations between hospital managers and senior doctors have been damaged by reorganisation and financial pressures.

Recognising that they two are working better together than they had in the past, the poll of 472 leaders and clinicians in management roles found that 60 per cent believe local doctor-manager relationships are positive, up from 47 per cent in a 2002 study.

Despite respondents saying that managers put patient care first, 37 per cent of respondents claimed that relations are likely to deteriorate over the coming year, compared to only 13 per cent in 2002.

Authored by Huw Davies and Alison Powell, Managing doctors, doctors managing, labelled financial squeeze and new regulatory drives as the main factors behind the divide. 88 per cent of respondents agreed that the system for managing and regulating hospitals was poorly co-ordinated and punitive, while 87 per cent saw rising tension between cost control and improving the standards of care.

Conversely, while 80 per cent of chief executives believed that relations were likely to improve in the next year, only 35 per cent of clinical directors agreed.

Huw Davies, report author, said: “The NHS faces a complicated, difficult task in delivering high quality, safe and compassionate care under rapidly changing demands, significant financial constraints and relentless media and political scrutiny.

“Good working relationships between managers and doctors mean that their complementary knowledge, skills and experience can be harnessed to address these challenges. But a key finding from our study was that successive and often conflicting government policies have undermined the stability of these relationships.

“When the link between doctors and managers fractures, it makes providing good care within the available resources much harder. NHS managers – both medical and non-medical – need to be valued by government, given enough resources, and provided with a stable context in order for them and the hospitals they manage to flourish.”