THE GRIFFITHS REPORT
But the most radical move came with the announcement in February 1983 of an Inquiry Team:
'to examine the ways in which resources are used and controlled inside the health service, so as to secure the best value for money and the best possible services for the patient;
'to identify what further management issues need pursuing for these important purposes.'
According to Harrison this had not been the orgnal intention of the inquiry which was to deal with 'manpower'. The change in terms of reference had been imposed by Roy Griffiths (soon to become Sir Roy Griffiths) as a condition of accepting the chairmanship:
'Griffiths’ objections, which were to the terms of reference proposed, were twofold. Firstly, being aware of the political saliency of the NHS ‘manpower’ issue, he did not wish to be cast in the role of ‘hatchet man’, cutting NHS staff, especially in what was almost certain to be an election year. Secondly, he took the view that the terms of reference were too restricted; logically enough, his perspective was that to inquire into the ‘manpower’ of an overstaffed organisation was to confine inquiry to a second order problem. Rather, the first order problem was ‘a management problem, or general problem’. Hence, only if the proposed terms of reference for the inquiry were modified to include this wider concern would Mr Griffiths accept.'
Griffiths was deputy to Sir John Sainsbury, who had recommended him as a major architect of the Sainsbury supermarket chain's success.
'The first meeting of the inquiry team was over dinner at Sainsbury’s. Early in the discussion, one member of the team described his view of the task before them simply as "gauleiter versus consensus". Asked if a gauleiter model would mean that doctors had to be in charge, another member replied "If so then we should all go home now".'
Harrison summarises the report's findings as follows:
'Firstly, the team were concerned that individual overall management accountability could not be located: "it appears to us that consensus management can lead to ‘lowest common denominator decisions’ and to long delays in the management process. The absolute need to get agreement overshadows the substance of the decision required. In short, if Florence Nightingale were carrying her lamp through the corridors of the NHS today, she would almost certainly be searching for the people in charge." ...
'The second aspect of the team’s diagnosis was that ‘the machinery of implementation is generally weak’: "there is no driving force seeking and accepting direct and personal responsibility for developing management plans, securing their implementation and monitoring actual achievements …. certain major initiatives are difficult to implement [and] above all lack of a general management process means that it is extremely difficult to achieve change. [A] more thrusting and committed style of management is implicit in all our recommendations."
'Thirdly, the inquiry team drew attention to lack of an orientation towards performance in the Service: "it lacks any real continuous evaluation of its performance. Rarely are precise management objectives set; there is little measurement of health output; clinical evaluation of particular practices is by no means common and economic evaluation of these practices is extremely rare."
'Finally, the team identified a lack of concern with the views of consumers of health services: "Nor can the NHS display a ready assessment of the effectiveness with which it is meeting the needs and expectations of the people it serves. Whether the NHS is meeting the needs of the patient, and the community, and can prove that it is doing so, is open to question."'
The core of the recommendations was that the previous 'consensus teams' (who might or might not reach a consensus) should be replaced at all levels by general managers (who might or might not be qualified clinicians - generally speaking, in the event, they weren't) who should have full responsibility over the management function.