I'd swap a tonne of management

It is fashionable to complain that the NHS has spent much of the extra funding provided over the past few years on recruiting loads of managers. Like most "well know facts" there is some truth in it. I should know since I am one of 'em. Irrespective of the 'new vs old' chestnut, one feature of most NHS management that does get me down is how little leadership they provide. It is a difficult time in the NHS. This government says it is transforming the way everything works through its major Payment by Results and Practice-based Commissioning programmes. There is a veritable avalanche of new stone tablets coming down from the Department of Health mountain. Changes and budget restrictions, new ways of working, breaking down established pathways from primary to secondary care; all these challenge staff at every level. It all cries out for positive leadership; someone who can inspire the team to rise to these challenges and achieve these ambitious goals.

From my lowly position, I can see none. I don't mean "not much" or "not enough". I mean NONE.

I'd settle for a few kilos of real leadership. Oh, I get lots of memos. I get loads of papers (usually cut and paste jobs from a DoH circular). I get deadlines and funding floors. I suppose I ought to feel pleased to be consulted (usually about how I feel about a decision that has already been made) and yet I'm not. Instead I feel that those that should be inspiring, motivating and making it happen, are behaving like any dictator worth his salt. They're hidden away down in the bunker sending out orders with no real idea what their troops are doing or if they're succeeding or not.

One thing's for sure; if we get it wrong, it won't be their fault. After all - they didn't get involved.