'I wince when I hear talk of sharp-suited NHS managers driving round in BMWs,' says Jan Filochowski, chief executive of the Poole Hospital Trust and a career NHS manager. ' We're less well paid than we would be in the private sector, and many of those who came in from outside didn't last.' His counterpart at Bournemouth, Stuart Marples, agrees. 'The NHS ethic is as secure with me as it is with any professional. My motivation in joining - and staying - is providing quality services for the locality.' Since the 1991 reforms, health service managers have had a bad press, accused of being paperpushers and/or overpaid fat cats. Quite wrong, says health secretary Virginia Bottomley. As Griffiths identified in the reforms, the problem is that in the past the NHS was undermanaged rather than overmanaged, with the service's clinical strengths being brought down by shortcomings in computers, financial management, and communication. These are now being put right. 'One of the dilemmas of the NHS is that any money spent on management, or explaining to the public, is condemned, the perception being that it's better spent on patients,' Bottomley notes.
Chief executive Alan Langlands also prickles at claims that the NHS is overendowed with managers. 'We're not overburdened compared with other organisations,' he asserts. The investment in financial management, he adds, is justified by the fact that the NHS no longer flounders in financial chaos at the end of each year.