The Frontline versus Bureaucracy

First published in Your Say St Albans & Harpenden Review: Photograph of the Author by

I was at a meeting in London yesterday with other like minded colleagues from around the UK. The focus of the meeting was to get a view for the future challenges for the NHS nationally and how they were being coped with locally. There is still a good deal of uncertainty in what the proposed changes might finally look like, but the general feeling was that there was enough information available for us to start reacting to the changes now. One can’t argue with the logic of reducing bureaucracy and investing in frontline services – whether it is health, education or any other public service – everyone would support that. But frontline services do need support, for pay, supplies, HR issues, strategic leadership and many other functions not considered ‘frontline’. Where do you draw the line? Do you cut your finance team and put at risk pay, do you get rid of your HR function and reduce staff well-being programmes, do you stop communicating with staff and the public. Who answers the complaints and Freedom of Information requests or writes the annual report and quality accounts? Difficult issues on which we probably all have different views. The vast majority of people join the NHS to provide a service to patients. Not all are frontline/direct contact with patient staff (although most are), but all contribute. The story is told of an unannounced visit by John F Kennedy to the space centre in Cape Canaveral in the mid 60s. He met a man leaning on a broom and asked him what his job was. The man replied,” Mr President, I’m helping put a man on the moon”. This may or not be true, but it makes the point - nobody can do everything to deliver better patient care, but everyone can do something.

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