Posted by: Witch Doctor | February 15, 2009

The Leadership Crescendo


A few weeks ago, The Witch Doctor said she would take her leave for a while in order to think about a few things that were troubling her about the NHS and for that matter the country world at large.

See repeat of the post below.

She never did, because so many other interesting things took over in the blogosphere at that time.

So, The Witch Doctor is still wondering if she has found the last bit of the jigsaw regarding what is going on within the NHS just now, and for that matter society at large. She thinks exploring the current fixation regarding leadership within the NHS might explain some of the questions she is asking herself.

So, The Witch Doctor and My Black Cat are going out into the wilderness for a while to muse over how the past became the present. However,  you will still feel our presence because from time to time we will post information on The NHS Leadership Partners on our other blog and also open a new section of links to relevant Leadership sites under the ANCIENT BOTTLE SPELL at the right hand side of this blog.

This is the type of information we will be exploring:


“The network programme will provide support to help chief executives meet the enormous challenges of driving forward complex health organisations, during a period of rapid system reform and changing demands. Chief executives who become members will be able to access a unique level of individualised professional support and a menu of development opportunities to meet the specific needs of their role, their career point, their learning style and their interests.

The network will draw on the full expertise of The King’s Fund, and offer a gateway to the insight and intelligence of a developing national and international network of chief executives in health services and beyond.”

Chief Executives within the NHS can book their place at a cost of £9750 although it seems they will have missed the first seminar which they say was to take place at the end of January.

We note the Chief Executives will be shown how to obtain the necessary skills to stimulate the market.

What market is that, My Black Cat?



Whenever I cast The Ancient Bottle Spell, I relate to you true stories of what I have seen or heard or done in the past. The details are scrambled so that my identity and those of others will not be revealed.


Some years ago, I was invited summoned to attend a meeting in a grand hotel beside the sea. This appealed greatly, because that part of the country was, and still is, one of my favourite places. This did not seem to be a typical educational meeting in a typical educational place. No learned societies were involved. The speakers had no expertise in clinical matters and the programme made no mention of the diagnosis or management of medical conditions. However, some of the speakers had a very high profile within the NHS at that time. Others seemed very close to government.

The Young Witch Doctor came to the conclusion that this invitation, which seemed to have compulsory connotations, and was undoubtedly a costly exercise, was designed to sweeten up senior medical staff in order that they would accept and enable Thatcher’s NHS reforms. This turned out to be the case.

We were treated well, my colleagues and I. In fact we were treated so well, that The Young Witch Doctor felt she was being wooed. We were introduced to the early vocabulary of management. This was long before many of the now exhausted terms such as “cascading, “benchmarking” and “overarching” were even heard of. We would have been amused by these terms then.

We were taught many things. We were taught how we should manage our time. We were taught about the forming, storming, norming and performing of committees. We were taught about QALYS. We were introduced to a sophisticated new computer software called “Casemix.”

But what we were taught related to management, government policy and health economics, not to direct patient care.

What The Young Witch Doctor remembers most was one particular speaker. Lets call him The Most Important Speaker because his position was such that, a short time before, he had been called into the NHS at the most senior level to take forward the government plan. He was considered a “good catch” for the NHS. The beauty of face to face meetings that “Second Life” will never achieve, is the ability to see gestures, facial expressions and demeanor as well as to watch screen presentations and listen to the spoken words. The Witch Doctor read the secondary signs very carefully and concluded that The Most Important Speaker, was an intelligent, able businessman who did not suffer fools gladly and who may have made some ruthless decisions in the past. He did not, like some of the other speakers, seem to be pandering to us.

What he told us was interesting. It happened too long ago to quote the exact words that were used, but the message was loud and clear.

The NHS was far more complex than any other business or organisation in the land. The NHS did not have the managerial capability to execute the planned reforms. Even looking outside of the NHS, there were not even enough managers of sufficient caliber within the whole of the UK to oversee the proposed plans for the NHS. He said if the reforms were to have any chance of success, then senior medical staff would need to learn very quickly how to fill the management gap.

Not long after that, The Most Important Speaker resigned from his job. I don’t think he was pushed. He took up another difficult project unrelated to the NHS. He did this successfully.

I always felt that during his short time in the NHS, The Most Important Speaker used his considerable experience to make a quick and accurate assessment of the situation. As a consequence, he removed himself abruptly from the formidable and depressing scene.


Over the past year or so, The Witch Doctor has had a feeling of deja-vu. The term “manager” is becoming obsolete and is being replaced by “leader.”

The Witch Doctor has been asking herself about the new elite breed of individuals that are being selected and are being given what are to be considered prestigious awards in order that they can be trained as future leaders.

What selection criteria are being used?

Is it really leaders that they are after?

Or is it followers?

Is there hidden panic in government circles about future healthcare?

Just as there is hidden panic about the economy?

Are the two linked?

Why is this government hell bent on trying to demean and humiliate doctors in the eyes of the public?

Is “Patient Choice” just a silly game?

Just a diversion?

Clients and customers may want “choice” in the same way that MP’s browse through their holiday brochures and surgeons may check out their eating places.

Real patients do not want choice because the patient journey is not a trivial holiday. It is a journey through worry, pain, and fear and the destination may be death. There is an obscenity about comparing “the patient journey” to selecting a holiday hotel. The patient wants the trust and security that a correct diagnosis will be made, the best possible care given and if necessary, a death as free from pain as possible. They want trust, care and security to be implicit within the health professions. They do not want to be responsible for doing the work of medical schools, the colleges and the GMC. They do not want to be responsible for monitoring that hospital cleaners are cleaning, the nurses are nursing, and the doctors are diagnosing. They are not employed as monitors. They are not voluntary monitors. They are patients with worries – sometimes unbearable worries. Worries that are very personal. Please do not increase their burden.

So, is there another reason for this very stupid Choice Agenda and an obsession with the equally stupid term “The Patient Experience?”

A reason not grasped by MP’s, civil servants or even cabinet ministers because they are not explicitly told about the reason?

The Witch Doctor wonders if she has identified the final piece of the jigsaw that would link the economic crash, demographic change, the Leitch Report, Agenda for Change, dumbing down, polyclinics and private health care.

And yes, what this blog was about at the very beginning – The Changeling MMC.

It would also explain the relentless promotion of the notion of a faulty medical profession to the public.

And the mushrooming of superficial and inane managment-speak.

It would also explain The Leadership Crescendo that we are now witnessing.

Has the time come to appoint “leaders” who are already proven followers?

Has The Witch Doctor indeed discovered the last piece of the jigsaw?

A jigsaw that she has been trying to piece together for two years now.

Or is the whole jigsaw a figment of her imagination?

These are questions rather than answers, because The Witch Doctor is not sure yet if she is on the right track. So, She is going to stop blogging for a while. Instead, she will do some reading and thinking. Where possible, without comment or opinion, she will place links to what she is reading on her other blog “THE WITCH DOCTOR’S CONTINUING PROFESSIONAL DEVELOPMENT” This may be of interest so some readers.

If The Witch Doctor becomes truly convinced she is on the right track, she will tell you what she is thinking.

By that time, though, others may have already completed the jigsaw.

So be it. This is not a competition.

If others reach the same conclusion before The Witch Doctor, it will make it all the more credible.

redapple.jpg a red apple ……………………

The Witch Doctor – Link to a random page






  1. […] our time in The Wilderness, My Black Cat and I are asking many questions while we try to find evidence to confirm that we may […]

Leave a Reply

Please log in using one of these methods to post your comment: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s


%d bloggers like this: