Posted by: Witch Doctor | April 23, 2011

The “Change” began in 1984


The Book has arrived.

Although it is short enough to read in a day, The Witch Doctor will read it very slowly, a few pages every day, with a highlighter in one hand.

Interestingly, she found the name of someone she knew in The Book. He trained her in the art and science of medicine. He was a consultant way back when The Witch Doctor was newly qualified and later a registrar in his unit. She had a great respect for this consultant and is not surprised at all that he still working hard to save the NHS for future generations of patients. He retired quite a long time ago. It would probably spook him to know his one time junior doctor, who he will certainly remember well, is and has always been, a witch.

No, it wouldn’t spook him. He would be amused. Even delighted!

The book is:


My Black Cat is in perfect agreement that it is indeed A Plot. The Witch Doctor on the other hand thinks it is Creep.

No matter, the outcome will be the same.

One thing is certain though, if it is A Plot it would never have worked if the medical profession had recognised and resisted Creep.

The Forward of the book is written by Dr Jacky Davis.

Here is the first sentence:

“Since 2000 governments have pursued a policy for the NHS that the electorate hasn’t voted for and doesn’t want.”

The Witch Doctor believes policies that set the scene for the “changes” that are being pushed through today, were introduced many years before 2000.

The first key date was 1984 with the publication of The Griffiths Report.

There are not many people around the country who know this, but there was a brief attempt to privatise a substantial number of clinical services in the late 1980’s. It was probably a trial run to see what a particular gung-ho General Manager of a major health board could get away with.

An advert for tendering was placed in a European publication in June 1989 when many NHS staff were either contemplating annual leave or preparing to go. Those left were too busy covering for absent colleagues to notice anything odd was going on. There was no consultation whatosoever prior to this advert being placed. None. It was a wonder it was discovered at all. The following week another advert was placed in the same journal for tendering for yet more clinical services.

The advert could have slipped under the radar, but just by happenstance, it didn’t. It was discovered by a member of NHS staff flicking through a supplement of The Journal of the European Community when bored in an airport lounge waiting for a flight. For a moment he thought he was dreaming. He pinched himself. The advert was still there.  He phoned a few people and the news passed around like wildfire. One of The Witch Doctor’s close colleagues phoned a friend in the media, the shit hit the fan locally, and the plan was scuppered.

Almost everyone has forgotten about this except The Witch Doctor and My Black Cat.

The post below was published some time ago in this blog. This describes the day The Witch Doctor became aware that something was afoot. The date was the mid-1980’s after the publication of The Griffith’s Report and before the advert was placed in the European Journal.

It was the time of expenditure of NHS money on new Trusts, new logos, new notepaper, new signposts, new posters, new management speak, new charters, new decor  and new furniture for managerial premises, new promises, and a new breed of consultants called “clinical directors” who would be rewarded for their obedience.

That was the beginning of it all.

Long before the year 2000.


It happened in 1984. The Orwellian year. A very special year for The Witch Doctor.

She remembers The Griffith’s Report well.

Griffiths was deputy chair and managing director of Sainsbury’s.


“The measure was to launch a cultural revolution and 25 years of continuous change.”

Damned right it did. A quarter century of continuous change is exactly what we got.

“Regional health authorities had four months to appoint their own general managers, then embark on district health authority appointments. Districts had until the end of 1985 to find unit general managers. The Department of Health began recruiting a national general manager. Mr Griffiths said this should be someone “almost certainly” from outside the NHS and civil service, with experience of effecting change in a large organisation.”

What Mr Griffiths did not appreciate was that there was no organization in the world as large and as complex as the NHS. No-one had that kind of experience. But the managers were appointed to the NHS juggernaut and set about trying to train the hospitals to become chains of grocery stores or shoe shops or telephone exchanges or coal mines.

At times they had a degree of success but only if they could take some of the staff with them some of the time.

But most managers found it stressful and some did not last the pace.


She remembers the first General Manager in her neck of the woods.

Oh, yes. Indeed she does.

He didn’t seem to be stressed at all.

He generated fear. He believed in iron rods. He was one of the “turn the screw till they squeal” brigade just like a Chief Executive who made an appearance some years later.

Neither of them lasted long.

The Witch Doctor can remember clearly the very day she started to mistrust the new system.

It was about seven thirty one morning when the Witch Doctor arrived for her clinic in a satellite hospital.

(The clinic doesn’t start till 9.00am but there is never anywhere to park then. The secret is to take some reading or dictating or paperwork with you and work in peace in the consulting room with the door firmly shut for an hour and a half till the first patients arrive.)

At 7.30 am it was a beautiful morning but as The Witch Doctor walked up to the main entrance of the building she passed a row of tubs that should have contained flowers but seldom did. The neglect was obvious. No-one watered these tubs. Ever. And they were too close to the overhanging roof to receive very much rain. So only the most invasive of weeds survived there. That day everything was so dry that even the weeds were on their last legs.


We witches have a saying:

“May all your weeds be wild flowers”

We don’t mind weeds at all. In fact the bottom of The Witch Doctor’s garden where the foxes live is a veritable haven of rampant weeds, wild flowers and trees that self seeded decades ago.

In the cultivated part of the garden, The Witch Doctor even has a little dandelion patch (friendly happy shiny faces), a clover patch (beautiful scent and occasional good luck) and a buttercup patch (for the vase in the spell pantry). She carefully brings harebells and foxgloves on from seed in the greenhouse and plants them in the rough parts at the edge of the lawn and under the trees because she thinks they are very beautiful flowers.

But we don’t plant our wild flowers in tubs!!!

I’m rambling………..


So, The Witch Doctor noticed the dying, dried up weeds in the row of tubs at 7.30 am.

At 8.50 am she discovered she had left her stethoscope in the car, so nipped out to fetch it.

Low and behold, the tubs were now filled with in-your-face multi-colored petunias, geraniums, begonias, fuchsias and busy lizzies interspersed with variegated ivy leaves which trailed to the ground.

Something’s happening, thought The Witch Doctor.

A couple of hours later when The Witch Doctor ventured out of her room to call in the next patient, she saw an entourage.

Like royalty.

But no sign of The Queen or any other member of the Royal Family.

Instead, the entourage was headed by The General Manager and a rather well known Member of Parliament plus a few doctors and nurses who were edging over into management.

A colleague was at the tail end of the entourage and he whispered to The Witch Doctor as he passed by.

“What a fiasco. It’s all up front. All show.”

Anyway The Witch Doctor was pleased that the tubs were now a colourful display. At least they would cheer the patients up for a few weeks. If somebody watered them.

When The Witch Doctor left that night, there were no flowers.

The tubs were empty again.

Even the weeds had gone.


That is The Witch Doctor’s memory of the start of the management structure introduced in The Griffiths Report.

All up front. All show. Little substance.

And so, 25 years on, NHS Chief Executive David Nicholson has the view:


“I would argue that the market has failed. Whatever the system is that we’ve been using, it simply hasn’t delivered the quality or quantity of leaders that we’ve needed.

“We’ve made some progress with the diversity of leadership in the NHS and there are undoubtedly more women, more people from black and minority ethnic communities and more clinicians involved than there were five to 10 years ago but we still need more.”

More of what?

Redheads, people with painted toe nails, witches, black cats?

Why, nowadays, does every other paragraph refer to leaders, My Black Cat?

And why nowadays, does every other sentence mention diversity. This is the ultimate marker that patronising bigotry exists within a nation.

The links were picked up from Dr Grumble’s interesting daily readings at the top right hand corner of his blog.

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  1. See also:
    The Hospital Revolution: Doctors Reveal the Crisis Engulfing Britain’s Health Service.
    John Riddington Young et al.
    There is no doubt that the NHS is very sick, possibly terminally ill. The cause of this illness is that it has a huge cancerous growth inside, sapping it of all its strength. This malignant mass is the management system.Just as a patient with cancer does not know for a long time that a disease is present, the vast majority of the British public is unaware of the true cause and extent of the sickness within the NHS.A cancer grows at the expense of the healthy tissues around it without serving any useful function. To the detriment of doctors, nurses and surgeons, the administration has grown bigger and bigger, and it has not served any useful purpose, as the shocking stories in this important book show.Cancer grows until it sometimes becomes bigger than the organ from which it has arisen. Twenty years ago there were just a handful of administrators, but now there are many thousands. Cancer eventually kills its host by an insidious process of infiltration and spread. By their own exorbitant salaries and continuing mismanagement and misuse of money, administrators have diverted precious funds and made our once thriving Health Service into an emaciated shadow of its former self. Sometimes cancer causes bleeding. The blood then flows away and cannot be replaced quickly enough by the ailing body. Doctors and nurses – the life blood of the NHS – have never before been leaving or taking early retirement in such unprecedented numbers. And they are going because of the administration, which has made many feel absolutely and utterly unvalued.The only treatment for a cancer is to completely get rid of it. If this were done, there would be an immediate and overwhelming increase in morale not only by the clinical staff, but by everyone else in the hospital, plus immense savings. This book is a vital expose of the crisis at the heart of the NHS and a rallying cry to save it before it’s too late.

    • One of the problems with managers is that they are expected to “manage” even when there is no valid management to be done. I have often felt that the name “manager” within the healthcare setting should be scrapped and replaced by the title “facilitator.” The difference may be subtle but it introduces the concept of helping rather than controlling. In my view those managers who originated from the professions (eg doctors and nurses) in order to “manage” other members of their own profession who were more than capable of managing themselves, was a deliberate act by government of divide and rule. After all, there already were heads of departments in place and in the main they knew what was necessary to run their departments efficiently – although granted, some had a leaning towards empire building. In the context of the medical profession, a good full time medical director who knew the staff well should have been able to knock back un-necesssary budding empires and see that there was fairness throughout.

  2. In the old days the hospital’s administrator was simply a useful facilitator. Calling managers “facilitators” won’t change the nature they have now. Some have come from NHS management courses – which don’t seem the best. Others they have been promoted because of the trouble they caused at lower levels. The jobs of another set were made redundant and they were forced to apply for management posts for which they are unable.
    None of them thinks outside the box. They just implement the received wisdom of the current management fads: SMART, shared services, mergers, accreditation etc.
    I was slow to pick up that the local management structure we have had imposed over the last few years though trust assimilations is a national one and not merely the whim of the new CEO who had bankrupted his hospital twice. I’m don’t know the origin of the new management Tier structure and management by workstreams and projects. These are clearly designed to create masses of wasteful change to keep the managers busily bullying each other and everyone else. Strife and waste are embedded in these structures.
    I wonder how these bad ideas were put in place. Central government? Academics and training courses? Professional management consultants? Common Purpose?
    John Seddon provides some pointers:

    but a reviewer implies he currently has little experience of NHS mismanagement: (P18ff)

  3. That is an interesting link ISOwatcher. I’ve watched all of it and at least some of it strikes a cord with what I’ve witnessed. I’ll probably link to it in future in an appropriate post.

  4. […] The Witch Doctor has no political allegiance whatsoever, her politics are her own and unlike any of today’s political parties. She is simple a Witch Creep Watcher. She has been carefully watching NHS Creep since 1984. […]

  5. […] The seeds of these weeds were sown intentionally by governments along the course of “The Pathway of Accountability” They were allowed to germinate, become saplings and slowly grow over many years – so slowly that few noticed. However, Black Cats and Witches have beady eyes. They noticed the beginnings of the gradual overgrowth  way back in 1984. […]

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