NHS managers’ commitment to a socially responsible role: the NHS managers' views of their core values and their public image

Abstract

The NHS began life in 1948 with the noble intention of providing free health care for all from cradle to grave. Today the NHS is the largest employer in Europe employing in excess of one million people and it has commonly been held that, since the NHS is an organisation committed to treating and providing care to patients, those working for the NHS are generally perceived to hold, in the main, altruistic values. Over the last two decades NHS managers have been given the responsibility for the implementation of the various NHS reforms which have been aimed at making the NHS more efficient, effective, accountable and business like. This paper explores the extent to which the managers in this role as change agents believe that they hold core values that are in line with the altruistic service ethos of the NHS and as a result the extent to which they believe they are seen to be performing and behaving in a socially responsible manner. Furthermore this study also provides an insight into understanding the managers' perceptions of their public image and assesses the extent to which this has an impact on the managers’ psyche, performance and commitment to the NHS ethos. Twenty eight managers from two Acute Care and one Community Care NHS Trusts in London were interviewed, after completing questionnaires, with a view to understanding their perceptions of their managerial culture and their public image. It appeared that managers generally believed that all NHS workers, themselves included, share altruistic values and demonstrated a collective commitment to the altruistic service ethos of the NHS. This therefore demonstrates the managers' commitment to behaving and performing in a socially responsible manner. As far as the managers’ perceived public image is concerned the research revealed that the majority of the managers, despite holding values that were altruistic in nature and similar to those held by clinicians, appeared to be convinced that the general public believed that doctors and nurses are the only professionals in the NHS who are motivated by a desire to serve/provide care to society and that these groups alone have an altruistic ethos. The managers indicated that they felt the public viewed them in a generally poor light and did not confer upon them the service driven values that were ascribed to clinicians. It is in the context of being the main change agents within the NHS that NHS managers appear to have become unpopular with the general public who tend to hold the view that “a service which managers are trying to make ever more efficient, rational and controlled cannot at the same time be caring and people centred” [Learmonth, 1997, pg. 219]. Whilst the NHS managers were aware of this negative view held by the public, they felt certain that this public perception was misguided and driven by several unfair and politically motivated agendas. They do not appear to have allowed this perceived negative public opinion to affect how they view their own role and in fact offered various reasons to explain why this public opinion was misguided and misinformed. This paper considers the implications of these views as regards the managers' role and commitment to the NHS.