It could be said that the problems highlighted above are all a result of the organisational structure of the NHS. The of initiatives and targets and the code of conduct as described in the text are indicative of a bureaucratic organisation and provide the rules necessary to ensure efficient operation of the organisation.One drawback of this system however is that it discourages individual creativity within the job roles; the job description acts as an instruction book for the job holder to follow and they will do as instructed or in all likelihood they will be replaced with somebody who will.

These strict rules or standard operating procedures as they are called in many organisations are required both in my industry, aviation, and the NHS to ensure that certain standards are upheld for the health and safety of both the staff and customers.It is these targets and initiatives or revisions of them – the product of bureaucracy – which create the apparent sense of instability within the management and affect morale within the workforce. You could argue that while they meet one part of the objective – to reduce costs – it simultaneously and directly contradicts the governments plan to create an NHS which is more caring and people centred.The level of government control over hospital policy at a local level is also a problem caused by the organisations’ structure. The NHS is still largely centrally controlled despite improvements in the area. The most recent attempts to address the issue being the introduction of Strategic Health Authorities and Foundation Trusts aimed at increasing the level of autonomy for individual hospitals and reducing the amount of bureaucracy involved in the delivery of patient care.(http://www. nhs.

uk/aboutnhs/howthe-NHSworks/authoritiesandtrusts/Pages/Authoritiesandtrusts. aspx). There is however still the problem of ‘symbolic policy-making’ (Edelman 1971 cited by Ham 1985), particularly in the areas of the NHS which have not immediately benefited from the governments’ attempts at de-centralisation, whereby the policy makers (government) issue an initiative but fail to make available the necessary resources to make its implementation possible. “..

.successive attempts to give greater priority to groups such as the mentally ill, mentally handicapped and elderly have not been accompanied by the allocation of significant amounts of additional resources, nor have ways been found of achieving a major shift towards these groups within existing budgets..

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act primarily as a way of maintaining political support and stability” (Ham, 1985:112) These situations will also lead to frustration within the management group trying to implement the new policies as directed but seemingly without the required support from the Department of Health, leading to further de-motivation.Resistance to change is also perceived by management among the clinicians; the main concern for the doctor is to treat the patient, whereas the focus of management is efficiency and implementation of new or revised policy. Riley (1998) clearly demonstrated the differences between the two groups. Their differences were also highlighted by the Chief Medical Officer when he addressed quality of care and the different views of quality that each had while introducing the concept of Clinical Governance.”Sir Liam also pointed out that the approaches to quality within the NHS were fragmented and lacked co-ordination. For example, the managerial view of quality was different from the medical view and it was not clear what methods would reliably lead to improvements in quality. If quality was to be placed at the top of the agenda, and clinical governance to be truly patient-centred, a profound cultural change was required. ” (http://www.

dh. gov.uk/en/Aboutus/MinistersandDepartmentLeaders/ChiefMedicalOfficer/ProgressOnPolicy/ProgressBrowsableDocument/DH_5049089) The effect of highly trained and skilled medical professionals who carry high status and are used to working with a high level of professional freedom being ‘managed’ by highly trained and experienced, but, non-medical staff and in particular the differing priorities that they have, has created a culture clash between the two groups of professionals which requires the culture change referred to by Sir Liam.As already highlighted, the standard of management is key to the standard of healthcare delivered however, the relationship between clinical and non-clinical staff is key to the standard of management governing its delivery. Conclusion While several factors have been identified which contribute to the problem of management in the NHS, I feel that it has been clearly demonstrated that all of these factors are interrelated and interdependent and ultimately all exist as a result of the structure of the organisation.

The financial difficulties faced by NHS managers in running their facilities, be it a GP running a local practice or Chief Executive of a group of hospitals such as Leeds General Infirmary and St. James’ Teaching Hospitals are all the result of the funding model in use by the government. However, in the large part, managers and clinicians alike are still subject to criticism from Government Ministers when it comes down to NHS performance issues and use of resources by way of the annual performance ratings.Communication problems are an inherent danger of operating large organisations and a certain degree of difficulty can be expected if not excused in the NHS purely as a result of its size – again this could be solved with more government emphasis on foundation trusts.

In short the problems faced by management in the NHS are in some form or other all either directly linked to its organisational structure or exacerbated by it and all could contribute to the erosion of staff morale.