Chris Lancelot: Who will make the managers responsible?

There are a number of uncomfortable parallels between the incompetent decisions made by finance executives before the credit crunch and those made in the NHS over the past 10 years.

In both cases, risky, short-sighted choices have been made by managers who should have known better. Then they collected their exorbitant bonuses - or, in the NHS, severance and pension packages - and disappeared, leaving chaos behind them.

The problem is the same: how do we discipline irresponsible managers? Senior managers can often be a law unto themselves - difficult to control, hard to reason with and almost impossible to remove.

In the financial sector, there is talk of delaying the payment of bonuses for three years, to ensure they have been fairly earned. But in the absence of bonus schemes how can we keep NHS managers under control, especially as many move to new posts before the full effects of their decisions are known?

NHS managers must be made to answer for their actions and, in the case of gross negligence or reckless behaviour, should be pursued relentlessly - then fined, sued or have their pensions or severance pay docked.

Just as it is wrong for bank executives to make huge profits from the disasters they themselves triggered, so it is intolerable that inept NHS managers should be spared discipline or punishment. They should be held responsible for all their decisions, even many years down the line.

We live in litigious times - yet managers and politicians are still relatively immune to actions for damages, despite being more responsible than most for instituting incompetent systems. Why should they not be held to account and required to compensate those whom they have failed? As a doctor I can be sued for an error made years ago: why should an NHS manager or a government minister be any different?

Perhaps in 20 years' time NHS managers will spend large amounts of time on 'defensive management', to make sure they have not inadvertently made mistakes. It will be no bad thing. They may even pay a large compulsory annual levy to a defence fund to insure against claims of incompetence.

For once the compensation culture seems to have something going for it.

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