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Howard McNulty is an independent pharmacy consultant
in Scotland
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What do Admiral Lord Nelson and Ian Carruthers, head of the transition
team for the NHS Institute for Innovation, have in common? Both have
relevance to the Royal Pharmaceutical Society’s current devolution
debate. As you can hardly have failed to notice, Nelson won the battle
of Trafalgar two centuries ago largely because he delegated authority
to his captains to work within an overall plan, and he trusted them to
use their initiative in battle. The French and Spanish fleet had no such
delegation or trust. So Britain won and ruled the waves for 100 years
thereafter. Nelson’s ideas were incorporated into naval strategy
within which delegation has a clearly identified role based on the size
of the task ahead.
Professor Carruthers, interviewed in the Health Service Journal (23 June
2003 p21) explained good management is about creating a framework and
letting people get on with it. He sees that “Creating a patient-led
NHS” offers many freedoms for future organisational change in England
with 80 per cent of NHS targets being developed locally by 2008. As England
moves to more local targets, the differing strategies, priorities and
actions will require local response.
Can the Society’s Council operate at a strategic level and delegate
and trust national “captains” to fight their operational
battles while working to the overall objectives? The case put by Lord
Fraser for Scotland and Wales to have national professional leadership
bodies is well made, given the need for the profession to engage with
their parliamentarians, civil servants, professional bodies, and to work
within various legal and structural
differences in the NHS and in local authorities. The logic is that England
also requires a national board.
However, we now have a new Council that may know little of the issues
involved, as few were involved in any previous meetings with Lord Fraser.
Some might feel threatened by proposals that allow for local leadership
of the profession. They may well need to see a convincing response to
the consultation process to take such a radical step. It could be detrimental
to the future of the profession if the new extended Council tried to
provide leadership for all three countries as well as handling regulation.
Nelson could not have won at Trafalgar if all actions had to be agreed
by him — captains had to respond immediately to the tactics of
their opponents.
There has been little discussion of this subject in your columns and,
it seems, we keep our views to ourselves. It is important for the new
Council to see pharmacists in all three countries show support for the
proposals but will we respond and, if we do not, how will the Council
interpret apathy?
The new Charter requires the Council to regulate pharmacy, pharmacists
and support staff and for that role it now has more non-pharmacist members.
The new composition and regulatory role will lead to new ways of working.
The Council must lead the profession too, but a Council with many non-pharmacists
is not so well suited to do this. If devolved leadership organisations
are set up in only two of the three home countries this would lead to
confusion and conflicts of interest, with the Council trying to offer
English operational and strategic policy advice, GB regulation and GB-wide
strategy and policy.
Pharmacies have the unique selling point of being the only health care
provider that supports both the general public as well as patients. The
way forward
offered by devolution is to allow the Council to delegate defined professional
powers to
national boards (our own trusted captains perhaps) that are better placed
to help the profession meet the needs of their public and patients, meet
governments’ policies and
develop along the lines of their respective NHS Acts and pharmacy contracts.
The profession has a great future if only it can help the team deliver
local health priorities.
Many pharmacists have been concerned over the loss of a body that represents
the profession because of the perceived concentration on regulation in
Lambeth. Lord Fraser’s suggestions for the prime functions of the
national boards would alleviate many of these concerns: these allow for
national strategic leadership and support for pharmacy practice development;
development and
implementation of Council policy and to
develop and implement national policy;
promoting pharmacy and its contribution to health and giving professional
advice.
However these boards may look, Lord Fraser’s suggestion helpfully
allows for local variation in the same way as the NHS Acts allow for
local pharmaceutical committees to be established to be representative
of the pharmacists in each board or trust. Council must be able to approve
the composition of the boards and mechanisms for filling places.
Some members may be elected and others appointed. And, given the growing
numbers of locums, they must have places on national boards. We have
professionally been driven on regulation by pressures generated by the
NHS but not everyone works for or within the NHS and non-NHS members
must be well represented on professional boards. Overseas members should
perhaps have a system for influencing Council.
Lord Fraser proposes that the Secretary and Registrar should be an English
board
director. This post is the overall GB leader and must be even-handed
and able to advise all three national organisations. Being tied into
one board is bound to lead to a conflict of
interest in the Council at some stage and trying to cover all three would
create overload.
Another concern is how much control the Council should have over national
boards. The report proposes an overarching professional senior group,
made up from members from England, Scotland and Wales boards, who would
meet regularly. If clear delegation and trust
exists between the parties then only a light touch from the Council will
be needed.
Thus the Council should be in a position, like Nelson, to benefit from
the freedoms that may be available in one country to develop new approaches,
ideas and services. However, the Council must also be able to overturn
a national body professional decision that was clearly against the wider
public or professional interest.
Equally, should one Government introduce a controversial policy such
as euthanasia and others not do so, it would be important for pharmacists
in that country to form their own policy and for the Council to have
to cope with different national arrangements. If governments are of different
colours, different national approaches will be needed. Provided that
the powers of the devolved bodies are clearly defined and Council does
its job with arms length monitoring, the proposals should work better
than they do now.
Major gaps in Lord Fraser’s report still need to be addressed.
For example, the
consultation paper does not show how
national input will be proffered to Council committees or how these relate
to directors, but these are elements of detail for resolution once our
views are known.
Another important issue is what these
organisations should be called. “National board of pharmacists
for England” does not roll off the tongue easily and is not inspirational.
Better names are needed.
In conclusion, Nelson famously hoisted his motivational message “England
expects” and the Society should hoist the signal: “Great
Britain now expects your views.” Members should write to Michele
Savage before 18 July (devolution@rpsgb.org or 1 Lambeth High Street,
London SE1 7JN), with their ideas and concerns, or the profession may
end up letting someone else rule the health care waves in the future. |
The
Pharmaceutical Journal