In the 1980s hospital-service costs were rising. Naturally, the government needed to do something about this. A report was commissioned. A grocer, Mr Roy Griffiths, was chosen to lead it. He duly gave his report, as a grocer. Now, I've nothing against grocers. They probably aren't that imaginative: they sell edible commodities for money: it's all rather simple. In fact I've worked for a couple of grocers; Lipton's and The International Stores. I have an understanding of the grocery business, from the lower-end, as a delivery-boy, to help fund my higher education.

Roy Griffiths said that he didn't understand how the hospital-service ran so well in the absence of a dirigiste management. In fact it was run by health professionals who generally knew what they were doing: and furthermore they accepted the need for economy. Hospital medicine is actually rather more complicated than running a food store. An intelligent person would have accepted that. But Roy Griffiths didn't have that intelligence. He was a grocer. He recommended comprehensive tiers of management.

The government took his advice. It spent a fortune on management. (The Health Secretary of the time was a lawyer without any medical experience.) Griffiths became a knighted grocer in 1985 for services to the NHS. Now the hospital-service is run by an army of desk-soldiers. It is a largely failed chain of grocery-stores. Poor Griffiths is now dead. As for me, I got out.

Our Medical Director, a doctor turned grocer, condemned my public press criticism of the new system of 'management by ignorance' as antidemocratic. His reasoning was that dirigiste management had been ordained by a democratically elected government and thus any criticism of it was inadmissible. I must say I raised my eyebrows at his junior school debating society logic.

I have even read articles in a hospital management journal which aver that the best form of management is by persons who have been trained in management but who have no direct knowledge of the field they manage. Managers can therefore move from sector to sector unencumbered by practical knowledge. Unbelievable, but true.

There is an argument for perceiving the current principles of hospital management as being counter-productive. Managers tend to heap administrative duties onto productive staff, taking them away from clinical work and damaging their morale. The advent of information technology has worsened this. IT in the hands of those who do not know how to use it squanders time and resources.

Senior hospital managers are themselves under constant pressure, and often invent favourable statistics, promoting appearance over actuality. They tend to move from hospital to hospital before their mistakes and inventions are discovered. Many hospital managers are more concerned for their own survival than for the good of the service they manage.

When management first began to make itself felt our department had a series of visits by two time-and-motion men who, in their sheer uselessness, constantly put me in mind of the self-styled land-surveyor's two assistants in Franz Kafka's The Castle.

How history reiterates itself! Recall HMS Pinafore, where a land-locked lawyer is awarded command of the British Navy. How similar. Dear Roy Griffiths: the lyrics might resound for you:

Stick close to your desks and never go to sea,
And you all may be rulers of the Queen's Navee!

[The opera HMS Pinafore, incidentally, lampooned the contemporary (but similar) situation in the British Navy. W H Smith, of the W H Smith railway bookselling empire and Conservative politician, was appointed First Lord of the Admiralty in 1877 despite having no naval experience. Gilbert's song depicts this in a perfect satire. It caught the public imagination. People used to whistle it behind Smith's back in the streets of London. Hilariously, it was purposefully played by a band of the Royal Marines when Smith went to Plymouth to launch a new warship. The object of Gilbert's satire is not so much a single personage as the system that de-professionalized and managerialized high positions in the British armed forces.]

Here is a link to a spirited production of the song. The incomparable John Reed of the d'Oyly Carte is the soloist. His voice is impeccably clear.

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