Scots BMA chair hits out at ‘bean counting’ NHS

The leader of Scotland’s doctors has attacked the “relentless rise of managerialism” in the NHS and the damage it does to patient care.

The 'corporatism' of NHS management culture has been criticised at the annual BMA conference in Edinburgh. Picture: Getty

Dr Brian Keighley, chair of the British Medical Association in Scotland, told the organisation’s annual conference in Edinburgh that during almost four decades working in the NHS he had seen an increase in “bean-counting”.

He called for action to tackle a tick-box culture of targets and put more trust back in the hands of doctors and other staff.

Sign up to our daily newsletter

The i newsletter cut through the noise

Dr Keighley said he wanted to talk to doctors about the “root cause” of most of the problems the profession faced – the “prevailing culture of the NHS”. He cited the investigation at Stafford Hospital in the West Midlands which has identified up to 300 cases where neglect by medical staff could have led to deaths.

Dr Brian Keighley

“The Francis Report was about Mid Staffs and England, but there are definitely echoes here in Scotland, whether that has been waiting list manipulation in Lothian, or a target-driven culture that distorts clinical priorities and evidence of health policy that is still driven by short-term political expediency,” he said.

Dr Keighley, who retires as a GP in Balfron, Stirlingshire, in a few weeks after 39 years, said he would leave with mixed feelings about his time as a doctor.

“Those mixed feelings will be regret at no longer seeing patients and advocating for their needs, but relief that no longer will I have to spend a large part of my working life filling in forms and checking boxes to satisfy the bureaucratic system that the NHS has become. And therein lies the problem of


“It is about the relentless rise of managerialism within healthcare over the course of my career and the consequent denigration of my professionalism and its clinical skills and values.”

Dr Keighley said health boards talked about patients as “their” patients, which he felt implied doctors were “mere technicians in the pursuit of their corporate aim”.

“What an insult to those of us who came into medicine to treat patients to the best of their ability – and perhaps naively saw NHS infrastructure as something there to facilitate clinicians treating patients in a professional context rather than to fulfil corporate ambitions,” he said..

Dr Keighley added he had no issue with good managers helping to make the best use of scarce resources.

“However, bean-counting and clinical direction by managers with top-down politically inspired targets are not compatible with relationships founded on trust between physician and patient,” he said.

“Patients are not widgets and I get upset when they are treated as such, and when I am considered a mere tool within a corporate design.” Dr Keighley said the “slavish addiction” to an ethos of “corporatism and managerialism” had led to all health staff feeling more disempowered.

An example of this was a GP sending a patient to a specialist only to have them referred back because the diagnosis did not fit in the current definition of that speciality, leaving them having to be sent back again to someone else.

“What I want to see for my successors in the NHS is a return to what is at the heart of laudable patient safety and quality initiatives – the centrality of the patient and his or her relationship with their doctor, nurse or therapist,” Dr Keighley said.

“So, my message to the Scottish Government is for politicians and managers to abandon the worst excesses of top-down direction, to stop measuring only things that can be measured, and to trust in the professionalism of its highly qualified and dedicated staff.”

Dr Keighley went on to praise the Scottish Government’s initiatives to improve quality and patient safety in the NHS, as well as its plans for a minimum price on alcohol.

But he said ministers had to “rein in the rampant managerialism” and “make doctors part of the solution and stop viewing them as part of the problem”.

Jackie Bailie, Scottish Labour’s health spokeswoman, said: “Brian Keighley has an established record of making serious and thought-provoking contributions. When Dr Keighley makes an intervention, politicians should take note.

“We need the right balance of ensuring accountability for the use of public funds, while also letting doctors and nurses care for patients. Clearly, there are concerns that the current balance isn’t right and we will need to consider how to correct that in the months and years ahead.”

Margaret Watt, chair of the Scotland Patients Association, supported doctors having a bigger say in the running of the NHS. “These people have the expertise and could really help put things right,” she said.

A Scottish Government spokeswoman said: “We are aware of the concerns and we understand that GPs want to provide their patients with the highest standards of care. Our Scottish GP contract reduced the workload associated with bureaucracy, and it will continue to be a priority to allow more time for GPs to spend with patients.”