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In the second part of a study of ward culture and management at Ashworth special hospital, in the aftermath of the Blom-Cooper enquiry, Joel Richman and Dave Mercer analyse the response of ward managers to the presence of external consultants. The first part, setting the context and outlining the survey methodology, appeared in the last issue of Mental Health Nursing (21) 4
Mental Health Nursing vol 21 no 5 pp 12-16
Ward managers' responses to external consultants
In 1993, ward managers' responses were mainly negative. When asked if the external consultants `gave value for money': 15 (65 per cent) claimed they had no value; three,
minimal/almost none; three, don't know and two (nine per cent) said yes, gave value. The two ward managers expressing positive values were both male, aged 40-45 years and internal appointees to their posts. There is a vast array of explanations for the ward managers' negativity
1. External consultants did not support ward managers' political ambitions
Initially, when appointed, the ward manager's role was hyped up, by visiting government officials and by the hospital's higher management group (HMG). They were releasing the hospital from its unhappy past and bringing a new order to the wards. The wards were the real hospital. As one manager said: "I came out of the induction on cloud nine - almighty and powerful."
They had to weld new team leaders and nurses as one. All former charge nurses had to re-apply for their old jobs, now called `team leader' or for a ward manager's post. Many were unsuccessful: the hospital chose many young nurses 'untainted' as new team leaders. Unsuccessful ones were known as `disgruntled "Gs"' Their high grades were protected financially Their potentiality for 'sabotage' was great. Ward managers had to neutralise them, often by an exchange process with other ward managers.
Ward managers had to review critically the skill base of their nurses. Many claimed expertise, e.g. in psycho-sexual counselling, which they did not possess and which had never been challenged. Staff development programmes were initiated to match ward needs. Managers were charged with reducing the heavy overtime bill -- not a popular measure. Some took risks and reduced the overall staff budget (the hospital's largest single cost) by appointing cheaper,...