There are many stakeholders whose powers influence developments within the NHS. Assuming you are a manager leading a change programme within the NHS, identify and discuss at least five (5) types of power that characterise the different stakeholders within the NHS. What are the main strengths and weaknesses in terms of power that you may possess as the manager?

The assignment is about identifying different types of stakeholder powers which influence development within the National Health Services (NHS) and the strength and weaknesses managers have in terms of power. A stakeholder is an organisation/individual who can influence or is affected by the attainment of a corporation’s purpose (Phillips, 2003). HealthKnowledge (2011) claims types of stakeholders as internal stakeholders who partake in the harmonisation, support, resourcing and publication of the stratagem from a native health and wellbeing companionship. External stakeholders who engross in sponsoring own sentimental and experience around discoursing important facility operator’s problems and local community affiliates. Stakeholders are analysed into quadrants depending on how influential and important they are in decision making (HealthKnowledge, 2011). The following are the stakeholders who have an impact on NHS changes (Department of Health, 2011).

-The Government

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-Health professionals



-Trade Unions

The Government has political powers (Mayer, 2005) and full jurisdiction over the NHS. Even with criticism whatsoever they insinuate to do is done with other professionals suffering the consequences. The government proposed a strategy to amend administration costs by 33% (King’s Fund, 2011). The community and majority of the NHS staff were not content as it appeared it would concern patients and staff in many ways. Part of the managerial role is actively reprioritising, negotiating to find critical resources when needed and, crucially, maintaining and initiating major changes. With no copious water to hold, in using managerial skills managers need to value the reasons for change and alert the government to the implications in advance during consultations. (2010) claims that managers are conventional professionals who engage in crucial standpoints within the NHS.

Managers established efficaciously their vocations without any official ability management support (, 2010), but the King’s Fund (2011) argues that managers need to modify and progress in preparation to meet the fluctuating civic assumptions reflecting on-going policy occurrences. Categorically, there is not much managers can do but reduce their schemes according to the allocated budget .This could give managers an arduous interval with the community as deviations yield their outcome on the diurnal succession and management of the NHS (Wright, 2011). Further hospital attendance may escalate as staff numbers are reduced in the community, which will mean additional effort versus less staff. The NHS Confederation (2007) claims managers are able to efficiently run wards unswervingly or deviously proving patient care. With the government counteracting, the managers are left with no option but to make the patient and staff agonize, working around the available resources.

All health professionals present with major responsibilities in patient management within the NHS. Using professional inequality, political and technological powers, Lawrence and Weber (2005) states doctors could change theatre procedure set up as they wish. Granter and Hyde (2010) claim doctors as not considering financial problems accompanied with changes they propose practically knowing that the manager has to deal with it. Davies and Harrison (2003) argue that this response type is due to incompatible professional culture between doctors and managers. As a managerial strategy, building consensus amongst doctors through reflecting, communicating clearly and honestly about this change the manager may attempt, encouraging doctors to work around available resources to which most doctors could repudiate. Perhaps the correlation matter between the two co-workers, argues could be evidenced back to 1980 government policy when NHS managers’ positions were up-stretched argues Lasserson (2009, pp175-176). Davies and Harrison (2003) further claims that doctors have been seen traditionally as autonomous and dependable to patients with managers at the lowermost of their line.

With the professional issue gap widening, the manager appears to be easily challenged and undervalued. Nevertheless, doctors need not use their extreme power in asserting the rightness of their approach over managers, but to work as a team claims Handy (1998). Using managerial human skills the manager could talk to the doctors who should incorporate financial obligations into their planning. Atum (2003) supports this by expressing the need required between doctors and managers in speaking a common language, as the caricature of their fighting is strange. Using their professional role as an added advantage, doctors may approach the Board of Governors and present their proposals, which will further weaken the managerial role. As mentioned by Edwards (2003), traditionally doctors are seen as important professionals. Further, Drife and Johnson (1995) claim managers and doctors need to seriously work on developing ways of working together.

The pharmaceutical industry is very important in the NHS as it supplies the medicines needed for patients’ treatment and for the day to day running of hospitals. The pharmaceuticals have the economic and funding power (Lawrence and Weber, 2005) to reduce the amount of medicine supplied to a hospital, which will lead to serious drug shortages in hospitals. The Association of the British Pharmaceuticals Industry (2011), states that the pharmaceutical industry should be seen as an NHS valuable partner rather than a medicine supplier. This arguably means valuing the impact of pharmaceuticals on the NHS. With such hospital conditions and no option, through using managerial power the manager may seriously negotiate for the supply of sufficient quantities of medication from the pharmaceuticals. Anderson (2007) proposes that managers embed the embracing of pharmaceutical companies, developing a framework for a joint working relationship between the NHS and pharmaceuticals. Problems need solving, despite variations in managerial places and the duties available.

Considering protocols to be followed within the NHS, it could be time consuming for the manager to wait for approval before commencing negotiations with pharmaceutical company. NHS South West (2012) argues this as tarnishing the manager as drug shortages may lead to erratic patient upkeep, intensifying patients’ jeopardy due to unplanned medical schedule fluctuations. Perhaps the doctors who can prescribe the alternatives available in the local pharmacy may not be willing to do so and may be very difficult to convince, which further weakens the manager’s powers. Due to complex governance the role of patient care, risk protection and safety as the manager’s first concern will prove very difficult (NHS South West, 2012).

Charities fund the NHS annually towards patient care, additional staff training, and purchase of medical equipment and contribute towards research into different ailments (Friends of the Royal Marsden, 2012). Lawrence and Weber (2005) state that, with economic powers, charities may withdraw funding from NHS; which in turn will heavily impact on the daily running of the NHS, staff and patients. Through using managerial strengths which may at times demand different skills, the manager may need to talk to the NHS governors to liaise with charitable organisations as well as allocating time for charities to get involved in debates and discussions. To prove the importance of charities the manager has to prove how donations are being used within the NHS (Our Charities, 2012) as well as how organised charitable activities help the NHS. This is supported by Robinson (2010) when he claims that charities raise funds for researches through organising events. With the managerial conceptual skills of being able to understand complexities and critical issues within an organisation the manager needs urgently to solve dilemmas through negotiations.

Perhaps how funds should be used differs between the NHS and the Charity, thus leaving the manager at a weaker point with no choice except to abide by the NHS plans. Considering managers’ competent ability to work with others, talking to the Charity Trusts may open doors to the negotiation table. Colaciechi (2011) states that charities consider themselves as playing a unique role in helping the NHS, and the Friends of the Royal Marsden (2012) claim the unique role of providing services enhancing patient and staff wellbeing. The manager will act in closing the gap between the NHS Board of Governors and the Trusts. Given the potential for conflicts of interest between charities and the NHS, Colaciechi (2011) argues that charities need to share problems, experiences, and incorporate working with other organisations to achieve the best practice. In support, Linck et al. (2008) state that charities should be made aware of the impact of the substantial contribution they make towards the NHS, which not only improves the patient outcomes but also staff morale.

Unions help protect workers’ common interests and improve working conditions. Lawrence and Weber (2005) claim that unions have the legal power to ask for wage increments for their workers. By so doing, unions add more pressure on managers to tighten job production and accountability in order to preserve profits in the face of higher wages claims (Verna, 2005). Through using managerial skills and considering resources availability, negotiating with the union representatives within the NHS and convincing representatives about the financial situation might help (Hirsch, 2004). After liaising with the authorities and using managerial powers involving the union representatives in joint discussions about the matter may or may not help (Corby and Blundell, 1997). Unions are considered strong. They can draw on grassroots militancy, which grabs public attention (Stewart, 2005) and can have a further impact on the manager’s strength, as whatever the union requests for members is considered an urgent need.

Managerial powers and ways to solve problems differ with the type of situation (Shetty, 2007) as the union continues to demand an immediate response. The only option for the manager is to turn to authorities for assistance in such difficult cases, argues Shetty (2007). This is supported by the Royal College of Nursing (2OO7) by claiming that trade unions have no obligation, but highlighting the problems impacting on services and people with an urgency to have the problem solved immediately. To avoid tarnishing the organisation’s name, managers will have to let the authorities deal with the matter in a way suitable to them proving their weakness in such occasions.

NHS managers and Stakeholders need to develop a common ground to deliver the best health service. Perhaps by building trust, communication and respect for each other’s responsibility they can successfully manage to close the gaps.


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