Two years ago, Jackie Baillie tried to suggest that the senior management incompetence and cover-ups associated with the Lucy Letby case were also present in the QEUH child deaths which Anas Sarwar was trying to connect to the Scottish Government.

‘Scotland’s model is the most radical, for it instead tries to align organisation with professional models and thereby use, rather than attack, the professionals’ role in rationing and treatment. It is radical because it starts with the way health services actually work.’ Greer, 2004: Page 4

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Today, the Guardian has:

Tom Dolphin’s excellent article on the failings of NHS management made sombre reading (The Letby inquiry report makes one thing crystal clear: too much NHS management is scandalously poor, 16 September). Yet I believe that most of our public services are thoroughly over-managed, with frontline professionals neither listened to nor respected by their institutional superiors, and at risk of damaging their careers if they speak out about poor decisions, excessive workloads and impossible targets or “performance indicators”.

Like so many of our current woes, the rise of managerialism can be traced back to the public service reforms of the Thatcher governments in the 1980s, and the mantra of “management’s right to manage”. As professionals were supposedly self-serving vested interests, the transfer of power to managers was supposed to increase efficiency and responsiveness to service users.

https://www.theguardian.com/uk-news/2026/sep/21/lucy-letby-the-nhs-and-the-rise-of-managerialism

Is there the same culture in NHS Scotland?

The most cited framing is Scott Greer’s four-nations comparison: England “bet on markets” and managerialism (trusts, contracts, competition, regulation); Scotland “bet on professionalism” (clinical networks, weaker internal market, stronger professional elites). England is described as having the strongest managerialist thinking in the UK.

From the opening key points in the above:

Scotland has bet on professionalism in which it tries to align organisation with the existing structure of medicine. This means reducing layers of management and replacing them with clinical networks, increasing the role of professionals in rationing and resource allocation.

England has bet on markets in which independent trusts, similar to private firms, will contract with each other for care while approximately thirty regulatory organisations will ensure quality. Competition, management, and regulation will be the keys to getting value from health spending while severing the link between frontline health services and the Minister.

Full text at: https://www.ucl.ac.uk/social-historical-sciences/sites/social_historical_sciences/files/106.pdf

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Footnote – The raw sewage? See:

Millions of litres of raw sewage in 50 toxic waste ponds and tanks, some huge, some stirred, most open to the air and all within a few hundred metres of a giant hospital for the seriously sick – Welcome to Glasgow under Labour

Sarwar knew from whistle-blowers in 2019 that the QEUH child cancer wards were vulnerable to significant bacterial aerosol infection from the raw sewage ponds less than 200m away

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