Commitment and concern in the health service

As part of a general review of the use of local health services resources, a specific enquiry was mounted to examine the recurring complaint of a lack of identity or sense of belonging made by staff working in the largest district of the Grampian Health Board. The investigation pointed to clearly identifiable sources of confusion and concern: (a) a need to identify with and feel committed to the health service; (b) a sense of purpose and direction; (c) satisfaction with the conditions of service; (d) an understanding of an individual's role and its relationship to others'. It is relatively easy to list the problems, such as friction between occupational groups, lack of commitment, uncertainty over duties and authority, reluctance to delegate and resistance to, or even outright rejection of, decisions apparently at variance with professional advice. In addition to these internal stresses the health service is perpetually beset by two other external problems, namely what it is expected to achieve and the finance allowed to attain its goals. The various groups within the service are in no way agreed on roles and responsibilities, Without agreement goals cannot be defined. Without goals, use of resources cannot be rationalized. Without a demonstrably fair distribution of resources, neither the public nor health service staff will feel confident or committed. Somewhere this cycle must be broken.