Man is not equal to his rhetoric

There's a line towards the end of the movie 'Die Hard 4.0' of which I was forcibly reminded today. In the film, Bruce Willis and a nervous young sidekick have entered the building where all the bad guys are - also holding his daughter hostage.
"What's the plan?" asks the junior.
"Save Lucy and kill everyone else," comes the instant reply.
"Sure, yes - but any idea how?"
No reply.

That's healthcare management in a nutshell. A missive this morning reminded us all of how the recession will hit healthcare spending. Fair enough - an important issue. But then follwed a list of approaches to coping with this lack of funding growth. Phrases like "Maximising our assets", "Integrating patient care" and "Leaner investments" were amongst the more inscrutable. But there was not a glimmer of a hint as to how this should be done.
Most clinicians are not particularly resistant to change - often they initiate it. However, the cumbersome, clunky, bloated administrative structure that currently underpins the NHS makes change well nigh impossible when not driven by a higher government target. As clinical staff are outnumbered by over two to one by the management and have less and less control over their destiny, I am not optimistic for rapid and effective change here.