Is the NHS really over-managed?

Managers There are over 35,000 managers in the NHS in England

It has become fashionable to bash NHS managers.

In fact, it is a common joke within the profession that you are better off saying you are an estate agent than health manager.

It is easy to understand why.

Ministers have been quick to criticise the "pen-pushing culture" in the NHS with both current Health Secretary Jeremy Hunt and his predecessor Andrew Lansley promising to reduce bureaucracy in the NHS.

The number of managers in the health service has already been cut by nearly 7,000 in the last three years and now stands at 35,650 in England.

But in the rush to tackle the "problem" has it been properly considered whether management and leadership in the NHS actually needs sorting out?

Research to be published later this summer by the Chartered Management Institute shines an interesting light on the issue.

The work has found the NHS has a poor record in investing in its managers.

Compared to other parts of the public sector, it spends nearly 30% less on training its leaders, the research suggests.

The CMI goes on to argue that this is misguided as good management leads to an engaged workforce that is more productive and provides better care.

Ian Reynolds, the chairman of Kingston Hospital, who has been crunching the figures for the CMI, is clear.

"It may be unfashionable to say so, but overall the NHS is under-managed."

Dean Royles, director of NHS Employers, agrees managers have been unfairly targeted.

While acknowledging the failure in management over the Stafford Hospital scandal had been "deeply embarrassing", he also believes good managers are a force for good.

"We know if we have engaging managers we have an engaged workforce. These staff are more likely to be committed, work well as a team and go that extra mile for patients," he says.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 92.

    Private health provision cannot be compared with the NHS as the private healthcare providers use the resources of the NHS.

    They are overcharging for a service that is mostly paid for by the NHS.

  • rate this

    Comment number 91.

    After 12 years in the nhs and previous management in the private sector (im not in nhs management) I agree with the fact the NHS is overmanaged and in my experience they are poorly trained. These are the people who write reports on savings in the NHS, they promote their posts and cut back on front line jobs where the money should really be being spent. It ain't brain surgery !

  • rate this

    Comment number 90.

    All our public services, including the BBC which is funded by licence payers, need to re-adjust themselves to the reality, not believe they are fantastic & therefore should earn loads of money; how can we justify Chris Patton's 6 figure salary, as well any bonuses, we do not know about? How can we justify doctors whose training is funded by taxpayers to set up as businesses?

  • rate this

    Comment number 89.

    The problem is that it has always been politically uncomfortable within trusts and the communities they serve to spend money on anything that is not direct patient care. Therefore, management training and staff health and wellbeing get squeezed. Both of these would indirectly improve patient care but because the expenditure is not directly on patient care, it is limited.

  • rate this

    Comment number 88.

    Thank you.

    If a business can do it more efficiently than the NHS, as you allude to in a public private co-operation, why not cut out the expensive NHS middleman?

    Businesses provide services all the time, you're using the internet right now.

    How has Lasik Eye Surgery achieved what the NHS cannot? Why has Lasik increased in quality, lowered in cost and enjoys virtually no waiting lists?

  • rate this

    Comment number 87.

    From 80. Peter_Sym:
    "72. Crow
    And a matron must be medically qualified to know when treatment is correct,
    No. Thats the job of a doctor (and the nurses make a 2nd pair of eyes to double check potential doctor errors)."

    Ok, but as matrons would always be there, nursing experience helps. Doctors would have less stress and error if matrons helped balance the load.

  • rate this

    Comment number 86.

    For natural bureaucrats, the world is scary without forms to document everything. They need order and organisation. Their reaction to any failure in their systems is to create more paperwork. For the rest of us, some paperwork is necessary, the rest a waste of time. Hence the endless story of admin staff creating more and more work that's meaningful to them, but meaningless to everyone else.

  • rate this

    Comment number 85.

    Apparently, the CMI report argues that NHS managers would do much better jobs if they were trained better. If so, then we could reduce their numbers, train them better, and get at least as good outcomes as we do now.

    Perhaps they could be trained on the importance of tackling bullying and promoting compassion? Or simply institute sanctions against managers who permit bullying or neglect.

  • rate this

    Comment number 84.

    It appears that the BBC seems to think that it is there job to continually defend and promote the NHS.

    We all want a better and more efficient NHS, however I would just like the facts and not the opinions of the BBC liberal elite.

    Perhaps the BBC could do with a few less extremely well paid managers, who don't get massive pay-offs for failure!

  • rate this

    Comment number 83.

    For 67. Sally:
    I can't reduce my point much. 400 character posts was already quite the incentive to try. :)

    Try this: NHS is a service, not a business, but if it procures from external firms who can compete, then the best of them gain a lot from the NHS, and the NHS gains a lot from them. There are more winners than if it has to compete internally because less is wasted if management is good.

  • rate this

    Comment number 82.

    #71 True, but that is the problem with the NHS big problems need multiple visits and masses of support and resources. But the small things need to be treated more like other consumer products, I had 3 visits to get a new hearing aid, excluding the original visit to the GP.

    This is where the managers should be focused what is the correct intervention and resources for the problem,

  • rate this

    Comment number 81.

    I was a PA to the ward manager, who was also a brilliant ward sister; I do believe that nurses should not be managers as this introduces a conflict of interest in their role as carers. Although the ward sister was brilliant, I believe that she was more concerned about how much money each procedure brought in for the department, influencing her decision on the most suitable patients to be admitted!

  • rate this

    Comment number 80.

    72. Crow
    And a matron must be medically qualified to know when treatment is correct,
    No. Thats the job of a doctor (and the nurses make a 2nd pair of eyes to double check potential doctor errors). A ward manager/matron should be doing the none-medical stuff like making sure wards are clean, patients fed & staff busy

    76. Sally. Why should a doc know what a procedure costs?

  • rate this

    Comment number 79.

    #9 'Without the profit motive you could strip away layers of management'

    I am afraid the opposite is true. With the profit motive you have a constant imperative to keep costs down. It is public sector bureaucracies that are inefficient because they lack the profit motive. This is why they grow ever bigger with a consequent increasing demad for more publice money

  • rate this

    Comment number 78.

    "46. Baffled_by_this
    @ 33 - So how did hospitals ever cope before such managers were forced on them? They must have done or they wouldn't exist."

    Hospitals have always had managers and administrators of one type or another.

    I was making the point that throwing more managers at the system and increasing bureaucracy won't solve the problems - a point your comment shows you missed completely.

  • rate this

    Comment number 77.

    Did you know that a law was recently passed (quietly and without much public debate) to make it illegal to go online and criticise the providers of privatised NHS services ? If you do so, they can sue you for libel, even if there is no financial loss to them.

    Utterly shocking.

  • rate this

    Comment number 76.

    Staff salaries are a cost! See @44. Why do you think the World's 5th largest employer only spends a fraction of what it receives on a patient? Most doctors don't even know how much a surgical procedure costs.

    I don't care a businessman profits off me, as long as I get what I want. This mechanism drives down cost & quality up. Look at computers, phones, TVs. Lasik eye surgey!

  • rate this

    Comment number 75.

    Wilberfalse - The problem with the NHS is the lack of military orginisation. Modern nursing came about from the military model set down by Florence Nightingale. The civilianisation of nursing, the move to graduate only nursing has sent the NHS down the wrong left wing middle class path. They moved away from the base model and it failed, but then thats labour all over.

  • rate this

    Comment number 74.

    This is a really silly story as none of the 'facts' presented answer the question asked. The reality is that NHS hospitals have ~50% of their staff in administrative roles, compared to 25% for private hospitals. Therefore there is evidence the system is 'over managed'. What they spend on those staff is irrelevant. The problem is poor managers and too many of them.

  • rate this

    Comment number 73.

    Ask a doctor who was training or practicing pre NHS, it will shock you how little admin staff there was for a hospital. The ward matron covered day to day running & the board/committee of the hospital had a secretary to take notes and dealt with fund raising & general hospital matters.
    ... relation is a retired GP that trained pre NHS.


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