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

Joined-up care: The elephant in the room

Ministers are claiming they are joining up the health and social care systems to improve the support given to vulnerable patients. But are the plans as good as they sound, asks Nick Triggle.

Read full article

More on This Story

More from Nick


This entry is now closed for comments

Jump to comments pagination
  • rate this

    Comment number 192.

    A chance of being managed at all would be a fine thing.

  • rate this

    Comment number 191.

    I have this sneeky suspicion that too many people who are employed as 'managers' are not really 'managers'. They are not people who are expected to make good management decisions, but are more like bureaucrats who follow the system.

    Good management is valuable, whether in public or private sector organisations. Too much bureaucracy, well.

  • rate this

    Comment number 190.

    Just because we keep expensive drugs in a fridge, does not mean that the fridge has to cost thousands; why are there no staff within the NHS designing, or making equipment, why does the businesses have to go to multinational companies like Siemens? Why do we not have local people to design medical equipment? What are Oxford & Cambrdge producing other than the numpties we see in westminster?

  • rate this

    Comment number 189.

    Don't confuse under managed with too few managers. The NHS has gazillions of managers, just they have no clue how or what they should be managing. Of course they all know how to milk the system for an ever bigger pay cheque.

  • rate this

    Comment number 188.

    173. Sally "You confuse Capitalism with: Corporatism & Cronyism. It's important to know the differences."

    Ah - your zeal now makes sense. You're not talking about capitalism as it exists (i.e. with built-in Corporatism and Cronyism), but capitalism as it exists in some utopian fairy-land. Good luck with that...

  • rate this

    Comment number 187.

    The problem is not just that there are too many NHS mnagers but the amount that they are paid is way over the top. To have so many staff of moderate ability on 6 figure salaries (not to mention the fat pensions they are building up) is a disgrace when none of them have to take risks or invest their own money. A cut in pay so no manager earned more than £80k would be very appropriate!

  • rate this

    Comment number 186.

    No.44 - huge worry to your RCN members if that's how your organisation does calculations. Any survey of management costs finds they're around 6% of total costs, which includes many clinical management posts, some of which will be occupied by your RCN members! No.44 suggests that only £36bn of the £110bn NHS budget is spent on patients. To be taken seriously you have to be able to handle numbers.

  • rate this

    Comment number 185.

    Politicians, professionals should stop telling the public that they are there to care for all their needs; patients need to be more aware of how to keep healthy themselves, without expecting the panacea as promised by politicians, doctors or nurses.Why do the public have no idea where to go with small/minor injuries. Why is NHS spending money in advertising,why are GPs not providing urgent care

  • rate this

    Comment number 184.

    @180 The USSRs health system wasn't as comprehensive as the NHS. No medical provider in the world offers what the NHS does. It's also worth mentioning how the people want to go back to the public owned one because the replacement is much worse.
    And who paid for the roads those cars drove on? The internet, computers, space rockets were all started by non-businesses so what does that prove?

  • rate this

    Comment number 183.

    The main problem with management in the NHS is that the non-clinical managers have no idea how to run clincal teams, and that clinical managers have no idea how to manage!
    If both sets of managers were supported and educated in their shortcomings then we would need fewer managers in total.

  • rate this

    Comment number 182.

    "114. queenoffife
    How many people does it take to do an odd job in the NHS?"

    Depends on wether it is "PFI".
    A few years ago (I doubt if anything has changed) I complained that there were no coat-hooks in the Ladies at the Princess Royal hospital in Farnborough (unhygenic!). I was told it would take a minimum of six months to get anything done because it all had to go through a PFI committee.

  • rate this

    Comment number 181.

    @179 Absolutely but we also need to ask why are the costs going up?

    Partly this is because we are an ageing population and partly because successive governments keep doing things that end up costing millions more. It needs to be taken away from party politics, vested party backers interests and ideology on both sides and run responsibly by people who know what they are doing.

  • rate this

    Comment number 180.

    ... communist and soviet is inappropriate to describe the NHS...
    Nothing wrong with stating the truth.
    What's the difference between the USSR's health system and ours?

    roads, education, policing, fire fighting etc.
    Who do you think does all that? People.
    Who works in businesses? People.
    Who do you think built the first trains, cars, planes? People for profit, not the government.

  • rate this

    Comment number 179.

    176. RoyaltyinThePremiership

    "Health care I believe to be one of those things."

    I do not think many would disagree with you here, but the question everyone needs to address is how big a health service can we afford. NHS needs to be cut down to size, in line with what the UK can afford. It's called responsibility.

  • rate this

    Comment number 178.

    If the main parties get their way, the NHS will be a complete oxymoron - it won't be national anymore, it won't be a service, and health will deteriorate as a result. By all means let the private sector research and develop new medicines but they cannot be allowed to hold a monopoly on health care. It's too important to fall into a profit-driven environment.

  • rate this

    Comment number 177.

    162. josy
    Fridges that costs £15K just to store blood products with an alarm in case of electricity cuts

    Those fridges hold tens of thousands of pounds in vaccines/drugs which are highly sensitive to temperature changes.

  • rate this

    Comment number 176.

    @173 I fully accept modern capitalism has become corporatism and cronyism, but your use of words like communist and soviet is just as inappropriate to describe the NHS which is neither.
    For a society to operate there must be things that society pays for be it roads, education, policing, fire fighting etc. Health care I believe to be one of those things.

  • rate this

    Comment number 175.

    How can we expect our promoted healthcare professionals to manage budgets in the millions of pounds, with very little or no commercial training. We need commercially minded professionals who know how to manage and alocate funds to where they are needed the most.

  • rate this

    Comment number 174.

    "142. John_from_Hendon

    Met the boss of a 1000 bed hospital yesterday.
    Department booking systems can't tell if the patient is an in patient or an out patient!"

    So which highly remunerated IT Consultancy designed that system, then?

  • rate this

    Comment number 173.

    I feel that our economic situation is dire, worse than our leaders will admit, and that such huge welfare & NHS schemes (all Soviet in nature) will be gone when the real economic crisis hits within that 5year time. Our Ponzi Scheme is catching up with us in other words.

    You confuse Capitalism with: Corporatism & Cronyism. It's important to know the differences.


Page 5 of 14



  • Man with typewriterLove to Patrick

    The official whose over-familiar letters infuriated his boss

  • Man's hands putting ring on woman's fingerName changer

    Why do wives take a man's name after marriage?

  • Person scratching their arm10 things

    Scratching really does make things itch, and other nuggets

  • Corsican flagCorsican mafia

    Are Corsica's days of mafia and militants over?

  • Mobil canopies on the A6 at Red Hill, LeicestershireEnglish heritage

    Zebra crossings to bus stations: unusual listed buildings

BBC © 2014 The BBC is not responsible for the content of external sites. Read more.

This page is best viewed in an up-to-date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.