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 212.


    You are talking some utter rubbish. 'Free market health system'? hahaha! comical! Nobody in their right mind would support such a stupid idea. There is no way we will ever follow the US example of healthcare which is one of the worst in the world!

    Free markets! ahahahaha

  • rate this

    Comment number 211.

    Those who wish to "manage" the NHS should have had to work their way up from the bottom, so that they have an understanding of what they are managing.
    There are far too many riduculously highly paid idiots with "degrees" in management all only too willing to do what they have to in order to make themselves indispensable - ie, sign bits of paper and "meet targets" oh and look after their mates.

  • rate this

    Comment number 210.

    @209 You found out about the Stafford hospital because the NHS has to publish figures. Private hospitals don't have to and so the scandals and there are many of them aren't as well know.
    You talk of justice? You can always go private in this country if you don't want to use the NHS but the idea that sick people would have to remain sick if they can't afford treatment isn't justice!

  • rate this

    Comment number 209.

    It's the providers fault. Period.

    Who provides/owns Stafford Hospital? The NHS.
    Can customers punishing this provider by starving it of income and patronising its competition? No.
    Can we dump its stock? No.
    Are we rid of it's negligent presence in healthcare? No.
    Is there any justice? No.

    Can you do all of the above in a free market health system without a state monopoly? Yes.

  • rate this

    Comment number 208.

    @197.I see when NHS hospitals kill through neglect it's the nationalised system that is to blame. When it happens in private hospitals (and make no mistake it does every bit as often as in NHS ones) it's the staffs fault.
    And you want companies to pay for roads? Companies are going bankrupt and now you want to start charging them for roads. You really do need to take your head out of the clouds.

  • rate this

    Comment number 207.

    It is economic forces of the free market that have bankrupted the coercive monopoly of the NHS. You are correct; coercion reduces output. The NHS is coercive, even when it fails we pay by force, if necessary. There is no incentive to improve itself to survive. In fact, it grows faster the worse it is, as Ian Reynolds wants. Now that is perverse. I don't think u understand the economics.

  • rate this

    Comment number 206.

    From 204. Sally:
    "Maoist China allowed no competition."

    Forced work reduces output for given effort, it is well beyond its efficient operating point. Doesn't matter whose ideology forces it, it's the same every time. Trust me, you really do need to understand this better. Human activity is governed by the laws of physics just like everything else.

  • rate this

    Comment number 205.

    From 204. Sally:
    "You begin by saying competition is best for output (production). Then you say it's wasteful. Then you contradict your 1st point, saying it should be limited to R&D. Hmmm."

    An LED runs efficiently at about 2/3 of the maximum safe power. Same for Peltier coolers, light bulbs, cars, and pretty much anything. Do you get it now? If not, study some basic science and engineering.

  • rate this

    Comment number 204.

    "Competition forces best output... Competition is very wasteful, best limited to development."
    You begin by saying competition is best for output (production). Then you say it's wasteful. Then you contradict your 1st point, saying it should be limited to R&D. Hmmm.

    Maoist China allowed no competition. Hong Kong embraced it. Which one excelled in R&D, production, wages, quality of life?

  • rate this

    Comment number 203.

    199. Val
    The article is about managing the NHS. I am pointing out that our current management structure and incentives, copied from the USSR, are a joke and our bankrupt healthcare system will collapse.

    You started talking to me, @95, revealing your confusion about the US health system. I hijacked nothing, just because you don't like dissenters you whine. Play me a violin.

  • rate this

    Comment number 202.

    Back (and no, Sally, no tantrum, just making best use of 400 chars in two replies, and having stuff I needed to do). Now for something I need to say:

    Competition forces best output. Science, engineering, show that best efficiency is rarely at best output. I learned that from lasers, LED's, refridgeration, running, electronics, audio.. Competition is very wasteful, best limited to development.

  • rate this

    Comment number 201.

    Either we want a health service that is genuinely free at the point of use, or we don't. at the moment even the poorest can access some of the world's best health care. we also need to decide what care to ration and what not to, what the priorities should be. it's as basic as that. management structures are secondary.

  • rate this

    Comment number 200.

    It's not perfect but, better than a Monopoly. U have the ability to shun bad a operator & reward better ones with ur £s, the essence of competition.

    But, the NHS Monopoly takes all of our money, grows, despite killing 1000s at Stafford Hospital. We have no choice. If a private hospital killed 1000s, they'd be bankrupt, its operators in jail, and its presence eliminated from the market.

  • rate this

    Comment number 199.

    198: Sally: If you read my previous posts, you will see that not once do I mention socialism or defend the NHS as it currently stands. In my first post I said that managers in the NHS may not be particularly good, which is, after all, what the article was about. That you have hijacked this HYS to put forward your quasi-religious views of the benefits of capitalism speaks volumes.

  • rate this

    Comment number 198.

    Capitalism as it exists in some utopian fairy-land.
    Capitalism still exists in limited areas. It powered us out of Feudalism. Hong Kong is a great success story.

    I put it you that: You are the only one pursuing fantasy. Hoping, praying, that somehow your socialist & insolvent NHS will turn around. Ponzi Schemes never turn around, you are the one in a "utopian fairy-land". The NHS dying.

  • rate this

    Comment number 197.

    It was a rhetorical question, the 2 are almost identical.
    I don't hear families of the deceased of Stafford Hospital yearning to return there.

    "who paid for the roads"
    We did. And we built them!
    Why do we want an expensive government middle man taking his cut? Town businesses could fund the roads in towns easily.
    Companies already build &B maintain intercity highways, and users pay.

  • rate this

    Comment number 196.

    The stunning level of incompetence of NHS management is one that has to be seen to be believed. The recent exercise in appearing to do something about the problem has taken the old PCTs, fired all the real workers to make it appear that something had happened, whilst transferring the middle to upper managers wholesale into the new CCGs, often with an increase in grade but none in competence.

  • rate this

    Comment number 195.

    People like Ester Ranzen advertising 'no win, no fee' lawyers adds vast cost to the NHS, local councils etc.

    Many of the 'non-jobs' in public services are there as it's calculated they could save the body more in legal fees than they pay. Protection from these costs requires vast amounts of paperwork to prove care is given in case of litigation

  • rate this

    Comment number 194.


    Ah, but it was not at Stafford, it was at a Private Hospital in the Surrey commuter belt. Not all NHS hospitals are bad like Stafford was, just like not all Private hospitals give you bad service like I experienced. But when you think you/your insurance are paying good money to a Private Hospital, you don't expect to end up in an NHS hospital, a lot worse off than when you went in!

  • rate this

    Comment number 193.

    #162 Josy

    I agree with you, but what you need to know is that during the bid process the British companies couldn't compete as they were to expensive. That is why we need proper commercial managers


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