NHS trusts: under managed, not over managed

Claire Helm profile picture

24 April 2018

Claire Helm
Analysis Manager


The BBC and other commentators have recently reported how the numbers of NHS managers have been increasing at a faster rate than clinical staff across the NHS.

It is important that we move away from the suggestion that investment in non-clinical staff is pulling investment away from the frontline. We know that the NHS needs to draw on the skills and expertise of both clinicians and non-clinical staff, including the vital role of NHS managers to deliver high quality care to patients.

This recent trend only provides part of the overall picture and must be viewed in broader context. Firstly, NHS managers make up a very small proportion of the NHS workforce – just 3%.

Since May 2010, the total NHS workforce has grown by 5% but the number of managers has actually fallen by 13% over the same period. Therefore, there are 4,792 fewer managers in the NHS than there were eight years ago.

Claire Helm    

The NHS is made up of large and complex organisations, all delivering services across multiple hospital sites, in community settings, on the road and in people’s homes. These large trusts need the management, administration and support infrastructure in place to support clinical staff to provide the best care for patients.

In some cases management play an important role in freeing up frontline staff to treat patients – we saw this first hand in the BBC documentary Hospital  that has shown how invaluable the contribution of operational managers has been in responding to the immense pressures on the NHS over winter.

 

Workforce trends

Secondly, when reviewing the workforce trends over a longer timeframe a different narrative becomes clear.

Since May 2010, the total NHS workforce has grown by 5% but the number of managers has actually fallen by 13% over the same period. Therefore, there are 4,792 fewer managers in the NHS than there were eight years ago. Looking at the workforce over this period encapsulates key national policy shifts that resulted in a shrinking of the NHS workforce, including the widespread erosion of NHS manager jobs.

From 2010 the government made proactive moves to cut administration costs in the NHS through the drive for efficiency savings and then again through the 2012 Health and Social Act reforms both significantly depleted administrative and management roles.

There was a sea change in policy after the publication of the Francis report which shone a light on safety and quality concerns linked to poor staffing. From this point in 2013 the numbers of clinically trained staff and managers began to climb but the number of managers has never returned to 2010 levels.

Thirdly, when considered aside other professions the increases do not seem disproportionate.

We cannot view the recruitment of managers as a choice between management and the frontline. Instead, we need both.

Claire Helm    Analysis Manager

For example, the numbers of consultants, doctors and support staff have all increased by 29%, 16% and 11% respectively since May 2010. The shortage of registered nurses across England has restricted the needed growth in this profession. But we cannot view the recruitment of managers as a choice between management and the frontline. Instead, we need both.

It is also important to take the wider health and care system into consideration. Although the number of managers in hospitals has increased, they have not been increasing as quickly as in some of the non-frontline NHS organisations. Clinical Commissioning Groups (CCGs) and NHS central and support organisations which include the arms length bodies have also seen a marked increase in the number of managers they employ.

 

The role of NHS managers

The recent growth in managers across the system reflects the increasing complexity of the work facing the NHS. Operational pressures, as well as the productivity and transformation agenda mean that the role of managers is pivotal in helping the NHS be responsive whilst maintaining quality patient care – you can’t be more efficient without the expertise to analyse your inputs, outputs, processes and data.

The role of managers is pivotal in helping the NHS be responsive whilst maintaining quality patient care

Claire Helm    Analysis Manager

Lastly, recent international research from The Commonwealth Fund shows that the NHS administrative efficiency ranks highly in comparison to many other western healthcare systems. In addition, in 2011 The King’s Fund also argued that comparing to the wider UK economy considering the number of employees, annual turnover, and size and complexity of the NHS, if anything; the NHS is significantly under managed. Our view is that this still remains the case.

To think that the NHS has a choice between more clinical staff or better management is a false dichotomy.

The NHS is operating in increasingly complex and challenging circumstances, with those in clinical and non-clinical jobs feeling more pressurised than ever. Yes, we need to ensure the NHS gets the maximum efficiency from the money it spends on both the frontline and non-frontline support functions. However, we should not undervalue the crucial role managers play in the day-to-day running of the NHS and the support they provide to clinical staff.

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