Management Madness in the NHS

This government’s failure to improve public services is perhaps most obvious in its many bungling attempts to reform our national health service. When looking for evidence of our leaders’ catastrophic mismanagement of the NHS, you’re spoiled for choices. A recent report comparing survival rates for conditions like cancer and strokes estimated that if we could just reach the level of comparable European countries, over 17,000 deaths a year, almost fifty every single day of the year, could be avoided. Then there are about 6,000 people a year dying from hospital-acquired infections – the number would be just about 120 if we matched the performance of some other advanced European countries. On its website, the NHS admits that around 34,000 people die unnecessarily in our hospitals each year and an additional 25,000 are unnecessarily disabled. But whatever your choice of figures, the only conclusion you can reach is that although this government has more than doubled healthcare spending from about £45 billion to £105 billion a year, death rates in Britain are still massively above where they should be.

One striking feature of this government’s approach to reforming the NHS has been the extraordinary amounts of money that have been squandered on building a new managerial class, most of whom have absolutely no healthcare training. The number of managers and senior managers in the NHS has shot up from around 20,000 in 1997 to about 40,000 today. We now have 5,000 more managers than we have medical consultants (34,900). Just in the year 2008, when the recession had already started, the number of managers in the NHS went up by around ten per cent while the number of medical staff only increased by about two per cent. There are various reasons for this almost obscene spawning of bureaucrats.

One is the government’s obsession with poorly-thought-through target-setting, meaningless reports, unnecessary form-filling and unproductive box-ticking. Another is that managers are often uncomfortable dealing with highly-trained medical staff, so they surround themselves with other managers and live in their own little world, all holding important meetings with each other where they can speak management gobbledegook and think up new and exciting initiatives. In most hospitals today you’ll find directors of strategy, of communication, of planning and development, even marketing directors. Naturally, they all feel they need offices full of secretaries and subordinates busily writing reports and attending meetings and going to training on teamwork and all sorts of other superfluous rubbish that has nothing to do with improving the quality of care delivered by the NHS.

Not only have the numbers of managers shot up, so have their salaries compared to most frontline medical staff like nurses and midwives. The average NHS Medical Keyboards salary of a NHS trust chief executive is now over £158,000 a year, more than double the 1997 level. Moreover, with this salary comes early retirement with a tax-free lump sum of up to £240,000 and an inflation-linked pension of over £70,000 a year. All the plethora of finance directors, marketing directors, strategy directors and communication directors will be getting similar enviably large pay and benefits packages. The increased cost to the NHS of these extra 20,000 managers is over £3 billion a year and they are a massive and unnecessary drain on NHS resources. If we could just get back to the level of management of 1997, the NHS would have an extra £10 million every single day to spend on medicines and patient care.

Yet while the managerial population is growing, the number of hospital beds the increasing army of managers have to manage has been falling – from about 250,000 in 1997 to less than 180,000 now. Where we once had 12.5 beds per manager, we now have 4.5. Just this statistic alone should make our government hang its head in shame. But quite the opposite is happening – the numbers of beds keeps on falling while the number of managers just keeps on growing. Then, of course, we should not forget the £600 million a year or so being spent by the NHS on management consultants, a cool £15,000 per manager, just to tell all these managers how to do the jobs we already pay them for doing. This situation is so farcical you almost couldn’t make it up.


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