To think the NHS is bloated with unnecessary management while frontline staff - doctors and nurses - are overworked and overpaid?

The big problem the NHS has is that it is almost impossible to fire anyone. As a result you have a lot of useless staff who wouldn’t last one week in a private organisation.

But they still need managing, the vast amounts drugs ordered, bedding, pharmacies, procurement, mtce, ambulances, staff training, recruitment, pay roll, emergency planning....mobility equipment... operate a morgue, even run a helicopter!

Working with SS, Councils, Care homes, private care companies....

Your average SME will not being doing a fraction of that.

Look at Trump? sacking vast amounts of federal employees and then desperately trying to re recruit them back again.... often without success.

Very easy to destroy something, almost impossible to rebuild it back.

I work for the NHS and can clearly see the issues.

Poor digital infrastructure resulting in huge amount of manual admin processes
Governance processes are now really heavy and clinicians have to do all the investigations/reporting
Lengthly complex processes, we need good managers that can streamline and cut out the mess.

I work in social care and work with NHS. I am amazed they are still spending money on posting letters to their stakeholders (social work) instead of sending emails. I simply don't know what to do with these letters as Wfh most of the time and trying to scan and then spend time shredding confidential waste is a faff. If they are wasting time and money on this what else are they wasting.

i think it is the lack of any decision making which is a problem and the red tape

Sounds like they need more admin being paid around £25k and less being paid £100k

The NHS is a massive organisation. Of course it’s going to require a significant number of management, admin and other support roles. I work in IT (not NHS) and can see that many NHS roles pay below market rate.

The reason the NHS is struggling is because of an ageing population: it’s a victim of its own success. And another problem is the expectation of a diagnosis for everything: even things that are just part of the human condition, or caused by issues in society.

And many hospitals have research projects ultimately aiming at delaying death, for all age groups, as you could say all medical intervention does.

Admin is c. 2% apparently. It just seems topheavy, and also, admin posts are no longer filled by people with some understanding of medicine and clinical needs but people who think the NHS is a business.

But it’s not profit making. You can’t compare them. They exist for different reasons.

I wonder if that's centralised in nhs England also and also perhaps included things like hr admin, or people involved in other aspects?

For example we have a completely seperate team involved with recruitment checks, putting out job adverts, pay roll and policy writing. They probably come under human resources umbrella

I was specifically talking about hr advisors for things like sickness procedures and disciplinary measures. We also have a senior hr vacancy that's been unfilled (,ironically due to one leaving as a result of excess leave due to stress)

I just had a look on line and it seems there are 16,000 HR staff in the NHS, about 1 per 88 staff. That's commensurate with various companies I've worked in.
How is it you're not getting your fair share?

I think this is what people struggle to grasp is the size of the organisations.

My old local trust (for one city hosp that didn't even include mental health and didnt even cover a whole county) employes far more people that nationwide chains of big business. In fact as a trust it employed more people than for example dunelm, pets at home and whsmith put together

It could work ;

Not really, fair post

But each of the 200 trusts is as big as a large company by itself. Trusts have £1bn turnovers, might have 10,000 staff, are hugely regulated and deliver literally life and death services. They are easily as big. As FTSE250 companies, far higher profile and with more complex services.

What I don't understand is how so many nurses get redeployed to 'coaching' type jobs which really don't require a qualified nurse.

I’ve cut from your OP to now.

Yes, to a point. But the reality is The Public have been convinced that Accountability is Key. You’ve read that no patient can be said to have drunk 200ml of water without it being recorded, but-if not, it can’t. No record? it, effectively didn’t happen. Vast swathes of NHS worker life is taken up RECORDING that something happened. Like a drink; let alone a right hip, not left- replacement.

So nanna died. Sorry. But, where is the record that she was hydrated, huh? Yeah? So; She died of dehydration? Contributory factor? As there’s no minute by minute record of her being encouraged to drink? What she managed? When?m

This is why the NHS spends millions on record keeping archivists. B7.

Did I carefully record that I asked a drunk, 6’ trucker called Bruce if he might be pregnant last night before I X-rayed him? Believe me, a B7 (£46k plus) ‘manager’ will check we both signed for it, tomorrow.

This bollocks is what you’re paying for.

I get this seems harsh. If you’re a granddaughter trying to find ‘closure’, ‘we want answers!’ -for your bereaved mum, but we’ve reached a stage where vast amounts of NHS £, in time and money, is spent on record keeping and record retrieving. So you can sue.

I work for an engineering consultancy, not a huge company. We are a small firm, we are not comparable to blue chip firms and their salaries. Our top consultant is on approx. £100k. Most at £50-70k.

I get that CEO's of huge companies earn a hell of a lot more than the £250k but the NHS is seen as different as it is government funded. Plus there are top people at the head of each Trust, which in the UK there are well over 200 of so overall the salary outlay is comparable to a CEO of a massive company.

Yep, loads of non important managers doing crap - bin all of the assistant/deputy director jobs, directors can have more junior managers not taking home nearly £100k

I agree op. I have a close friend who has been doing a total non job in the nhs for years. She is paid more than a lot of doctors yet she doesn’t really seem to do anything other than have meetings with other similar pointless managers

Its not about management or admin - there are many studies previously mentioned highlighting there isn’t enough management. As a ward manger (30 beds) I managed 60 plus staff and had responsibilities around supporting our junior Dr colleagues as well as making sure all 30 patients had the best care we could provide. You forget that many managers will be clinical - people still doing hands on care. I couldn’t have run that ward without admin - they did all the data returns the hospital needed to do to appease NHSEngland or the Dept of Heath, they audited, answered calls from worried relatives, co-ordinated discharge paperwork, did some admission admin I could go on. If I hadn’t of had that support I would have drowned!

The issues are there are too many patients, patients are more complex, there is not enough space or beds, social care is challenged so patients can’t be discharged, there is not enough staff with the right skills, not enough people want to train to be nurses! There is not enough time to think how things could be improved- as there is always someone waiting for care. The NHS would be much worse without admin/ management as people like me would spent all their time doing admin/ data returns/ budget management instead of looking after patients.

As some of the sources posted above have already demonstrated, currently about 3% of the 1.3 million NHS staff are managers. This compares with about 12% managers in the private sector. We are already way beyond the middle ground.

This does not mean that all NHS managers are effective, efficient and performing well. That would be an unreasonable expectation and everyone will have examples of poor NHS management. But the plural of anecdote is not data and the data is clear that the NHS is under managed. This under management will itself lead to those managers who are in place being more likely to be inefficient and ineffective.

The criticism of mangers as target chasers etc fails to recognise that these managers are simply enacting what government requires of them, and then that same government berates them for being ‘unnecessary’ and ‘bloated’.

It might not have changed

lots of places do this - is it called Bradford Factor? Ridiculous policy.

I think you need managers who support the clinical work but not arms length ones who do “transformation” or “commissioning” there are loads of exec level people on 100k plus who are too far removed - get rid.

Sometimes there can be, but many of the people I hear complaining about managers don’t understand their work.