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

DH and I left our NHS management roles with great salaries and pensions in 2011. We felt our roles and any prospective roles did not represent value for taxpayers money. We also didn't like how constrained the management culture was, innovation or improvement was rarely possible as budgets were strictly preallocated. It was very demoralising.

That might be your experience, but I’m a good bit older than you, and have none of those. I know I’m fortunate!

I’m not sure about very senior management positions, but we seem to have the opposite problem at my trust, we don’t have enough managers and the managers we do have are managing four different areas and also working as part time bed coordinators, which means pretty much nothing gets done to improve the service as they have no time to do it.

We also have practically no admin staff, so despite me being band 7 clinical, a lot of my time is taken up with doing band 2 admin work like printing and posting letters and adding appointments to Lorenzo. My problem is I’m very limited in what I can do to improve the service without the approval and input of the higher ups and the people higher up are too busy managing beds in ED to attend any meetings and make any changes.

Sadly this has been the case for decades OP. I can remember having exactly the same discussion back when I was a student nurse in the later 80s.

It's controversial but I don't think all doctors are badly paid, junior ones yes.

100%

I work for a consultancy and we work for the NHS a lot. Although they employ our consultants as the experts, there are always so many NHS staff involved in the meetings etc. I know a couple are needed for arrangements on site etc but on one project, we had provided a project manager and the contractor doing the actual work had their own project manager. The NHS then provided a third project manager for some reason even though they really weren't needed. We'd have constant meetings where half of the NHS people didn't have any input.

I found it weird because of the huge underfunding, that there are so many management staff. The ones at the very top take huge salaries.

I can absolutely believe it. In January 2017 what was then Central Manchester Foundation NHS Trust advertised for an Assistant Director of Equality and Diversity (new post) who would report to the Associate Director of Inclusion. I can't recall exactly how many direct reports the Assistant Director would then have to hire but it was three or four. I recall totting up that the mid-point salary costs alone of this team would be close to £250k, before on costs.

It's scandalous. Equality and diversity requirements apply to the private sector too and no company would ever justify this. The existing management would learn to do it themselves, as part of their general duty.

The reason there’s cost cutting exercises where support roles are reduced etc. is so senior management can be seen to be doing something. Same in the private sector. When roles are inevitably re-hired a few years down the line, it doesn’t matter, senior management has moved on to another part of the company / to another company, so they’re not accountable.

Rarely are cost cutting initiatives worthwhile in the long run. The only people they benefit are management consultants who make a fortune from them.

The NHS Confederation literally exists to justify pointless bureaucracy.

I recall seeing an advert for DEI director in the NHS that paid six figures. It was around the same time as a friend who worked as an ICU doctor in London left for Australia, as the pay for her NHS role (registrar level, I believe) wasn’t enough to raise children on to a decent standard.

Don’t know what the solution is - if we got rid of the managers, what would they go off and do? Hardly a buoyant job market right now.

It's really not me that doesn't make sense.

Nail on the head. Always happens when they try to apply "open market" methodology to government controlled organisations. They're wrongly using "financial" yardsticks to measure performance etc by putting a price on everything, but the figures used are entirely artificial and you have a small army of people pushing money around, recording it, analysing it, reporting it, etc., but it's all artificial so completely pointless.

It's like the state controlled railways where there's a small army of admin staff charging between train operating companies and national rail, etc., when there are delays to "punish" the firm that caused the delay. Again, all entirely artificial, especially when national rail and some of the train operating companies are government owned/controlled, so again, just pushing money between different govt controlled bodies, recording it, analysing it, reporting, etc.

They really need to stop using "pretend" figures to measure performance. Financial performance figures works to evaluate performance, efficiency, etc out in the real world, in the open market, but it's just a pointless waste of time trying to play with pretend money (even if it's actually paid, it's still pretend in that the charges etc are manufactured in the artificial world, not real world). Just create performance targets etc based on actual performance and not pseudo cash.

All the different trusts are also arguing between themselves as to "whose budget" each treatment/service has to come out of, so you get GPs refusing to issue drugs requested by a hospital consultant claiming it should be the consultant who issues them and vice versa, same with blood tests - one dept won't do a blood test for another dept which is crazy as my OH has to go to two different places for his blood test to be done twice a month, yet it would save the NHS just to do it once and tick a few more boxes on the form - but because of fragmentation, neither dept wants to "pay" for tests for a different dept, so both depts end up "paying" - of course, if sanity prevailed, they'd come up with a compromise where OH alternated between depts month by month, but there's no "oversight" of common sense to let that kind of micro efficiency happen.

You make no sense? Whats a ridiculous thing to say? Its ridiculous to ask what the solution is? Its ridiculous that all companies have more support staff than they need?

How is contradicting to ask what the solution is when restructuring and getting rid of a few roles at the cost of millions isnt the solution. The roles we lost werent a "luxury" they just wanted a reason to get rid of the old ladies!

Call bullshit all you want.
I’m assuming the team is large due to the amount of emails, meetings and endless events they seem to organise.

And no I haven’t forgotten that it is supposedly set up for patients, but when front line staff are so busy, who actually reads the newsletters or attends the events? Not me or any colleagues I know.

Internal markets screwed the NHS up. Each ward and department now has their own budget, their own systems, it's ridiculous. The money all comes from the same taxpayer pot.
There's massive waste in procurement, inefficient IT and no joined up thinking or long term planning. They just lurch from crisis to crisis.
When the hospital had a budget there was one finance department and management team, now you have multiple teams all running their own little fiefdom.

I agree that every single company, not just the NHS has to many "support staff" but what is the solution?

What a ridiculous thing to say.

We just went through a 10month review for the back office staff where i work, cost millions to undertake we thought the numbers were going to be slashed and only a handful of roles and people were made redundant over it. And in a few years time, they'll realise it was a mistake and re-hire again.

I've seen this too. A company "restructures" and gets rid of support roles that are deemed a luxury, then soon realise it was a mistake and hire the same roles again. Directly contradicting your (silly) point above.

I agree that every single company, not just the NHS has to many "support staff" but what is the solution?

We just went through a 10month review for the back office staff where i work, cost millions to undertake we thought the numbers were going to be slashed and only a handful of roles and people were made redundant over it. And in a few years time, they'll realise it was a mistake and re-hire again.

Cant do anything about what's happened before now, but they need to change for the future, but again how do you do that?

Someone like Delotties, would happily charge the NHS 10's of millions to come up with a new structure and "NWOW" but would it work?

I’d be going to university to study nursing this year if the fees weren’t so astronomical. I also think students should be paid at least an apprentice wage whilst on placements.

lots of people want to get in to the NHS and try and do some good, but unless you’re 19 and living at home, it’s not always financially feasible.

The “too many managers in the NHS” trope has been trotted out for ever since the dawn of the Daily Mail 🙄
There are too few good administrators. Can’t fill the many many vacancies because the pay is poor for the qualifications asked for. Desperation on the part of the NHS means people are employed without a skills test to check for initiative, attention to detail and organisational ability. Extra admin staff are needed to cover for the carnage created by others who lack these skills, as well as resilience so that they are frequently on sick leave with stress/anxiety/depression. For weeks at a time which puts even more pressure on the ones left to cover who get fed up and leave.

This is about the third time I’ve addressed a specific point of yours, only for your response to be that ‘it’s not about that’.

You keep asking whether we should question the distribution of funds. I keep providing evidence to show that the funds are probably about as well distributed as they can be, and that NHS problems aren’t caused by that. You keep repeating the same thing. It’s a bit circular, perhaps because the evidence doesn’t say what you’d like it to say.

If your points were valid they couldn't be undermined.

That just doesnt make sense. So you expect a desk based role to never earn above say 40k compared to a doctor on 100k? (which is stupidly low for what they do)

You cant compare the roles, desk based roles have to offer a competitive salary otherwise people wouldnt want to do them and then the pressure is back on the nurses and docs.

And a bit rude to assume that people working from home arent doing much

And no, i dont work for the NHS, i work in transport.