And agree that the idea that you don't need managers is stupid. Of course you need managers. Just as money is needed to be spent on evaluating outcomes and what actually works.
The general public IMO have not got a clue about what it needs to run a large organisation well. And the NHS suffers because of that.
Also we spend far less on healthcare than nearly every other developed country.
God this is so nonsensical. As has been pointed out, the NHS is the fifth biggest employer in the world. It's a mammoth organisation, it needs management. It almost certainly needs more not less.
These comments about managers are wrong. The number of managers mushroomed under Labour, as did the number of organisations administering the NHS. There were hospital trusts, PCTs, intermediate care trusts, health and social care trusts, ambulance trusts, acute trusts, mental health trusts, etc, etc, etc.
Loads of these were abolished and merged into foundation trusts. It meant that rather than having 8 boards of directors, 8 Chief Executives, 8 accounts departments, 8 payroll departments, 8 HR departments, 8 estate departments, 8 procurement departments, 8 office blocks, etc, etc, etc, they’re all streamlined into one. That was a huge step in the right direction and made a massive difference.
There were also many, many managers under Labour, frequently at Commissioning level or associated with Commissioning, who would sit in nice shiny offices and never ever encounter a patient or a doctor or a nurse or visit a healthcare setting. Most of them were concerned with ‘business transformation’ and a drive to make the NHS run more like a business. They had legions of expensive consultants nobody was quite sure what the purpose of was. Usually to spout a lot of jargon about blue sky thinking synergy of vectors that nobody understood but everyone pretended they did. They often used very inappropriate techniques of assessment like balanced scorecards which completely ignored that the were dealing with human beings not units of stock. They were also notorious for sending fact finding missions into hospitals which interfered with their running and cocked up all their processes then went back to the office and recommended the board introduce completely impractical, expensive and useless guidelines and policies designed by people who had know idea about the day to day operation of services. These would be introduced for a while, screw everything up, causing huge costs and delays, then eventually be abandoned when frontline staff pleas enough with enough finally got through. I know this because I worked in one of these departments. Many of them were made redundant in 2013, but I also know from my LinkedIn that most of them are now set up as private consultants selling the same services back to the NHS for three times the price. They cost loads (I’m talking £1,000 per day plus) achieved paltry results and added very little value.
There are brilliant bits of the NHS and brilliant managers, mainly the closer to the frontline the better the managers, although I have come across some truly excellent foundation trust management teams.
But it is still an issue. The figures from the King’s Fund report don’t cover consultants or many clinical managers so I’m not entirely sure they are that useful.
There are crap bits of the NHS too. I once worked on a team which was parachuted into places where things had gone wrong (frequently unnecessary deaths, abused or neglected patients, poor practice) and believe me there are some parts of the NHS where employees have the attitude that the primary purpose of the NHS was to employee it’s employees and that patients were an unwelcome inconvenience who should shut up and die quietly. Frequently those places came to crisis precisely because of the ‘NHS are angels and should be above criticism’ attitude that many of its biggest supporters have especially Labour, who presided over travesties like Mid-Staffs.
Yes, it is underfunded in comparison with other developed countries, but most of those (including France and Germany) receive much of their funding via a social security system where everyone is required to pay for health insurance so much of the funding comes from those payments from the insured via private companies rather than straight from the government. Sweden, which also has a single payer (government) like us has similarly poor results. There is also a reluctance in the UK to invest more, because more money doesn’t really result in the improvements one might hope for because it isn’t spent efficiently.
I would far prefer a European system where people pay towards having a health service via insurance and patient choice means poor providers are pushed out. Nobody can be refused insurance because the government regulates it so people with long term conditions can’t be excluded. It works well.
And you do have to question, if the NHS is as great as its supporters say it is, why, in 70 years, has nobody ever copied it? We look a bit silly abroad. Insisting the NHS is the jewel in our crown when it has pitiful results.
Sorry for the length, but I do have a bit of experience in this area so have a bit to say about it.