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

[AlertBird]

It seems like every time the NHS is in crisis (which is always), the conversation turns to needing more funding. But where does that money actually go? It feels like the system is overloaded with layers of management, bureaucracy, and admin roles that don’t directly contribute to patient care, while the people actually keeping the NHS running - doctors, nurses, and other frontline staff - are stretched to their limits and underpaid.

I’m not saying all management is useless but has it gone too far? Shouldn’t more of the money be going to patient care and those who actually treat patients rather than creating more high-paid managerial roles?

AIBU to think the NHS has become a bloated system where too many people exist just to justify their own jobs?

I agree with you but you’ll get a truck load of butthurt middle managers and people with non-jobs coming on to sulk.

I’ve worked in the NHS. There are SO many pointless non-clinical roles. The NHS doesn’t need internal communications officers on £35k a year to send staff “Thank you” postcards and put out a newsletter nobody reads

Yes, but I think the key word is unnecessary management. There are some management staff whose role I would question.
More admin staff are probably needed to give clinical staff more time for clinical duties.

I was a consultant in the NHS previously. I did spend a fairly large part of week dealing with issues with issues an administrator could have done, which would have enabled me to spend more time with patients.
I work overseas now and have much more administrative support.

underpaid?

This post is about 20 years out of date. This all started with the Sainsbury Review, then by Alan Lansley when he was in charge of the DoH

Might want to check the thread title

I thought there was a study done showing that what the nhs needed was more management not less, and that the lack of management resulted in a bullying culture. I’ll see if I can find it.

I’m nearly 70 - OMG the string of operations/ scans/ ulteasounds/ resections/ docs appointments, routine clinic checkups / physio etc and on and on and on that people my age and older receive is unbelievable-I can see exactly where all the money goes.

Completely agree. I have a few friends high up in random management roles within the nhs. All paper pushing. Nothing of real value

Title meant to say overworked and UNDERPAID.. as the post itself clearly states.

It feels impossible to win on this. People only want NHS money spent on doctors and nurses, but they also don't want doctors and nurses wasting their time doing the administration. One of the reasons that frontline staff are so stretched is that they are doing functions like bed management that shouldn't sit with them.

With my OH's cancer and chemotherapy drug fiasco, he has to speak to several "admins" along the way between booking his blood test through to telling the dept the date he's due to start (cos they're incapable of working out a start date 4 weeks since the last start date), then phoning someone else to tell them he needs the drugs to be available at the hospital pharmacy 2 days before he starts, then the pharmacy to tell them to expect the prescription and to hold them in the pharmacy rather than sending them heaven knows where to some random hospital to be picked up and finally on the pick up day itself, phoning the pharmacy to check they're there and have been "approved" via the secondary controlled drug approval system, to be told they havn't, for him to phone another "admin" to give them a kick up the backside to press the "approve" button on the controlled drug system, to phone back the pharmacy to check it's showing on their system. That's a lot of phone calls to numerous "admin" people who are mostly completely incompetent. This happens every sodding month. It's exactly the same routine every 4 weeks for the past 4 years, yet every month they act like it's something new that they've not seen before and he has to talk them through every step of the way. Some months, it all goes tits up and he has to get the cancer specialist nurses onto the case - so poor admin is making the specialist nurses spend their time knocking heads together rather than actually being hands on with cancer patients - once it took the nurse a whole afternoon to sort it out - they'd have done it quicker without the crap admin staff having to be involved. I think there's a real case for far fewer admin/management staff but recruit better quality - i.e. quality rather than quantity.

Yes, no one likes talking about this because it makes it sound like people are to blame for not dying, but the reason the NHS takes more and more money to do the same is an ageing population. I had a serious eye injury and almost everyone at the ophthalmology clinic was over 80, many older. Many of them were there for sight-saving procedures - this was a clear and real need. It was also a level of need for that service that just did not exist a few decades ago.

Multiple research papers all conclude that yhe nhs has far too few managers. See here for example:www.nhsconfed.org/long-reads/nhs-overmanaged

yes - school are the same! Teaching staff get shafted and the trust IT or HR managers on 60k+

I've been around the block in healthcare, both NHS and private, and I've long held the view that the Pareto Principle very much applies in NHS management: 20% of the people do 80% of the work. On that basis I'd be wary of tarring every NHS manager with the same brush but my god there is some dross in there.

One of my favourites was when I called the Public and Patient Engagement Lead at one of the then CCGs when I was working as a contractor. Before I'd even finished introducing myself she actually said "I don't do any doing." There we had it: I was being paid £750 a day to redesign a service and one of the requirements was for patient and public involvement in the redesign. I'd only wanted some advice about whether they had any preferred methodologies or existing participation groups, but the starting point of the woman whose actual job it was, was to refuse to do it.

Add another fifteen year to that twenty and you'll be closer.

Absolutely. Cut the managerial nonsense and pay front line staff better.

Gawd, time goes by so fast! You're correct!

Ah, yes, the NHS Confederation. For managers, run by managers!

🙂 👍I don't know who Lansley was, I just remember my mum, who worked in NHS hospitals from late 70s to '99, remarking on the talk of the need to get shut of the extraneous pen pushers, this was sometime early to mid 90s.

The NHS is an enormous organisation. Compared to other outfits of similar size it has too few managers, not too many.

However the quality of that management and the prioritisation of what it's spending time on is definitely worth investigating.

Which roles do you feel are unecessary?

We've already had it suggeted that internal communications officers are unecessary. In an organisation of 1.5 million staff.

Did you not see this last week?

https://www.dw.com/en/british-pm-starmer-announces-nhs-england-to-be-abolished/a-71911413

My sister is a nurse, when she started her department had 11 nurses and two admin. Now it's 11 admin and two nurses who are rushed off their feet.

I am also helping someone with an NHS bullying employment tribunal. It has exposed to me that so much time is spent with petty squabbling between staff and departments, it's unbelievable.

The NHS is not short of staff (1.4 million) or money (£180Bn) but is short on best practice.

I think the roles are often needed, but massively iverpaid. Any desk based job that involves attending meetings and sending emails should be 40k max, but HR staff etc are often paid almost as much as the doctors. The doctors shoukd be getting paid 3 x what any desk based office worker is paid, and nurses 2 x