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?

kinds fund - https://www.kingsfund.org.uk/insight-and-analysis/articles/big-election-questions-bureaucracy-nhs-2017#:~:text=However%2C%20there%20is%20no%20persuasive,they%20should%20not%20be%20denigrated. Other countries spend 50% more on health admin than us.

Warwick business school:

https://www.wbs.ac.uk/news/how-many-managers-does-the-uk-s-nhs-need/

IPPR, as reported by the BMJ. https://www.bmj.com/content/381/bmj.p1313

I could go on. There is no evidence I can find to the contrary. Does anyone have any fact based evidence to the contrary or is it just anecdotal?

I'd also be interested in knowing which roles people think are unnecessary. I often see people say "I have no idea what these NHS managers do all day, get rid of them" but unless you know what they do, how do you know they're not necessary?

I'm a software testing manager in an NHS hospital. Do people on this thread know what my job entails? Do they think it's necessary and contributes to good patient care? Or would they get rid of me?

And how would a hospital attract good people to desk based roles if they're paying shit wages? You'd end up with an even more badly run and managed hospital as you'd either have low, skilled staff or not enough.

I know. Of all the roles to go after in the NHS corporate world, a Comms officer on 35k seems a bizarre choice 😄

There have been frequent reviews and independent reports that have all concluded that the NHS isn’t over managed.

That’s not to say that there aren’t instances of pointless roles or poor people working in NHS management. But anecdote doesn’t equal data.

We must also remember the nature what the NHS does. It’s healthcare delivery. Literally life and death. It is necessarily highly regulated. That regulation is inefficient and always will be. Quite a lot of the ‘pointless’ NHS management stuff really is pointless 99% of the time but has been deemed necessary because we need to keep tabs on everything, report on everything, keep people informed about everything, in case things go wrong.

I have a friend who is the lead consultant in a large hospital department. She’s always bitching about having to do the staffing rota. Why on earth are you doing this, when with your highly trained medical skills should surely be put to better use, I ask. Well there’s no one else to do it from outwith the department and she can’t delegate to a more junior staff member because the rotas, and who gets what time off is such a bone of contention no one else could really be asked to take that much grief / accusations of favouritism. Madness. Get more admin staff in!

In my experience (allied health professional) we could do with more admin staff for smooth running of clinics. I actually think there's more waste due to not enough admin. We haven't even got enough admin to have reception cover in lots of clinics. Leads to lots of problems. More admin please if anyone with sway is reading this!

I agree. Over run with admin. And nurses on computers instead of taking care of patients.

Often, positions come into existence because of either a capacity shortage (which in what is definitely an undermanaged system is very real) or a skill deficit (which is unforgivable, but sadly inevitable in an organisation that over promotes career generalists without ever training them properly.)

What starts out as the cheapest, dirtiest workaround then grows legs of its own and becomes an expensive luxury that nobody has the wherewithal to actually get rid of even if they wanted to.

i think the majority of people who bang the too many mangers drum have zero idea how many managers there are and what they do

THE BIGGEST FAILINGS ARE WASTE AND INEFFICIENCY they cripple the NHS

as for pay the NHS pay is subjective people just quote the bottom line band of the pay scales where the reality is some roles they can earn between 25/30% on top of base pay by enhancements , 6 months sick pay generous holiday allowance and a hefty above average employer pension contributions

and not let’s forget people who take zero responsibility for there wellbeing

do tbh management is a blip rather than the cause of the downfall

This is just nonsense. At my hospital we have 500 consultants. They are all paid £100k+, and rightly so.
We employ 10,000 people overall. The HR team has one person in it earning £100k.

I get that some management roles are necessary, but are all of them? It’s not just about internal communications officers; it’s about the layers of bureaucracy that seem to have grown while frontline staff are still struggling. The NHS employs over 50,000 managers - do we really need that many when doctors and nurses are leaving due to poor pay and working conditions?

If a doctor gets paid 100k, how much should a desk based role be paid then? I would say less than 50%, the same skill and hard work isn't required, and if it can be done from home people are often not doing much

50,000 managers would mean that 97% of NHS staff aren’t managers. Seems reasonable.

I’m a nurse in the nhs.

I’ve never suffered anxiety before. But I can’t sleep before my shifts now with severe anxiety, I feel sick going to work. I finish a shift and can’t sleep with worry. We are always short staffed or outnumbered by inexperienced staff which makes for a dangerous ward. My colleagues are having panic attacks, at least two nurses cry on shift every shift, we are trying to look out for each other.

i want to leave nursing.

not sure what the answer is. Our management team just keep saying “we’ve got you the numbers” but half of our staff have less than a years experience which in a skilled Itu setting isn’t good enough but the experienced nurses are leaving left right and centre

The trust I work for has a large ‘inclusion and diversity’ dept.
I can’t tell you the joy the very frequent emails about gender, advertising meetings re. trans, non binary etc etc bring when I’m living on my last nerve with a huge caseload of complex patients.
They get instantly deleted by practically all my colleagues. We don’t even have time to read them.

I sympathise, and thank you for your work.

But the problem isn’t too many managers. Frankly it’s too many patients. And too few nurses. Cutting managers wouldn’t solve either problem, and would create new problems.

The only solutions are to reduce patient expectations (ie for the NHS to do less) and for nursing to be made a more attractive career option through such things as higher salary, uni fees paid for etc. All long term solutions. If we sacked all the managers today there’d still be too few people wanting to become nurses to actually mean more nurses to help you.

It’s not just about the number though - it’s about whether that management structure is effective. If the NHS is constantly in crisis, with frontline staff overworked and underpaid, isn’t it worth asking whether those managerial roles are actually improving efficiency? More funding is always called for, but without addressing how it’s spent, won’t the same problems just continue?

100% agree. Just one example but it always makes me laugh. When the covid vaccine was first rolled out and given to HCW there was some left over in the hospital. The hospital were given permission to vaccinate some of the most high risk inpatients should the patient wish to have it. Cue 3 (three!!) qualified healthcare workers (now in non clinical managerial roles) come to the ward, along with hospital PR person and photographer to make a big deal of this moment. Oh, turns out not one of them knows how to use the (now 3 year old) electronic health record because it's too complicated to use and they haven't bothered to learn. So seek out the help of staff nurse who is already run ragged with 12 patients in her care and not a minute to spare... to help the 3 of them do the mandatory checks, consent, administration and documentation of the vaccine. All while they smile for the camera🙃 And then swan off to coffee like the most important people in the universe. Please tell me how any of this is seen as ok.

I’m calling bullshit on this. How big is this ‘large’ team? I presume your trust employs thousands of people so I’d be interested in how you know that ‘practically all’ of them immediately delete emails.

And you seem to forget that the work of NHS diversity teams isn’t really about staff. It’s about patients - making sure that services are welcoming and suitable to everyone.

Well you have asked that question; and have been told provided with numerous links to academic studies which show that the NHS is under managed. I’m sorry if that evidence disappoints you.

The NHS’s many problems are not caused by manager numbers or structures. They’re caused by an ageing population, increased expectations which can’t be met, over-diagnosis and over medicalisation of some MH conditions, shortage of clinical staff, and poor facilities. Management structure comes way below any of those things.

Also, many (not all) admin staff … we’ve had the misfortune on both mine and DHs side of the family to have lots of relatives needing care and hospital time/appointments over the last few years.
The number of incorrectly booked appointments and discharge letters with glaring spelling errors and in a few cases, an entirely different medical condition discussed is highly alarming. Lord knows the errors they make that we can’t see.

On computers? Doing admin you mean?!

It’s not about how the salary of a desk based job in the NHS compares to a doctor’s salary. It’s about how it compares to similar desk based jobs outside of the NHS. Why would you want to do a desk based role role in the NHS and earn say £35k when you can go do a similar one elsewhere and get paid £60k for it? So all the people with the right skills for it go elsewhere

As I said, can you explain which roles you feel are unnecessary? Specifics.