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’ve worked in a senior admin role in the NHS for 20 years and stand very firmly by the principle that you do need admin and management roles. Do you want your doctors and nurses dealing with complaints processes/governance/meeting management or actually get them to triage and treat?
The problem with the NHS is that it is very very slow to adopt new technology, and it’s almost impossible to get rid of terrible people.

I’ve never been employed by the NHS so can’t comment with any real knowledgeability. However, I have many years experience of working in the public sector elsewhere and suspect similar trends apply.

IME a lot of management roles exist to try to overcome processes that are no longer fit for purpose. Rather than redesign the process (which is admittedly challenging), they just pay people to deal with the problems resulting from it. And they only deal with half of it. The rest of the fallout is left to the frontline to manage rather than allowing them to actually get on with patient care.

This is why wholesale reform is needed. There are vast inefficiencies in the NHS that even I can see (an insider must see even more). But there are egos and politics involved in NHS Trusts and ICBs which prevent this. It needs a long-term (20-year +) agreed cross-party approach to really achieve improvement.

It was clear what you meant by the context -that won't stop some pendants here nitpicking, though.

I totally agree with you, it's a complete travesty and not at all where people would want their hard-earned tax contributions to go.

My DH is a university lecturer. His eyes roll so far back in his head at this guff that he could look straight down the back of his kecks. He'd prefer students to attend lectures and seminars, listen and pay attention rather than chatting and twatting on phones, and hand in legible work on time - their own work, that is. Regardless of what side they've decided to dress on that morning, or whether they're Ryan or Rihanna, or whatever.

It’s not about targeting individual job titles but about questioning whether the balance is right. The NHS has a growing number of high-paid non-clinical roles while frontline staff are still stretched thin. For example, do we need so many senior managers and executives on six-figure salaries when A&E departments are chronically understaffed? The point isn’t that all management is bad but whether resources are being directed effectively.

Is this true though? Do hardworking tax payers really not want NHS buildings that are safe? Do they not want NHS staff to be appropriately qualified and trained? Do they not want processes in place and monitored to make sure that medicines are handled properly? Do they not want doctors paid on time?
That’s what managers do! Amongst many other very valuable things that, were they to not happen, people would quite rightly be furious about.

So you'd like a discussion about whether the NHS has unnecessary managment roles without discussing any managment roles?

Or is it that you actually don't know anything about the NHS's structure or its non-clinical roles and so can't give specifics?

A typical NHS trust has perhaps 10,000 staff. The only non-medical managers paid six figures would be the Board of Directors (maybe 7 people?) and perhaps the leaders of large corporate teams like Finance and Digital. Maybe another half dozen people. So max 15 out of 10,000. None will be paid anywhere near the private sector equivalent for leading an organisation of that size and complexity and turnover (because very few such private sector businesses actually exist.

So there aren’t ’so many’ on six figure salaries. And I’d argue that we very much need at least the few we have.

Out of interest, how much do you think the Director of Finance, say, at a £1bn turnover business with 10,000 employees should earn? Bear in mind that a FTSE250 DF would probably be earning £1m+.

I think some admins just create work for themselves tbh. The amount of times I've emailed asking 2 or 3 clearly laid out questions and they answer one and ignore the rest so theres more back and forth.

I had about ten emails back and forth with an NHS admin a few years ago asking for copies of my x-rays so that I could show them to my physio. She kept refusing to send them and when I pressed on "'why" I eventually got the response of "its just not usual thats all, but here you go". Ten flipping emails when they could have done it first time.

Not NHS but get emails all day with communication stuff and award nominations and do this competition and celebrate this and join this meeting

I’m in a call centre, we don’t have time to read the email let alone nominate someone for something so all the lower paid staff get left out of this kind of stuff unless we do it in our own time. What actually happens is they carry on with the meetings and awards etc and none of us get involved

It’s a fair question but I don’t think it takes an NHS expert to recognise that frontline staff are struggling while management has expanded. The question isn’t whether some non-clinical roles are necessary (of course they are), but whether the balance is right. If every crisis leads to call for more funding, isn’t it reasonable to ask whether that money is always going where it’s most needed?

With the repetition of meaningless soundbites and inability to answer a direct question, I'm starting to think this is a bot/ChatGPT.

The issue isn’t just about how NHS exec salaries compare to the private sector - it’s about whether the NHS, as a publicly funded institution, is allocating resources in a way that best serves patients. The NHS isn’t a FTSE 250 company; it’s a public service. If A&E departments are chronically understaffed and nurses are striking over pay, shouldn’t we be questioning whether the distribution of funds is optimal? The discussion isn’t just about individual salaries but whether the structure itself is delivering the best outcome for patients.

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.

If you weren’t constantly undermining my points, I wouldn’t feel the need to repeat myself. Goodbye.

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

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.

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.

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.

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 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.

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.

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.

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!