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?

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.

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

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.

The NHS Confederation literally exists to justify pointless bureaucracy.

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.

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.

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.

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

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.

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.

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

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.

Huge salaries ? Says the person who works for a consultancy.

A typical NHS chief executive is paid between £150 - 250k. They manage the equivalent of a very decent sized company in the private sector. Go find a private sector CEO who earns that little.

The average consulting partner in a consulting firm will earn 500k to 900k.

Is there inefficiency in the NHS, of course there is. You should see the hoops we have to jump through to buy anything from a procurement perspective. And it just got worse. Why? Because of legislation telling us that for anything we want to buy we have announce it, publish in x y z places, run a procurement, make sure it's reviewed by lots of people, mark it, document everything meticulously, publish all the results, wait 10days, then award the contract. To buy a few hundred Adobe licenses.

We didn't invent or ask for all this. The government did because they wanted to make Competition. And then we get blamed for inefficiency.

FWIW the number of DEI roles is a LOT less than people think

@Whyherewego procurement is the first problem I'd want to tackle.

Oh bless ya cotton socks. its ok.

Laughing at the suggestion that £150k isn’t a huge salary 😂

When I was at the NHS we were always told the directors on £120k got paid so much because the buck stopped with them if something bad happened. But it never did. If there was a never event or a serious incident, they’d be in a new role in a Trust in Scotland quicker than you can say “escaping blame”. The director turnover was off the scale. Always a bunch of nasty fuckers as well.

Same with education. My sister has had several paper pushing roles in local government.

She used to organise summer camps for middle class kids in North London (it was meant for everyone but most of the kids had never even been on a bus before as they were driven everyone.).

A typical NHS chief executive is paid between £150 - 250k. They manage the equivalent of a very decent sized company in the private sector. Go find a private sector CEO who earns that little.

Unless it's a family member taking over the family firm a private sector CEO will have the intellect and skills to do the job and be held accountable for doing so. That's why they are paid more.

The only ones who get anywhere in NHS senior management are the ones who have hit targets, usually by bullying, lying and stepping on people. They are, by and large, fairly one-dimensional production managers who have only ever known targets and terror. Most of them have never had any management training whatsoever, many have not stepped inside a classroom since they did a BA in Geography in the early 90s.

One chief exec I had, an ex-nurse, was barely literate. She used to say things like "turn this into English."

DH is an NHS manager and feels similarly.

I work in the nhs as a specialist clinician but spend most of my time doing admin work.
For example today I've spent time emailing out resources and creating a flyer (because I have no admin to do it)

Managing complex hr process, which probably takes me twice as long because my training is clinical. We are woefully understaffed hr wise, so often stuck with people for long drawn out processes because we have so few hr advisors available

The trouble is when you have clinicians like me doing this stuff, we are acting outside our skill set. I'm a senior therapist, i have ooodles and oodles of clinical experience, masters etc all in things that aren't this.

We don't have hr support because they can't recruit because they aren't paying equivalent wages to other sectors.

I once was on a project that had project managers. While I rolled my eyes initially at some external cost the difference of these things being run by people with experience in managing budgets etc was massive.

I would assume people think my job is useless because they don't see the processes that I'm supporting, staff I'm managing, and clinical quality I maintain.

A typical NHS chief executive is paid between £150 - 250k. They manage the equivalent of a very decent sized company in the private sector. Go find a private sector CEO who earns that little.

Competence matters though

Is that what they tell you?

My inclusion department has just successfully campaigned for one of my staff to get reasonable adjustments they would have left without

They are also doing specialist training for international nurses and helping reduce the disparity of health care progression (which is bloody horrendous in representation)

They've also been providing training on managing communities needs. He'll they've even supported me in managing some politics around someone going off after a miscarriage that isn't properly represented in policy

The get rid of DEI is a right wing talking point, that ignores how instrumental they are in making sure people get equal access to health care. As an employee Should you get sick and want to not be fired, be sexually harassed, want to take maternity leave or come back from it... you're likely benefiting from some DEI support, campaigning. Let alone for the patients accessing health care who might need clinicians up to date on specific issues facing their populations.

We shouldn’t need whole departments to not be harassed or having workplaces abiding the law

It’s far too reductive to say ‘desk job = not worth X salary’. The ‘desk’ is not indicative of value or usefulness.

The finance and operational directors, for example, have a huge amount of responsibility on their shoulders. The the uppers in finance will all be qualified accountants.