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?

A lot of it isn't law though, and the laws that are there are highly subjective. Most people's managers in the NHS will be completely untrained people with a clinical background only.
The policies etc that I follow are made by consulting people like dei representatives to understand equality impacts

Prevention is better than cure - good people are out there but they I did meet a lot of shitty unqualified NHS managers who were interviewed by a mate and that’s why they are where they are. Don’t get me started on the piss takers who were always off sick. I had a admin colleague who’d been off sick for 4 years in total out of 10 and was furious when they wanted to sack her because of it.

The management system needs a huge overhaul in general really.

I'd argue some of that is lack of hr support.

You have nurses for example in charge of managing if someone is following sickness policy which is unlikely to be their natural skill set, then when you want to proceed you obviously need hr support. But in my many trusts this is surprisingly limited.

In my areas for example we have 1 part time hr advisor and a shared one with the other half on the trust. We have a staff group bigger than many national businesses, for example wh smith (all employees from truck drivers, to senior staff to shop workers). In no world would WH smith be expected to function with approximately 1 full time equivalent hr person.

I got to where i am (id like to think) because I was strong clinically. I got promoted up in steps from entry level jobs. At no point have I had any hr training, I've been left to read policies and implement them. For example I'm now expected to write building risk assessments, then bollocked when someone complains about disabled access. The trust doesn't own the building, the only disabled loo has been blocked for an age, and I'm spending lots of clinical time chasing it because recently they slashed corporate pushing more facilities, hr style stuff onto clinical managers

Ironically my role is actually a clinical one but by virtue of them axing the managerial one those tasks fall to the senior clinicians

I don’t know about you but the systems were so illogical. So in the Trust I was in, if you were off sick 3 times within the space of a year you got hauled into a room with a po faced HR person asking if you’re a skiver. One year I was off with a chest infection, went back on the Monday, shouldn’t have so was off again on the Tuesday. That counted as 2 sickness periods. Then I had a few days off after surgery. But the people taking 6 months off wouldn’t have this as it was counted as 1 sickness period! Everyone moaned about it but getting something done involves 4,917 different people and forms, and for some reason public sector gets away with running in a way a money making business wouldn’t dream of.

I mean the policy must have changed now but still it was ludicrous (and we had oodles of HR people in our not v large Trust)

I'm not saying it isn't a lot of money. But compare that to the average FTSE 100 CEO. How many millions do they make ?
All I'm saying is comparatively speaking a CEO of trust manages the same sort of size operation and is paid a fraction.
Whether or not anyone should be paid that much is an entirely separate debate and I'm not justifying it. And I'm not saying they're good people either.
But I found it laughable that someone who works for a consultancy firm whose partners earn 500k slagging off a trust CEO for earning the same as a senior manager in a consultancy when they've got 10k staff reporting into them and a 1bn budget.

Come off it, no-one is talking about no admin or management roles at all. There is a middle ground.

My DD spends a lot of clinical time doing management/admin stuff that has to be but there is no one to do it.

The NHS receives less money per head of population than other european countries... relatively easily but

Blaming a lack of investment in the NHS on "too many managers" is a typical British response to a problem that can be solved, but would require more money to be spent.. ie No one wants to pay any more tax.

I note no one is suggesting we hand back the 4% NI cut, which is costing the Govt £10 billion PER YEAR!!

Its all squeeze even more out of NHS staff and then blame them when it all goes wrong.

I work in the nhs and I totally agree. The only admin we need are our amazing ward clerks and the consultant secretaries. What we don’t need is a glut of waiting list managers and higher who are only interested in figures and spreadsheets and not patient care

Sorry, you work in a hospital and think waiting list managers aren't necessary? Without them, who will make sure patients get given an admission date? That they seen in order of urgency? That patients expedited by their GP do indeed get seen sooner? That there are beds and theatre operating lists available on the days the patients who are being admitted? Will the consultants do all that?

And if you think the only admin needed are ward clerks and secretaries, who is going to staff the outpatient reception desks? Manage new referrals? Book appointments? Manage the hospital finances? Handle recruitment of new staff? Order equipment? Arrange outpatient clinics? Answer the phones? And everything else that needs to happen for a hospital to run successfully?

I think there is a lot of waste in the NHS when it comes to equipment.
I used to do a lot of buying and selling through auctions. There was one we used to go to called Canute International medical. Basically they had the contract to take everything away when a hospital ward was refurbished. The stuff they had was unbelievable. When a ward was refurbished everything went. Didn't matter if the laptop/dialysis machine/whatever was a week old off it went to the auction. Most of it was being bought and sent in shipping containers to Africa. Canute no longer exist so I don't know if it's the same now but I bet it is .

You should definitely put your ideas into practice. Get rid of all the managers except your ward clerks.

Just don’t complain when the lack of payroll managers means you don’t get paid next month.

To be fair you wouldn’t be able to complain cos you’d have got rid of the complaints team.

And actually there’d be no way to complain because you’d have got rid of IT (so no emails) and Procurement (so no pens or paper).

Agreed. I work in the nhs in a clinical role and have five layers of management above me who do either very little or no direct clinical work.

Sometimes there can be, but many of the people I hear complaining about managers don’t understand their work.

I think you need managers who support the clinical work but not arms length ones who do “transformation” or “commissioning” there are loads of exec level people on 100k plus who are too far removed - get rid.

It might not have changed

lots of places do this - is it called Bradford Factor? Ridiculous policy.

As some of the sources posted above have already demonstrated, currently about 3% of the 1.3 million NHS staff are managers. This compares with about 12% managers in the private sector. We are already way beyond the middle ground.

This does not mean that all NHS managers are effective, efficient and performing well. That would be an unreasonable expectation and everyone will have examples of poor NHS management. But the plural of anecdote is not data and the data is clear that the NHS is under managed. This under management will itself lead to those managers who are in place being more likely to be inefficient and ineffective.

The criticism of mangers as target chasers etc fails to recognise that these managers are simply enacting what government requires of them, and then that same government berates them for being ‘unnecessary’ and ‘bloated’.

Its not about management or admin - there are many studies previously mentioned highlighting there isn’t enough management. As a ward manger (30 beds) I managed 60 plus staff and had responsibilities around supporting our junior Dr colleagues as well as making sure all 30 patients had the best care we could provide. You forget that many managers will be clinical - people still doing hands on care. I couldn’t have run that ward without admin - they did all the data returns the hospital needed to do to appease NHSEngland or the Dept of Heath, they audited, answered calls from worried relatives, co-ordinated discharge paperwork, did some admission admin I could go on. If I hadn’t of had that support I would have drowned!

The issues are there are too many patients, patients are more complex, there is not enough space or beds, social care is challenged so patients can’t be discharged, there is not enough staff with the right skills, not enough people want to train to be nurses! There is not enough time to think how things could be improved- as there is always someone waiting for care. The NHS would be much worse without admin/ management as people like me would spent all their time doing admin/ data returns/ budget management instead of looking after patients.

I agree op. I have a close friend who has been doing a total non job in the nhs for years. She is paid more than a lot of doctors yet she doesn’t really seem to do anything other than have meetings with other similar pointless managers

Yep, loads of non important managers doing crap - bin all of the assistant/deputy director jobs, directors can have more junior managers not taking home nearly £100k

I work for an engineering consultancy, not a huge company. We are a small firm, we are not comparable to blue chip firms and their salaries. Our top consultant is on approx. £100k. Most at £50-70k.

I get that CEO's of huge companies earn a hell of a lot more than the £250k but the NHS is seen as different as it is government funded. Plus there are top people at the head of each Trust, which in the UK there are well over 200 of so overall the salary outlay is comparable to a CEO of a massive company.

I’ve cut from your OP to now.

Yes, to a point. But the reality is The Public have been convinced that Accountability is Key. You’ve read that no patient can be said to have drunk 200ml of water without it being recorded, but-if not, it can’t. No record? it, effectively didn’t happen. Vast swathes of NHS worker life is taken up RECORDING that something happened. Like a drink; let alone a right hip, not left- replacement.

So nanna died. Sorry. But, where is the record that she was hydrated, huh? Yeah? So; She died of dehydration? Contributory factor? As there’s no minute by minute record of her being encouraged to drink? What she managed? When?m

This is why the NHS spends millions on record keeping archivists. B7.

Did I carefully record that I asked a drunk, 6’ trucker called Bruce if he might be pregnant last night before I X-rayed him? Believe me, a B7 (£46k plus) ‘manager’ will check we both signed for it, tomorrow.

This bollocks is what you’re paying for.

I get this seems harsh. If you’re a granddaughter trying to find ‘closure’, ‘we want answers!’ -for your bereaved mum, but we’ve reached a stage where vast amounts of NHS £, in time and money, is spent on record keeping and record retrieving. So you can sue.

What I don't understand is how so many nurses get redeployed to 'coaching' type jobs which really don't require a qualified nurse.

But each of the 200 trusts is as big as a large company by itself. Trusts have £1bn turnovers, might have 10,000 staff, are hugely regulated and deliver literally life and death services. They are easily as big. As FTSE250 companies, far higher profile and with more complex services.

It could work ;

Not really, fair post

I think this is what people struggle to grasp is the size of the organisations.

My old local trust (for one city hosp that didn't even include mental health and didnt even cover a whole county) employes far more people that nationwide chains of big business. In fact as a trust it employed more people than for example dunelm, pets at home and whsmith put together