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 just had a look on line and it seems there are 16,000 HR staff in the NHS, about 1 per 88 staff. That's commensurate with various companies I've worked in.
How is it you're not getting your fair share?

I wonder if that's centralised in nhs England also and also perhaps included things like hr admin, or people involved in other aspects?

For example we have a completely seperate team involved with recruitment checks, putting out job adverts, pay roll and policy writing. They probably come under human resources umbrella

I was specifically talking about hr advisors for things like sickness procedures and disciplinary measures. We also have a senior hr vacancy that's been unfilled (,ironically due to one leaving as a result of excess leave due to stress)

But it’s not profit making. You can’t compare them. They exist for different reasons.

Admin is c. 2% apparently. It just seems topheavy, and also, admin posts are no longer filled by people with some understanding of medicine and clinical needs but people who think the NHS is a business.

And many hospitals have research projects ultimately aiming at delaying death, for all age groups, as you could say all medical intervention does.

The NHS is a massive organisation. Of course it’s going to require a significant number of management, admin and other support roles. I work in IT (not NHS) and can see that many NHS roles pay below market rate.

The reason the NHS is struggling is because of an ageing population: it’s a victim of its own success. And another problem is the expectation of a diagnosis for everything: even things that are just part of the human condition, or caused by issues in society.

Sounds like they need more admin being paid around £25k and less being paid £100k

i think it is the lack of any decision making which is a problem and the red tape

I work in social care and work with NHS. I am amazed they are still spending money on posting letters to their stakeholders (social work) instead of sending emails. I simply don't know what to do with these letters as Wfh most of the time and trying to scan and then spend time shredding confidential waste is a faff. If they are wasting time and money on this what else are they wasting.

I work for the NHS and can clearly see the issues.

Poor digital infrastructure resulting in huge amount of manual admin processes
Governance processes are now really heavy and clinicians have to do all the investigations/reporting
Lengthly complex processes, we need good managers that can streamline and cut out the mess.

But they still need managing, the vast amounts drugs ordered, bedding, pharmacies, procurement, mtce, ambulances, staff training, recruitment, pay roll, emergency planning....mobility equipment... operate a morgue, even run a helicopter!

Working with SS, Councils, Care homes, private care companies....

Your average SME will not being doing a fraction of that.

Look at Trump? sacking vast amounts of federal employees and then desperately trying to re recruit them back again.... often without success.

Very easy to destroy something, almost impossible to rebuild it back.

The big problem the NHS has is that it is almost impossible to fire anyone. As a result you have a lot of useless staff who wouldn’t last one week in a private organisation.

it is shocking to me that some large london hospitals post their letters, do not have emails addresses quoted in the letters, perhaps too big and unwieldly to manage

Well, first off, it was you who compared them when you talked about NHS wages relative to engineering consultancy wages.

It seems to be a common tactic amongst the NHS Manager-sceptic community to make a point, have it debunked, and then say that’s not the point.

But regardless, your new argument seems to be that it’s OK for a profit making company to employ a top manager on £1m+, but you begrudge the same role in an NHS trust of the same size being paid one tenth as much? Even though the person concerned would be in charge of healing the sick, dealing with people in the last stages of life and the first of untold grief, bringing babies into the world, and spending £1bn of public money as wisely as possible?

It’s a bold take, I’ll give you that.

Or perhaps their client group is overwhelmingly elderly and prefers real post? And perhaps it’s required for audit and information governance purposes?

I think the big problem in the NHS is an ageing population, costing way more to keep alive than could possibly be afforded.

But you do you…

I agree and it's the same in councils; difficult to fire anyone/full sick pay from day one (which leads to so many lost days with some staff taking the piss) and so much dead wood.

nope not in the area i work in but they dont even quote an email address in their letters.

In our trust we still have paper because an extremely vocal minority of our patient groups are tin foil hat nut jobs who refuse to support any move to digital systems because they refuse for their data to be handled electronically.

And if you think NHS management is expensive, you’ve never seen how bad clinical staff can be a managers, or how much time they waste on administration when it could be done by cheaper admin staff, who actually understand administration. This is not helped by the extremely snobbish attitude of some of my colleagues towards non-clinical staff.

our letters are posted, there is no discussion around emailing letters, however our contacts are made very much by email.

Exactly this. In fact there is no single company in the UK that is the equivalent of the entire NHS. Shell has 100k employees, NHS has over 1.4m. Shell CEO is paid around £8m.
Honestly I wouldn't be the CEO of a trust if you paid me double their salary. Yes it's different because it's public sector and the pension is good, but I don't think VampVamp and others have actually thought what it means to be accountable officer for a trust.
And by the way VapeVamp the fact that NHS have project managers even though your company supplied project managers, I can confidently tell you that it's because your company PM does not do all the things that need doing. How do you think your invoices get paid? PM has to raise a PQ, confirm the work was done as per contract and then raise the PO and get the invoice paid. Who does all the risk management and governance which again is required of public sector as we can be FOId on this stuff? Who does the benefits tracking? It can't be left to the supplier as the trust would end up in the daily mail criticised for being hands off !

Just on that point big companies do have DEI teams. I worked for one with c30,000 employees who had about 8 in the Inclusion team.

You keep repeating this without actually giving anything solid that you’ve based on your opinion on. Just the hur dur too many managers.

I 100% agree as someone who has worked in the NHS for 25 years, internal markets caused so many problems for us.

Full sick pay from day one? nope, can take 5 years before the 6month full pay kicks in.

Or do you think a nurse who contracts Covid or another illness during her work should be on SSP and then sacked after 2 weeks? Maybe you do.

The processes and employment law for firing poorly performing staff is exactly the same in a private company as it is in the NHS....