To think NHS management needs serious scrutiny?

[MyHeartyBlueShaker]

I have no issue with the hardworking frontline staff but I can’t help but feel that NHS management and the way resources are prioritised need a serious investigation. From money being wasted on bureaucracy to strange spending decisions, it feels like something isn’t adding up. AIBU to think this should be looked into more closely?

Do you have any actual examples of this? Or are you just parroting bullshit you've read online?

What makes you think money is wasted on bureaucracy and what are the strange spending decisions? Some specific examples please. I'm not saying you're wrong, I'm just wondering how informed you are to be starting this.

It’s already being looked into by NHS England with a plan to reduce senior management by 30% in the next year

No, I’m not parroting anything. I’m speaking from personal observation and wider public concerns that have been raised over the years. Just because a post questions management structures doesn’t mean it’s uninformed or malicious. It’s a valid discussion to have, especially when we all rely on the NHS and want it to be as effective as possible.

I have a friend who works in the NHS and her department is an actual joke. Some of the stories she tells about money wasted makes my blood boil. Meanwhile I have to buy my medication for a chronic illness online as NHS only prescribe the cheapest shittiest version of it.

Every organisation needs management. Services don’t run themselves. Systems don’t procure and upgrade themselves. Staffing, recruitment, training, compliance, regulation doesn’t sort itself. Estates and budgets don’t manage themselves. Performance management, comms, service design doesn’t sort itself.

Do you really think the NHS can run with just clinical practitioners? If so, then I’m going to take a stab and guess you’ve never been senior in an organisation to see what back office functions are required to ensure the day to day running of the business.

I’m not claiming to be an expert but from my experience as a patient, former employee, and through people I know working in the system, I’ve seen layers of admin, consultancy fees, and tech projects that don’t seem to improve frontline care. Add to that the frequent headlines about millions spent on failed systems or rebrands, it just makes you wonder. I’m not saying I have all the answers but it feels like there’s room for more scrutiny and transparency.

So I used to be a nurse I remember working on a ward that was refurbished at a cost of £1000000, only to close it down permanently less than 12 months later it had only been completely refurbished about five years prior to that,
I'm no accountant but it made no sense to me .

Over 20 years ago, I did financial consultancy work for the NHS, including a world infamous hospital.
My reports drew attention to waste, poor management of resources, allocation of contracts to , erm, undeserving companies, etc.

I was thanked, paid, & nothing happened.
I might still have those reports, maybe I'll re-submit them.

Can you elaborate? Is it primary (GP) or secondary (hospital/community) care? Where is the wastage?

Do private and charity firms not waste resource? Is every other industry and organisation out there the leanest and most efficient as possible? Do any other businesses have the same challenges as delivering healthcare to the whole population?!

The biggest wastage in the NHS is from patients - not taking care of their health in the first place, using the wrong type of healthcare (going to A&E instead of calling 111 for example), and DNA ing appointments! The public have a role in saving the NHS too.

Often though clinical staff get promoted and climb the management tree quickly with no real training in management.

I never said the NHS should run without management. I fully agree that support functions are essential to any complex system. My concern isn’t about the existence of management but about how it operates and whether resources are being used effectively. There’s a difference between necessary infrastructure and bloated, inefficient structures that don’t always serve frontline care. It’s fair to want more transparency and scrutiny, especially when so much public money is involved.

Looking at an actual study, the NHS doesn't spend a huge huge amount on admin compared to other countries

https://www.kingsfund.org.uk/insight-and-analysis/blogs/comparing-nhs-to-health-care-systems-other-countries

All managers start somewhere. Knowing a service and how it works clinically is often extremely advantageous.

Specialist units, eg HR, finance, will be qualified in their field. Service managers will, quite rightly, often be clinically based so they know what’s required legally, regulatory and practically.

What alternative are you suggesting? Management interns straight out of uni?

Or experienced managers from the private sector who will want bonuses and higher salaries than the NHS pays?

But you have no examples. You’re starting a thread without anything to back up your claims. How do you think that will make workers who do their best feel? Do NHS staff really deserve that?

Fine if you’re talking about a specific situation that you can evidence - but a general “how shit and inefficient are NHS management” isn’t helpful. You’ve added zero substance to your post.

I'd just be happy if they ditched all the identity politics, rainbow crossings, flags, banners and pins oh also ditching there stonewall/lgbt youth Scotland subscription fees etc.
Oh yeah if they could stop discriminating against women and then fighting an indefensible court case about it at our cost looking at you nhs fife.
From foi responses my health board (nhs fife) could save over £1 million per year if they just did that and then sacked the edi staff who can't even follow the law

Let's hope if the NHS does get more scrutiny that you, OP, are not part of it. It is ridiculous to assume the 'hard working' doctors and nurses are all innocent and the managers are all corrupt/terrible at their jobs. There's no reason to think that a nurse is any better/worse than an NHS manager or a hairdresser or a binman.

Your thinking that we should scrutinise the NHS management but not the medical/nursing staff is so incredibly biased, I can see why others think you have an agenda. More union bullshit is my best guess!

Good managers in the NHS are like gold dust, perhaps because they can earn more in the private sector? Thry dont seem to stay long in ourclocal Trust, or else they are constantly rotating around departments. Very senior management do make some very questionable financial decisions sometimes i must say. For example, they wanted the Doctors and nurses to work overtime to reduce the waiting list in dh's specialty, but didn't want to pay them overtime rates, so the staff said no. So the Trust contracted it out to a private company who charged them double what it would have cost to pay their own staff the overtime! 🤦‍♀️

I think you may be reading more into my post than intended. I never said all NHS management is “shit and inefficient” - my point was that some spending and decision-making within NHS management seems questionable from the outside and that greater transparency could be beneficial.

I did mention consultancy fees, layers of admin and headlines about failed tech systems - those are patterns that concern many people, including those inside the NHS. It’s not a personal attack on frontline staff or on the concept of management itself.

I get that it’s a sensitive topic, especially if you work in the system. But scrutiny and support aren’t mutually exclusive.

Thank you, this is exactly the kind of example I had in mind. It’s frustrating because the skills and commitment are there but the decisions from the top don’t always seem rooted in logic or sustainability. I get that it’s a complex system but things like what you’re describe really undermine morale and public trust.

THIS perfectly demonstrates the incredibly defensive and slightly unhinged response senior NHS staff seem to have at any suggestion that the NHS could be managed better. Listen, I manage large publicly funded projects. I’m very well aware that large operational endeavours need massive amounts of back office management.
Im also well aware how, in very large organisations, systems can become completely disjointed, roles can end up being legacy roles that no longer function in any meaningful way, communications can so be badly managed so that the left hand doesn’t even know the right hand exists… and there can be plenty of careerist senior people merrily furthering their careers with no regard for actual care or public service.
Visit an emergency department. Ask the doctors ( if you can find one) if senior managers ever even set foot in the department. I have.
So before you blame the public for their own illnesses maybe it would be prudent to even be open to the slightest possibility that the NHS could be run better.

I totally agree with you OP and I talk as someone who has extensive experience of working in the NHS

@SunnySideDeepDown

its a well known fact that the nhs has to many managers and to much duplication, hence the government getting rid of nhs England. Then we have duplication is care board level, so much so my area is going to be merged with others to stop that duplication, loads of managers not needed in there

Its not a case of not needing managers at all, it’s a case of streamlining those that are there that are not needed

The NHS has around a third the number of managers compared to the economy as a whole, and where there are more managers there are better outcomes. It categorically does not have too many managers.

Managers and management in the NHS - Research, University of York

Agreed I used to work for the mental health trust That featured on panorama a couple of years ago where an under cover reporter secretly filmed staff being abusive towards patients and behaving in very unprofessional ways , I never worked on that unit and it's a huge trust
When it all came out managers were horrified, but I bet they barely set foot in clinical areas prior to it all