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?

Classic example of waste in The Times today. The trust already at the centre of a legal case over a trans women allowed to use single sex changing has sent a Pride calendar to staff.

To summarise- “The 36 page document Pride Month 2025, begins with a graphic in which each day in June is dedicated to celebrating an LGBT theme….. The calendar is understood to have been produced by the Trust’s LGBT network “

How much did this cost out of the NHS budget? Surely money which would be better spent on actual patient care!

That's a really good study, thanks for sharing

Maybe it need more competent managers?

Every line of spending is scrutinised- even down the cost of the an evening district nurse having to have a work phone so she isn’t so vulnerable working at night! So is every mile driven if you work in the community!

Every post and role is reviewed to make sure it’s adding value. Have you not seen the news - thousands of staff will be made redundant - clinical staff and admin. There are no jobs for those qualifying in the next 6 months. Some trusts are losing 600 plus staff!!

As a nurse and a manager cost savings/ efficiencies/ productivity- it’s what I spend most of my time doing - instead of patient related stuff.

Without managers to take on the nonsense we have to do for NHSE, DH, the ICBs etc I would be doing more and more admin, audits, finance and data reviews than I am. When I should be with the patients and my colleagues.

There is plenty of scrutiny- look at annual reports, the quality account, cqc inspections, ofsted inspections, section 11 reviews, board papers, sub board papers, icb board papers, safeguarding reviews/ inspections, internal audit outcomes, nhse inspections and interventions, staff survey outcomes, external
audit, financial statements, FOI requests etc… how much more scrutiny do you want???

I couldn’t give specifics as it would be incredibly outing as she’s been working in a particular community working on a specific issue using new technology so all of that
combined would tell anyone exactly who she is! But suffice to say most of her days seem to revolve around meetings discussing next steps in “an approach” eg “eat less, move more” (not that, but along those lines) without any actual action from the 15 people tasked with rolling out this “approach” in her community.

They will talk about it, make spreadsheets about it, discuss all the potential benefits of people eating less and moving more, invite stakeholders to presentations about it, look at ways to embrace new technology as part of this approach. Then the project comes to an end, all these consultants are let go as their temporary contracts end and the ‘work’ they did for 2 years doesn’t amount to anything.

She went in with high hopes that she could make a real difference in a rural community and came out jaded as fuck that this is what her taxes have been paying for! She was actually criticised for not being a team player as she wanted to actually DO something not just talk about it endlessly. At least she got well paid while doing it though.

That’s a good example of where priorities can seem a bit off, especially when frontline services are under pressure. I absolutely support inclusion and belonging in the workplace but when resources are tight, there needs to be a serious conversation about cost-benefit and how decisions are made. Transparency and accountability are key.

I agree that clinical managers like yourself are often doing the impossible under huge pressure. My post wasn’t meant as a blanket dismissal of NHS management. It’s more of a reflection of how, from the outside, some high-level spending decisions or structural inefficiencies don’t seem to translate into better care.

I’m aware that scrutiny exists in many forms but perhaps that’s part of the issue. There’s so much internal reporting, paperwork, and bureaucracy that it sometimes feels like the system is tangled in itself. I wonder whether some of that scrutiny is ticking boxes rather than driving change. I genuinely don’t mean this as an attack on those doing the hard work - just an invitation to reflect on how the wider system operates and how it might better support the people (like you) who keep it going.

But you aren’t offering scrutiny. So far you’re just making vague assertions.

Those of us working in the NHS are well aware of it’s shortcomings, and most of us agree that it requires improvement, but the root cause isn’t poor middle managers.

I’m unsure why you are getting so much backlash for asking this question! I am a nurse and my answer to your question is YES! Someone hit the nail on the head above - the management within the NHS isn’t great. If you’re great at your job and genuinely want to make a difference you are stopped by red tape, therefore you cut and run to a better/better paid job in the private sector. On top of this they can’t sack anyone, it is almost impossible to get sacked by the NHS so useless managers just remain and others pick up the slack for them (and I am absolutely talking from experience here). There are also far too many senior managers all doing the same job, but again, they can’t get sacked so instead of getting rid of them they cut frontline staff! It’s shocking and absolutely needs investigated and a complete reshuffle but it won’t happen as government/seniors will need to admit failings and would likely to be worried about what would be found under them. Don’t get me wrong, of course we need management, but there are far to many useless jobs within the NHS and the public sector in general tbh.

DH has worked with, not for, the NHS for 30 years. He is an IT/Managing Consultant. The stories I could tell you.

But, be aware, some trusts are run efficiently and well run by competent managers, they are receptive to new ideas and change, they pilot schemes, they have good outcomes, they are run for the benefit if their patients.

Other trusts are the complete opposite.

DH can name the worst trusts and the worst managers across the country. They consistently move around via revolving doors. Often being paid off to leave, only to pop up somewhere else 6 months later.

The NHS doesn't employ good independent managers. They employ NHS people, who often don't have a grasp of what efficiency looks like. They know no other way, and are resistant to change. Those trusts tend to be run for the benefit of themselves, not the patients.

Wow, what a rude response. Do you work for the NHS? Is that the reason why you are coming across as so shitty towards the OP? Reading some of the responses to this thread it appears the OPs concerns are very valid.

Don’t forget the rainbow crossings in the carpark. 20 trust spent over £46k on this alone. More waste that could have gone on front line services.

I fully agree about waste and poor management. My OH has had incurable but treatable cancer for nearly a decade. He has first hand experience of many tens of thousands of pounds (maybe hundreds of thousands) of wasted drugs, wasted tests etc. Not front line staff fault but cock ups in administration and management, i.e. wasted appointments, expensive unused drugs, bags of expensive chemotherapy drugs thrown in the bin, etc. No one in the NHS seems to care.

One example, one of his drugs costs £3k per tablet (he is prescribed 3 per month, once weekly). Cost as per NHS website, so yes, it will "cost" the NHS less, but will still be a huge cost, not just a few pounds a time. He only takes 2 tablets per month as agreed with the oncologist, but apparently it's "too hard" to change the prescription to 2 per month instead of 3, so every month, he gets an extra tablet. He has no control over the prescription as it's ordered and dispensed by the oncology dept (not like a GP where you can tick boxes) so he has no control over when to order nor how many to order. He gets 3 every month whether he needs them or not. Now got quite a stack on them in his cupboard!

That's not the only one either. Another expensive chemo tablet is £300 per the NHS website and he gets prescribed 21 per month (3 weeks on, 1 week off). But again, as agreed with oncologist, he had them every other day, not every day, so only needs 10 or 11, so that's another 10 wasted every month.

Then tests. When first diagnosed he had a suite of tests, i.e. skeletal x-ray, full body MRI, CT scan, bone marrow sample, and full (literally full) suite of blood tests (literally every test possible!). After the first diagnosis was confirmed by our local oncology dept, he was referred to the next country for their "big" hospital oncologist to review, and first thing he did was order it all again as the referral letter hadn't included any test results. So, everything done a second time! Then, because covid delayed his infusions (they cancelled in the first week of lockdown and forgot to tell him when to start again), he'd gone too long without any monitoring or infusions, so they had to do the full suite of tests a third time as they couldn't re-start without ticking their boxes!

That's not to mention things like MRI scans where his oncologist has on record he's allergic to the dye/marker so should be referring him for non-marker MRI scans, but several times he's got to the MRI scanner and they're instructions were to do a marker/dye scan, which OH rightly refused, so wasted appointment and referral back to oncologist to re-refer the scan without marker. Another time, he was due for a neck MRI scan, but it went through referral for a lower back MRI scan, so again, waste of an appointment.

There's just so much sheer incompetence. You don't see it if you don't have much ongoing treatments, but for those who do, it's a regular issue.

@HostaCentral

The NHS doesn't employ good independent managers. They employ NHS people, who often don't have a grasp of what efficiency looks like. They know no other way, and are resistant to change. Those trusts tend to be run for the benefit of themselves, not the patients.

Nail on the head. Definitely run for the benefit of some staff and statistics, rather than for the benefit of the workers.

That old "Yes Minister" episode of the new hospital ward that was highly efficient is so true - i.e. it was efficient and "ticked the boxes" because it had no patients!

DH life was saved by a major London teaching hospital ten years ago. He gets on especially well with his lead surgeon, he sees him twice a year and sometimes has ‘a friendly chat’ over the phone .

He tells me this surgeon and his team are in despair over the new administrative difficulties caused by the new IT system, to the extent the surgeon is considering early retirement. As he and the patients say ‘ what was wrong with the old system? It seemed to work perfectly well, much better than the new one which results in Appointments booked wrongly, confirmed for different times for the same appointment, confirmed three times by letters when it has been agreed by email and response…….’

Will that do @randomchap ?

The entire government and everything it touches is designed to waste money.
They've spent half a million quid changing the dot on the logo for the gov.uk website

BlackBelt Barrister (Daniel ShenSmith) explains more
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Hard agree OP. Too many management consultant types earning a small fortune by telling clinical staff how to be more productive and cost effective. These people are parasites.

Husband is a senior consultant in major teaching hospital and despairs at how huge amounts of money are squandered on projects that aren’t patient centred.

well, turning heating off in June? having cold water in toilets for start?

NHS desperately needs shit hot private sector managers who can review and rearrange processes. These people would be paid top rates but they'd save tons of money. Including on useless admin

ETA - not external consultancies, but people who actually understand how process should be run. And yes, heavy investment in IT

An example from the hard-hat estates POV. Our little company looks after the heating and hot water plant for five or six city-county hospitals and one London teaching hospital.

Every single one, even within the same NHS Trust, has a unique qualification process and bid process. This is just plumbing (on an industrial scale though). Surely, if a company is approved as qualified in one hospital, then you might think it would be logical that it's qualified to work on others without re-doing the paperwork. Just add approved companies to a central or even regional NHS-approved register and ask for x number of bids against an agreed job spec and deadline. The pricing is more likely to be competitive, and fewer delays, because it's easy to see which companies are in the next ring of geographic range. But no, they re-invent the wheel every single time. It's bureaucratic profligacy.

Who is saying doctors and nurses are innocent? And innocent from what? Do you have evidence to say they are not? What are they have suppose to have done? When you say a nurse is any better/worse what do you mean? Morally worse/better? More clever ? What are your reasons for wanting to scrutinise medical staff?

I'm still mystified by what at least half of those (often permanent) 8cs and above recruited during COVID actually do these days.

I'd also like to know exactly where the money that the government, via NHS England, gives to teaching hospitals actually goes as in the last two Trusts I've worked at it's been a bit opaque to say the least. You are talking millions, not insubstantial amounts. Someone really needs to investigate.

And I still don't understand why more functions (accounting, recruitment, HR, training, several others) haven't been merged across local Trusts yet.

Then there's the bringing in managers from outside whose incompetence and lack of knowledge are eye watering.

And meanwhile ward clerks, domestics, health care assistants, porters, catering staff, are on a pittance.

Our society is completely wrong.

But these are legal issues - it’s a classic case of ‘you’re damned if you do, you’re damned if you don’t’. Trusts can be sued for discrimination. They are also required to do certain work by their contracts. I’m sure the management would also much rather be doing the bread and butter clinical work but it’s not that simple.

But if one supplier does something wrong, or their work is dangerous - it then becomes a national problem, no?

There is value in having diversity in contracts and suppliers.

No competition = increased costs. If one firm has the whole NHS, the NHS then find themselves having no equivalent large enough firm to compete and drive down prices in future bids. Not to mention that it will exclude using local businesses.

I have a close friend working for an NHS trust that's in special measures.
The management still went on a 2 day (overnight) 5 star spa hotel for their away day. (WTF?)

My local hospital has the heating.on full blast and all the windows open, whatever time.of year you go. Makes no sense.

Every single time there is a care quality scandal it says it's going to "learn lessons", till the next one rolls around.

The bullying culture is well documented, including making medics who raise care quality concerns, sign non-disclosure agreements, then they're blacklisted. Despite every single NHS document claiming to welcome feedback and every expert saying that whistleblowers must be protected.

So yes, I think there are many issues with NHS management.

What do you suggest ?