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Enough political point-scoring: management is crucial to the NHS

1 June 2006

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Elaine Guy
AMSPAR Vice President

“This has been the best year ever for the NHS,” according to Patricia Hewitt. Not everyone has agreed with this statement, made when the secretary of state apparently had flu. She received a very “warm” welcome from members of the Royal College of Nursing – so warm that she had to abandon her speech. Three days later at the Unison conference, Ms Hewitt was heckled. Uppermost in the minds of those who did not agree with her bold statement was the threat of job cuts to help reduce the staggering NHS deficit.

Andrew Lansley, the Conservative party’s spokesman on health matters, must have thought the birthday of his life had arrived when all this was going on. Never mind the NHS having a good year: it’s clear that 2006 has been a good year for Mr Lansley – so far.

Mr Lansley often has something sensible to say about the NHS, but recently he has been chasing media headlines by criticising NHS managers. For example, “With 100,000 more administrators in the NHS than in 1997, it is no wonder that NHS finances are out of control.” In the same period, the NHS has employed an additional 300,000 staff. Are one-third of them really in management grades?  Interestingly, official NHS figures show that there are just 39,391 managers in the NHS – surely not an excessive number for the largest employer in Europe, an organisation employing more than one million people.

The need for management
In any organisation, managers are an essential part of the workforce, perhaps even more so in the NHS. Effective managers take care of the business, administrative and financial procedures, ensuring that doctors, nurses and other allied health professionals have the time they need to do what they are best at – caring for patients. Mr Lansley can’t really believe that, in addition to that function, clinicians can run the whole of the NHS?

Managers take care of recruitment and training of support staff; they supervise patients’ services and, very importantly, ensure that bills and salaries are paid. Obviously, this is only a small part of what they do, as those of you working in general practice will be very well aware. You have to deal with all of these things, often singlehandedly, unless you are lucky enough to have a deputy. You deal with the bank, accountants, roofers, builders, cleaners, PCTs, strategic health authorities, hospital trusts, staff and patients – plus many more – as part of your everyday work. How many MPs or, indeed, non-NHS managers have such a diverse workload?

Careless cost-counting
According to Mr Lansley, the cost of NHS managers has risen by £578m in the last two years. He seems to believe that this huge sum would allow the NHS to employ 27,000 more nurses or 8,000 more doctors. Would it? I don’t think so. Even if it did, does Mr Lansley believe that these doctors and nurses would recruit themselves, train themselves, do their own administration and pay themselves?

Figures from the NHS show that the average salary for an NHS manager is £38,200. How much does Mr Lansley earn? The basic salary for an MP is £59,095; on top of this they have a staff allowance of up to £84,081. They also qualify for “incidental expenses” (whatever they are) of £19,325. Note that the average salary for an NHS administrator is £16,000. The average cost of running one MP works out at something like £200,000 pa. Wouldn’t the NHS be able to recruit more clinicians if there were fewer MPs? I don’t suppose there is any chance of that, though; after all, MPs are essential, aren’t they?

Vital role
Mr Lansley might like to know that, as with any large business, managers and administrators are essential to the effective running of the NHS. The plain fact is that the changes already made to the NHS and those planned for the future actually mean that it is undermanaged.

That’s not just my view. The chief executive of the NHS Confederation, Dame Gill Morgan, said: “The private sector, on average, has much higher levels of managerial staff. The NHS deals with over one million patients a day. That level of complexity takes a lot of managing, so that doctors and nurses can get on with their job.”

Managing that complexity means being well trained – something AMSPAR knows only too well. We tailor our Diploma in Primary Care Management, and all our training and development programmes, to meet the needs of GPs and the teams that run their surgeries.
My advice to all politicians, and I’m sure that of NHS managers both in primary and secondary care, would be to concentrate on the real issues, and stop making easy targets of the hardworking professionals who actually make the NHS work.

(Association of Medical Secretaries, Practice Managers, Administrators and Receptionists)
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