It happened in the late 1990s: someone realised the NHS needed investment and new staff. They looked around, assessed the situation and with a forceful thump on a large table they shouted, “Fetch me more managers! Lots of them. To hell with the cost!”
And so managers were fetched and they came in various shapes and sizes. And some were helpful. And others worked in the communications office and nobody really knew what the point of them was.
Time passed and we looked around to find there were 45,000 managers in the NHS - a remarkable 12 per cent rise from 2009, an astonishing 84 per cent rise since 1999. There has meanwhile been a 5.8 per cent rise in consultants in the last year. If the number of managers continues to rise at this rate, they will be ready to march on London by 2028. Well, not march obviously, but certainly send a very stern memo.
‘The number of managers we have is not the problem. What many of them were employed to do is the problem: run a marketplace rather than a health system’
But in these times of austerity those numbers won’t rise will they? Because according to the BBC, the Department of Health intends to make cuts of £4.35bn over the next two years. And who is preparing these cuts? The managers.
To be fair we know that the NHS needs managers. And we know that there are some excellent managers of services, professions and trusts. But there is also often a sense of ever increasing separation between some managers and clinicians - a separation not demonstrated by their different skills or even their pay but by what they see as the object of their labour.
Now we know that in the coming months lots of people are going to feel their services are vulnerable to cuts. NHS managers might take up a lot of stationery but amount to only 3.5 per cent of a workforce of 1.43 million people. And according to the DH, the health service will reduce management costs by 30 per cent by 2013.
So managers are vulnerable too and, sarcasm aside, that matters because we don’t enjoy seeing people made vulnerable by circumstances. And the repercussions of both the rapid growth in management and the impending cuts can only cause problems for clinicians can’t they?
We have quickly grown roles that may or may not have proved helpful. We have too many organisations, too many departments, too much bureaucracy. But in making cuts politicians are unlikely to abandon the internal market system. We will still have purchasers and providers and competing trusts and too many separate organisations - those in charge of making cuts will seek to protect the systems they have built and simply spread the administrative load more thinly.
Clinicians won’t benefit from that. The number of managers we have is not the problem. What many of them were employed to do is the problem: run a marketplace rather than a healthcare system. It is tiers of administration we need to target rather than jobs and, in doing so, we might just create a unity of focus and purpose that not only will make the NHS more cost and labour effective, but also begins to build a culture that is more conducive to patient centred care.