NHS is undermanaged not overmanaged, finds major report
A major study has called for the government to “rethink” cuts to administration and management after finding no substantive evidence that the NHS is over-managed.
The report by the King’s Fund Commission on Leadership and Management in the NHS found the health service in England was “over administered” but not over managed, despite claims to the contrary.
It concluded: “There is no substantive evidence that the NHS is over-managed. There is appreciable evidence…that it is under-managed – even if some of that management may not always be highly effective and is centred on the wrong things.”
The 2010 NHS white paper announced 45 per cent cuts to management to tackle “excessive bureaucracy, inefficiency and duplication” and a document accompanying the Health and Social Care Bill set out a “one third real reduction in administrative spending by 2014-15”.
The commission called the targets “simply arbitrary” and said ministers and the DH should “re-think” the cuts.
It said the result of creating new bodies, such as consortia and health and wellbeing boards, “is likely to be an increase in management and administrative posts, not a reduction, and not necessarily an improvement in either management or leadership.”
Commission chair and King’s Fund chief executive Chris Ham told HSJ the NHS may not be able to “keep control” of its finances if it loses too many managers.
He said: “There has already been a loss of experienced leaders… that is to be regretted if we don’t now have in place people who have been in the NHS before when finance was tight.”
He added: “If the government wants to cut back on management costs it has to look at how those costs arise in the first place.”
The commission found the rise in the number of managers in the health service in England since 1997 was not matched in the rest of the UK. It said much of the administrative burden was due to “targets and terror” and demands from government.
Waiting time targets, patient and staff surveys, data transparency and patient choice as well as private sector involvement and increased regulation had all been more prevalent in England, the commission said. “All that requires much administration and some management,” it said.
The policy of replacing single waiting time targets with multiple performance measures “can only add to the NHS administrative and possibly management costs”, the report said.
Some money could be saved through sharing back office functions, but the policy was “more likely to lead to financial failure than an improvement in patient care”.