Lansley’s defence of management cuts is disingenuous and dangerous

14 July 2011 | By Alastair McLellan

“I try to avoid saying things that are capable of misinterpretation,” Andrew Lansley told HSJ last week.

Readers will judge for themselves whether the health secretary has been successful in achieving that goal during his first year in office.

Politicians are rarely unhappy when talk of “too much bureaucracy” is translated into “too many managers”

Mr Lansley was talking about hospital reconfiguration - but he made much the same point when pressed during his NHS Confederation conference speech on why he had not spoken up more for NHS managers.

As soon as the question was asked, the health secretary adopted his now familiar tone of barely restrained frustration: hadn’t he always attacked “bureaucracy” and not “managers”? Hadn’t he always praised the importance of good “management”?

He was not responsible “for what the Daily Mail writes”.

This is disingenuous rubbish. Mr Lansley - in common with many politicians - is rarely unhappy when talk of “too much bureaucracy” is translated into “too many managers”. Praise for those in management roles is saved for speeches aimed at NHS leadership which are unlikely to get wider coverage elsewhere.

But the language on management resource is changing.

Mr Lansley has begun to use the term “over-administered” as opposed to “over-managed”. This is surely a nod to the seminal King’s Fund report on NHS leadership which made exactly the same distinction.

It also links into a developing theme. Mr Lansley’s office was very keen to stress to HSJ that any criticism of “over-management” applied only to the non-provider sector. The implication is that many of those working in national and commissioning roles are bureaucrats who add little value.

That point of view was challenged directly by NHS Confederation chief executive Mike Farrar, who spoke of both the “dangerously low” levels of management in the service now and the future management cost limit.

Mr Lansley dismissed the idea that this would have any impact on patients.

But HSJ understands that it was not the first time Mr Lansley had heard such a view last week. In a private meeting, Royal College of GPs chair Clare Gerada told the health secretary that patients’ lives were at risk as a result of the way in which the reforms were being implemented.

Mr Farrar called for an end to “crude” targets for management numbers. Mr Lansley speaks of imposing a “discipline” on management costs and reminds the NHS it is getting off lightly when compared with other public services.

So far, so depressing. But discussion at the NHS Confederation conference revealed a rapidly strengthening policy trend - and its clash with Mr Lansley’s plans could make things even worse. Competing with the heath secretary’s desire for “liberation” and “choice”, is a growing determination that the reforms must not be accused of undermining the “national” nature of the NHS or weaken performance in high profile areas such as waiting times. These concerns are lining up alongside the growing importance of keeping a grip on finances as the key drivers in this government’s stewardship of the NHS.

To hold the line on service provision, waiting times and financial performance at a time when primary care trusts and strategic health authorities are being eviscerated will mean only one thing - increased central control. Given that control will be delivered by a “centre” undergoing its own cutbacks, it will often be pretty blunt.

Mr Lansley has declared it is now time to press on with the reforms. By insisting on maintaining the blanket management cost reductions in the non-provider sector he is making another rod for his own back. HSJ predicts that pressure from elsewhere in the government, as well as the growing complexity of the reforms, will see yet another (disguised) U-turn - although, sadly, not before some of the fears expressed by Mr Farrar and Dr Gerada are realised.

Readers' comments (14)

Anonymous | 14-Jul-2011 3:02 pm
In the non-provider sector, AL could reduce the number of "managers" by 70% or more and things would become considerably more efficient, not less.
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Anonymous | 14-Jul-2011 3:08 pm
Ah, Anon 3.02. How utterly refreshing to stay unsubstantiated and indefensible sweeping generalisations return to these pages. Welcome back; it must be hard to find a mouthpiece for unmitigated stuff and nonsense during this brief week or two when the tabloids are behaving themselves for a while.

Oh, and by the way, if you've got a robust peer-reviewed piece of research that backs your staement up, love to have the link on here.
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Anonymous | 14-Jul-2011 4:43 pm
All very well talking about bureaucrats in national and commissioning roles who add no value, but you don't get away that easily Mr Lansley. These individuals didn't just walk in off the street and begin working off their own backs in the corridors of Richmond House, because they fancied it. These roles were obviously felt necessary (at least by somebody). The problem appears to be this insatiable appetite which the DoH has for creating more and more initiatives, many of which overlap and most of which add little or no value to anybody. This coupled with the unremitting desire to know everything going on, about everything and controlling everything and therefore requesting report after report, paper after paper, meaningless statistics which gather dust all result in operational managers and staff drowning under an ocean of bureaucracy. This is exascerbated by the constant need to report more and more up the chain, because although they speak local autonomy they really mean central control - enter the high admin costs. But most worryingly in all of this manager-bashing is the depressingly familiar tone of a man who only sees managers/bureaucrats/administrators as 'thing's with no feelings or worth. Many have given years of sterling public service and are committed to the ethos of public duty. They deserve better.
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Anonymous | 14-Jul-2011 4:54 pm
"Have you got a peer-reviewed piece of research to back that up?"

This is a questioned asked by non-provider sector managers day in day out and applied to virtually every proposed change made starting with an adjustment to their paper-clip quota. Its the question they ask before moving on to the paper-clip equality assessment and privacy review.

Basic arithmetic tells you that if you cut down on the number of people asking these questions when they are not appropriate, the more efficient you will become...

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Anonymous | 15-Jul-2011 7:37 am
No more to add, I think the HSJ Editor has said it all.
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Patrick Newman | 15-Jul-2011 10:28 am
Too many anons - gets confusing. I suggest the use of 'noms de clavier' so we can easily address the correct contribution. I agree with anon 4.43 - health policy makers heal thyself. I wonder if Mr Lansley considers whether Mr Nicholson is an administrator or a manager. He is certainly not a provider. He could dispense with him and invite him back under the Big Society initiative to do his job on a voluntary basis. The superficiality of the let's cull managers argument is reflected in the attack on the Back Office staff whose purpose is to enable large organisations to function more efficiently. Achieving productivity gains will be hindered by the perpetual resort to clichés and generalisations about different groups of staff serving throughout the NHS.
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Editor's reply
Some users may want to change their user name and first name/surname to a pseudonym on the page below - then there's no need to post anonymously and things might be a bit less confusing.

http://www.hsj.co.uk/my-account/account-settings/
Anonymous | 15-Jul-2011 1:40 pm
"These individuals didn't just walk in off the street and begin working off their own backs in the corridors of Richmond House, because they fancied it. These roles were obviously felt necessary (at least by somebody). The problem appears to be this insatiable appetite which the DoH has for creating more and more initiatives, many of which overlap and most of which add little or no value to anybody."

This is exactly right but it does not mean AL is wrong to slash the number of managers - quite the reverse. The "somebodies" who are forever creating new and overlapping initiatives staffed by new managers are the managers themselves. The more of them you have, the more initiatives are produced and the more the terrible thing grows...

Slash back the number of managers and you at least slow things up for a while.... its a bit like clearing a country path of brambles

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Anonymous | 15-Jul-2011 1:45 pm
Patrick, as anon 4.43 I take your point about 'noms de clavier' and will attempt to achieve this (if I can work out how to do it!) By the way brilliant post - spot on.
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Anonymous | 15-Jul-2011 2:09 pm
What a bore it is to read the ongoing vitriol which pours forth on these pages from Managers intent on having a petty little pop at counterparts across the great Commissioner / Provider divide. Interesting that you've nothing better to do. According tothe King's Fund, which is surely the most reliable source of information on the subject, there is no evidence the NHS is overmanaged and the opposite is probably true based on peer comparison with other equivalent systems. So why not get a life and make constructive contributions or just stick to Facebook.
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Martin Rathfelder | 16-Jul-2011 1:53 pm
I will believe that the NHS has been liberated when people who work for the NHS are prepared to post under their own names.
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SandsofTime | 17-Jul-2011 1:47 pm
Unfotunately we are not allowed to publish under our own names because of the bullying culture, FOI, Data Protection, Human Rights, Health and Safety, and the risk of phone tapping
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SandsofTime | 17-Jul-2011 1:49 pm
Surely the point of slashing all these managers would be to speed things up. And if you clear the brambles doesn't that give a breathing space for Japanese Knotweed
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Anonymous | 18-Jul-2011 2:03 pm
Good point about the Japanese Knotweed, as tangling as brambles if not more so.... trick is to slash it all back initially and then repeat every one every six months...
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Dr Paul Worthington | 19-Jul-2011 3:37 pm
Anon 14 july 4.54; if you checkout anon 15 july 2.09 and their comment about the excellent Kings Fund report - that's precisely the point to be made about published evidence. Let's not guess at solutions or react with a kneejerk; let's look at what we can learn from robust and well-executed analysis and evaluation and do something about it.

And forget about Japanese Knotweed; I want to know what I can do to the layers of slugs savaging my lettuces
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