Today the government’s spending review will be announced and the implications for the NHS will start to become clear.

Whatever the detail, two things will remain unchanged; the scale of the financial challenge facing the service and the potential lack of management capacity to deal with it. The grimness and immediacy of the upcoming financial crunch is set out by Professor Nick Bosanquet.

He suggests that the NHS’s financial chickens may come home to roost roughly one year from now. Even if he is a little out on the timing, the reasons he identifies for the crunch make it a case of if, not when, the crisis will arise.

According to Professor Bosanquet the last time the NHS faced such a challenge was in 1987. He does not draw the link, but it is a fact that one significant change since that time was the widespread introduction of general management into the NHS.

Now we are supposedly entering the post-general management age, when numbers and responsibilities will reduce.

But are we all in danger of accepting this “wisdom” at face value and arguing the toss over tactics rather than strategy? Could it be that, ironically, as managers become threatened their value might begin to be understood and appreciated more widely - as, for example, recent statements by the British Medical Association have suggested.

Work by PA Consulting analysed management costs at US charities - which are required by law to report them. These costs typically ranged from 4-8 per cent.

PA’s work was cleverly extrapolated by Steven Toft, a director at the Crucible Consultancy. He makes the salient point that charities are under even greater pressure than public sector organisations to keep costs low. Despite that, UK charities spend 5-13 per cent of expenditure on management costs.

And NHS management spend? Well, however you slice it, the figure does not get much higher than 3 per cent.

This fact should give all interested in saving the NHS from the fate described by Professor Bosanquet pause for thought. A pause in which they might ask themselves the question: “Is the NHS under-, not overmanaged?”

An action plan for busting NHS deficits