Published:25/04/2002, Volume II2, No. 5802, Page 4 5

The role, influence and numbers of NHS managers is left unclear by Delivering the NHS Plan, the document issued by the Department of Health in the wake of last week's cash-soaked Budget.

The 44-page document makes no mention of 'managers', despite promising thousands of extra doctors, nurses and scientific staff.

The five mentions of management are overwhelmingly in the context of franchising for failing trusts.

As well as 50,000 more clinical staff, Delivering the NHS Plan says the huge increase in funding announced by chancellor Gordon Brown will provide 40 new hospitals and 500 primary care centres over the next five years.

Institute of Healthcare Management chief executive Stuart Marples said: 'New buildings, developing new ways of working and extra staff to be recruited and managed implies some investment in management.'

He suggested that 3 per cent of the new NHS money would go on management, the same proportion as now. This would mean a total£2.2bn spend in 2003-04 on management, up£201m in 2002-03.

'I would always argue 3 per cent is low by comparison with other complex organisations, ' he added.

NHS Confederation policy director Nigel Edwards said: 'We have been told management costs will fall as a proportion of total NHS expenditure. But there seems to be an awful lot to be done. The NHS appears to be under-managed, not over-managed.

'We need to get away from seeing management as a cost. High-quality management makes a difference. It needs to be better planned.

That is not really understood by the people making policy.'

Manchester University reader in public management Dr Kieran Walshe said: 'We have a huge focus now on workforce planning, with great emphasis on future needs for doctors and nurses.We are not doing that for managers.'

But Imperial College London professor of health policy Nick Bosanquet emphasised the political 'sensitivity' of manager numbers. 'We need some more managers in primary care trusts but we should be concentrating on improvements in IT and support structures. There can't be a net increase [across the NHS].'

NHS manager numbers have risen sharply over the past five years, with a 22.6 per cent increase - 4,840 whole-time equivalents - between 1997 and September 2001.

David Hunter, professor of health policy and management at Durham Univeristy, thought the government might 'buy in wholesale management and staff from the private sector': 'Management capacity is going to come through that route rather than traditional training. The other route will be including management in the careers of doctors and nurses.'And he predicted: 'We could be beginning to see the demise of the general manager in terms of lay managers - and increasing doctors and nurses.'

A Department of Health spokesperson said it would 'aim to have the right number of managers working in the NHS to ensure that the extra NHS investment is used wisely' and would balance that with a need to 'minimise extra bureaucracy'.

www. doh. gov. uk www. hm-treasury. gov. uk