Published: 16/09/2004, Volume II4, No. 5923 Page 16 17

Managers are the backbone of the health service, so preventing them becoming the whipping boys of the general election campaign is essential

The party conference season is a landmark occasion in the political calendar, and this year it has a special significance because of the general election expected within the next 12 months.

Already, this thought is enough to flash warning signs for most people working in the NHS. An election campaign means that political parties will be gearing themselves up to fight over the major issues of the day, and especially the NHS.

A general election usually means pledges to end the latest health service 'scandal', be it waiting lists, hospital cleanliness or NHS charges. One target that seems to have a constant presence in every political party's sights is waste and bureaucracy, which is then automatically equated to administration and management.

But perhaps this time NHS managers may not have to reach for their hard hats. The NHS Confederation has been working for some time to improve the profile and reputation of NHS managers, and we have seen some real results.

For example, the refrain that there are more managers than beds in the NHS - popular 18 months ago but never true - now seems to have died down.

Unfortunately, the emphasis has now shifted to an attack on all support and administrative staff, including managers - essentially the 16 per cent of NHS staff whose role is not to provide patient care directly.

When you look beyond the tabloid headlines attacking NHS support staff (my personal favourite is the Daily Mail's 'March of the NHS pen pushers' from April this year, although I do also rather like The Daily Mirror's 'You have been quango'd' from a month later) the statistics demonstrate a clear story. There are 199,880 NHS staff classified as working in infrastructure support, the category normally tarnished as 'bureaucrats'. Some 92,000 of these are employed in 'central functions' - the office support staff who run finances for the 600-plus NHS organisations, keep their computers operational, deal with human resources issues and carry out the legal work necessary in the modern NHS.

Also included are health education workers - the favourite targets for the 'silly jobs' brigade, but in reality public health workers reducing a future drain on NHS resources.

A further 72,000 people work in hotel, property and estates. These are the maintenance staff who keep NHS property operational - caretakers and gardeners, the catering staff who cook and serve for patients, and laundry workers, without whom hospitalacquired infection rates would really rocket.

The final group within this classification is NHS managers.

There are 35,300 managers working in the NHS - which works out at a little under 2.8 per cent of all NHS staff.

Needless to say, when the NHS Confederation commissioned a public poll earlier this year, we found that the general public really had very little idea about the number of managers in the NHS - over half thought that managers made up more than 20 per cent of the workforce.

Instead of comparing the number of managers and beds, a far more useful calculation would be to compare the number of NHS managers with the amount of money for which they are responsible. The NHS budget for 2003-04 was£61.3bn, so this means on average each manager is responsible for£1.74m.

Meanwhile, the proportion of the NHS budget spent on management has fallen over recent years, from 5 per cent in 1997-98 to 3.9 per cent in 2002-03. These statistics show that allegations of NHS investment being squandered on management costs are simply untrue.

Persuading some politicians and sceptical sections of the media that administrative, support and managerial NHS staff have an important role to play in the delivery of excellent patient care, even if they are not responsible for the delivery themselves, is sometimes an uphill struggle. This is why the NHS Confederation has come together with Unison at the Health Hotel to influence delegates to the Labour party conference, and we will be repeating our work at the other party conferences.

We have created a pack of case studies, introducing people to the 'bureaucrats' that are often criticised and explaining their role.With so much misinformation on this issue in the public domain, reducing the statistics and accusations to the most personal level is the way forward. Criticising a nameless and faceless bureaucrat is easy, but critics find it harder to question the contribution of Bedfordshire and Hertfordshire Ambulance and Paramedic Service trust chief executive Anne Walker, for example, or South Tyneside District Hospital patient appointment service clerk Helena Metcalfe, who were both featured in our case studies.

We will also be encouraging people to re-examine the wider debate on efficiency in the public sector. The Gershon and James reviews, on behalf of the government and Conservative Party respectively, are both committed to making the public sector more efficient and promoting best practice that can be applied in different sectors.

The results of the Department of Health review of its arm'slength bodies, announced in July, produced a sensible set of recommendations for streamlining the health sector.

But the challenge is to implement these reforms without harming patients - the very group such efficiency drives are designed to assist. Striving for efficiency itself is a worthy and worthwhile aim, with the potential for saving public money, but it does not follow that money spent on administrative and managerial costs is all wasted.

Reforms on the basis of efficiency must not take the approach of 'rationalisation-bynumbers' - cutting 10 per cent of the workforce, saving 20 per cent of the budget - but should instead examine how patients are best served. For example, I have some concerns about the decision to merge the National Patient Safety Agency with the National Clinical Assessment Authority, because I believe this will discourage clinicians from reporting errors for fear that they will then be investigated by the NCAA. In this instance, I am not convinced that any savings made through reduced administrative costs will necessarily improve standards of patient care.

In contrast, the Modernisation Agency has successfully modernised services and improved patient outcomes. So now is therefore the right time to change its remit and reduce the scale of its operations, saving money to be spent elsewhere.

This whole debate suggests there is a bitter divide between staff who care for patients and those who provide support services. In reality, we are all working together to create an effective, efficient, and caring NHS. By working together, we can create the best outcomes.

When the idea of setting up a Health Hotel at the party conferences first came to me, I did not imagine that such a large number of organisations covering such a broad range of health issues could be brought together in just one year, but we have been able to do this through close co-operation and our common aims. In the same way, when different sectors of NHS staff are allowed to work together, close co-operation and shared objectives allow us to deliver effective patient care.

In the NHS today we have some of the best clinicians in the world, dedicated to caring for their patients.Managers and support staff are the backbone of the service, and without their contribution patient care may suffer. Support staff may be the target of political attacks in the months to come, but the important thing is to make sure politicians understand that if we cut back on those who support NHS staff too severely, we risk paralysing the entire NHS.

Dr Gill Morgan is chief executive of the NHS Confederation.