I am one of those people who says “I told you so”. The NHS Commissioning board has identified that it is struggling to find suitable people to fill its senior vacancies and there is a risk of posts remaining vacant.

The NHS reforms have so far cut 18,000 senior posts. The determination to reduce the management headcount, the uncertainty about future posts and structure, the macho management way in which existing posts and structure are being discarded, and a belief not discouraged by high-ups that future redundancy and early retirement packages will not be so generous has led to a stampede for the exit.

It has been the older senior managers who have gone, these are also the ones with most experience and while not always in tune with the agenda they have knowledge and skills that cannot easily be replaced.

This was entirely predictable. HR Directors across the NHS will and  have identified this risk, mangers will have warned against it and unions foretold it.

Unfortunately this is typical of how a politically driven change is forced through. It is the big bang approach, because that’s the best way to deal with resistance. This is a familiar and costly pattern in the NHS. The previous big restructurings in the NHS – the introduction of PCTs and the restructuring to fewer bigger PCTs – saw huge amounts spent on redundancy and early retirement packages for directors and chief executives.

These costs were hidden in what was claimed to be efficiency savings. Well they would have made savings eventually if they didn’t keep being overtaken by another restructuring!