There have been difficulties scaling up the NHS response to the virus outbreak. The NHS is a vast institution with a huge budget and many staff. It rightly needs some well paid managers to run it and deliver on the general tasks set for it by government.
In England we have NHS England and Public Health England at the top. I have written recently about the senior management of Public Health England. NHS England is run by seven executive directors on salaries of around £200,000. In 2018-19 NHS England made 31 people redundant in the band £100,000 to £150,000 and made 29 redundant in the band £150,000 to £200,000. This implies it was not short of management. It had 24,000 employees to manage and direct its £114 billion budget.
It would be good to hear more from them about how they prepared with Public Health England for the kind of emergency we now are living through, and to learn more of how they organise their supply chains to scale up deliveries of PPE and medical equipment when needs demand.
There is also considerable management skill in the operating parts of the NHS at local level. Each area has a Clinical Commissioning Group with senior management to acquire and provide health services locally. A local District General hospital is organised as a Trust with a team of Executive Directors, as are the Mental Health and Community services through a separate Trust.
So the NHS has senior CEOs, Finance Directors, Medical Directors, Nursing Directors, Strategy and Operations Directors at the England level, and at the local level by main activity. The issue today is how they work together to ensure the smooth delivery of crucial supplies to hospitals, surgeries and care homes, and where ultimate management responsibility lies in each case. We need well paid high quality management, but we do not need excessive overlap or too many advisory rather than truly executive posts.
Given the numbers and the pay levels of these managers shouldn’t we expect them to take some responsibility for delivery on PPE, equipment and capacity planning.