Article for Conservative Home on NHS management

There are 36,000 managers in the NHS. They should be asking themselves why the patients are unhappy, struggling to get a GP appointment, and why so many of their staff are unhappy, with thousands on strike. The well paid Chief Executives and senior managers have been largely invisible to the public over the strikes. They have in their rare interviews told us the disputes are between Ministers and Unions. They claim to be neutral.It is difficult to see how managers can be neutral. They hire and fire the staff. They promote some and not others. They grade the jobs, they award increments and decide how many people to employ. They have big powers over huge budgets.They can make an employee’s life better if they handle staff well.I and others have been urging the NHS to publish a manpower plan. The  Opposition has taken up the cry.  The NHS needs to reassure patients there will be enough staff to look after them, and reassure staff there will be enough colleagues for the workload. I find it bizarre that they do not have a public plan already and that it has taken so long to prepare one. The main NHS cost is staff.The NHS top managers also need to tell taxpayers they want to look after them as well. Productivity has been falling in the last three years when record extra sums have been put into NHS budgets. Managers spent a lot of money on Nightingale hospitals which were then little used and closed down whilst non covid waiting lists soared. They spent a lot on taking over private health capacity during the pandemic yet underused the facilities there. Test and trace costs went very high, with limited positive results. Now the pandemic has subsided clearing the backlogs has been impeded by poor labour relations.If the senior managers thought the pay review bodies decisions on pay were wrong they should have pressed for an early additional cost of living supplement or override. If they thought the system was still correct they could have given more support to Ministers in making the case, and helped more staff with increments, gradings and promotions. Doctors say a lot of their unease is about work patterns, shifts and availability of support staff. These are matters managers can manage better.They have of course kept the Pay  Review body system implying their support for it.It is not just senior management in the NHS that can help more. There  has been a very poor productivity performance in many parts of the public sector at a time of big rises in budgets. There are many examples of public services making choices that annoy many members of the public. In highways Councils have plenty of money to narrow roads, complicate junctions, reduce access for vans and cars, paint more lines and erect more signs. Meanwhile potholes go unmended  and bypasses are delayed. In Housing illegal  migrants get hotel places as a priority whilst legal residents are on waiting lists for homes for years. The state struggles to carry out Ministerial wishes to end the small boats trade across the Channel.The public sector performs many administrative tasks. Computing power can assist, streamline and improve much of this. The public sector spends a lot on new computers, so where are the savings from automation? Where are the civil service proposals to simplify, reduce cost and raise quality that the digital revolution allows? What is the future for applying artificial intelligence in everything from health to education , where it could assist valued professionals with diagnosis, prescribing and tutoring?Ministers have allocated lots of extra money to key services, especially health. They have set out what the public would like to see, including easier access to a GP, shorter waiting times and more hospital beds. It is time we heard from managers about how these services can deliver more and serve the public better. Getting on  well with the staff would be a good starting point.Sent from my iPad


  1. Mark B
    May 4, 2023

    Good morning.

    There are 36,000 managers in the NHS.

    Does this figure include those that serve on NHS Trust Boards ?

    I fear not.

    1. NottinghamLadHimself
      May 4, 2023

      When something goes badly wrong, by some miracle, not one of them seems ever to be held responsible, however.

      The NHS is only following the pattern of organisations generally in the UK, public and private, where the managerial classes – many of whom went to the “right” schools – take for granted that they will have authority without accountability.

      They are only following government in this respect.

      1. Mickey Taking
        May 4, 2023

        Dinosaur argument. Blame the Manager when the handsomely paid players don’t bother. Tactics, game plan, individual role, team-talks all count for nought if they can’t be arsed.
        Apply the same to the NHS. I’ve heard and witnessed so much of what goes on inside the multi-faceted strange imagined monolith. Mostly over-staffed, casual, error strewn, administration shambles….Get to the theatre level and they are excellent. First step to deal with the current mess – announce termination of Agency hiring from say 1st Jan 2024. The shirkers will have nowhere to run, find other jobs? Where pays the total incomes of the nursing grades and working conditions?
        The truth has to be told.

      2. Ian B
        May 4, 2023

        @NottinghamLadHimself +1

        Shows how bad things are under this corrupt shower, I am agreeing with NLH

    2. Neil
      May 4, 2023

      There’s a steady trend away from ‘real’ jobs towards managerial and clerical jobs with little, if any, connection to well-being or happiness. Read the late David Graeber’s 2018 book ‘Bullshit Jobs’. In the 1960s we were promised a roughly 10-15 hour week by the 21st.C. Instead, these useless office-type jobs appeared and people work longer hours than in the 1970s.

      It’s not just a developed world phenomenan. He said it’s been replicated in many middle-income countries. UK universities started to suffer, having managed to remain almost autonomous until the 1980s.

      The NHS clearly has a bad case of it. It reminds me of Twitter, which reportedly sacked 80% of its workforce and saw no decline in service standards.

  2. turboterrier
    May 4, 2023

    The whole way the NHS is structured is out of date and not moved with the times and adopted new ways of working. The 76 years of culture imbedded in the organisation and that of the departments that run it is damning.
    Over 40 years ago large industries and business and commerce took a long hard look how to work smarter not harder and reduce all the waste occurring in their operational procedures.
    This resulted in cell and team working which had been adopted in Japan to help in their recovery from their disastrous war experience. This amazing (not) discovery that you do not need tiers and layers of management bought about a new way of thinking and expectations.
    Well trained teams working in many cases as self controlled units. It was identified people at the coal face could identify and correct bad processes and practices and continually be looking for continual improvement because they were empowered to do so much faster than trying to convince all the layers of management that used to exist.
    Start with one bite of the very large apple with one of the smaller trusts to completely reinvent the way it works and use properly their greatest asset their front line staff, not all the managers, directors CEO’s with all their support staff structure they generate.
    The state of the NHS at present there is nothing to lose as things are not going to get better carrying on as they are.

    1. Cuibono
      May 4, 2023

      That’s the sort of thinking that landed us with the appalling “system” we have.

      1. turboterrier
        May 5, 2023

        As with a lot of the visitors to this site I can only draw on my experiences of working in and with organisations the introduced change(s) by turning the management triangle upside down.

    2. IanT
      May 4, 2023

      I have a good deal of experience of two NHS Trusts, the one where I live and the one where my mother lived. You would not really believe that they are part of the same organisation, given the differences in their performance. Fortunately, our local NHS Trust seems well managed and we’ve been very happy with their services. We can arrange appointments and get seen at the time agreed. The other Trust was much more chaotic with cancelled and ‘lost’ appointments, long wait times and frankly rather indifferent nursing staff.
      When I see NHS ‘problems’ being discussed on the media, the suggestion is that the whole of the NHS has problems but from my experience this is not actually so. I can only conclude that any service level differences at Trust level have to be down to the senior management. Anyway, bottom line – I’m not planning to move elsewhere….

      1. a-tracy
        May 5, 2023

        I agree with you; some trusts in places such as Oxford have a brilliant service and others are pitiful.

    3. John McDonald
      May 4, 2023

      76 years ago there was no such thing as the management culture. Someone to be called a manager was very unusual. May be only the Bank Manager. Things and activities need to be organised and managed but you don’t have to be called, and be, a Manager to do this. It’s a skill like plumbing and a little up the ladder Engineering. A plumber and an Engineer can manage. Can a “pure” Manager do the Plumbing and Engineering? This is the 21st Century “Management” problem -too many managers not enough skilled people at all levels and positions in society.

      1. Trader
        May 4, 2023

        So what do you want? Get rid of the managers and have doctors order the food, plan the cleaning, schedule the surgery?

  3. Wanderer
    May 4, 2023

    One can criticise the NHS Managers for a lot, and you rightly do. But Test and Trace was an ill-considered programme demanded by your government, if I remember rightly.

    You may as well in a similar vein criticise the HS2 contractors for cost overruns. The fact is the government’s decision to do these projects was flawed. I’d like to see some accountability there, too.

    1. Michelle
      May 4, 2023

      ++ I too would like to see some accountability of Government on these issues. Accountability of individual MP’s, Ministers too.
      Passing the buck and ignoring Elephants is neither professional or honest.

      1. Lifelogic
        May 4, 2023

        “professional and honest” this is politics, that would never catch on. Only about 100 Tory MPs remotely in this category and one fewer now the party have kicked out Andrew Bridgen for telling the truth.

    2. turboterrier
      May 4, 2023

      Accountability from ministers and politicians?
      Steady up there, that’s a step too far.

      Far too many trying to operate outside their limits of capabilities

      1. Bloke
        May 4, 2023

        Managers are appointed to manage, but so many can’t.
        Performance-related pay would spur some, or starve them into needing hospital treatment.
        The life support services they fail to deliver might not save them.

        1. Gabe
          May 4, 2023

          Well as NHS “customers” do not pay the managers often “manage” by trying to deter them. GPs try to push them to A&E, hospitals to social care and visa-versa. Huge waiting lists and delays in treatments, shoddy treatments and vast inconvenience for users are their main methods. Fair competition between state and private (rather than the current you pay four times over for private system) and make all who can pay do so is the solution.

          Four times over is once in taxes for others, then extra taxes/NI on what you earn to pay you medical insurance, then the insurance premium, then 12% IPT tax on the premium. Idiots Starmer and Gove want this for private education too with 20% VAT on school fees! This would cost far more than it raises and damage education hugely too. Yes Bridget Phillipson the Shadow Education Sec. thinks private schools can magically find this 20% without increasing fees! Clearly her education, logic or reasoning is rather lacking!

    3. Lemming
      May 4, 2023

      Too right! Mr Redwood’s columnns all have one common feature – an attempt to distract attention from the failures of thirteen (13) years of Conservative government

      1. Lester_Cynic
        May 4, 2023

        Absolutely correct + 100

    4. Ashley
      May 4, 2023

      The system of a “free at the point of need” paid for by tax payers, communist NHS is also driven (and retained) by deluded serial governments is a total disaster too.

      It kills fair competition & innovation and ensures delays, incompetence and rationing. It fails both patients and indeed NHS staff appallingly.

      1. Narrow Shoulders
        May 4, 2023

        The idea of free at the point of use is OK, it is the funding that needs to be changed. Move from block grants to payment by procedure.

        The taxpayer can still pay if it must but it should only be paying for delivery.

    5. Lifelogic
      May 4, 2023

      Indeed test and trace was a massive waste of money on a pointless project circa £35bn or £1,400 per household for zero (indeed negative) value. So what was driving this? Corruption, lobbying, vested interests, hands in the till or just gross incompetence? Even larger money spend on the large net harm vaccines.

      1. Lifelogic
        May 4, 2023

        Allister Heath today:- “The war on cash poses an existential threat to our financial independence
        It’s terrible for the elderly, and risks giving massive power to social engineers and faceless bureaucrats”

        It sure does not only with they take circa 50% or our money off us they will start to treat the rest as if it were theirs. You can only but this and that they will demand – not what you want and need. They will know everything you do, where you are and everything you spend (or or allowed to spend).

      2. Cuibono
        May 4, 2023

        Well when you know that people need £800,000 loans and £10,000 per day ( or was it hour?)….
        Then you know it is all about following the money!
        We have witnessed a huge 2008-style fire sale/transfer of wealth probably on a MUCH vaster scale than ever seen before.
        Even enclosures…wars…taxation.
        Never before on this scale.
        The powers that should never have been have taken everything.

      3. a-tracy
        May 4, 2023

        You wanted more men testing faster than women Lifelogic. Now you’re crying net harm. Everyone in government, actors, and friends made those resisting testing pariahs. People have very short memories.

        1. Lifelogic
          May 4, 2023

          No contradiction here at all Tracy I remember what I said perfectly well. I had assumed that the vaccine worked as the vaccine companies, regulators and the UK government had claimed (80-90% protection and they were “safe and effective”). Had they been so then rolling out to men slightly younger than women would have saved many lives as men were are a higher risk for a given age.

          It is now however (arguable ed) from the statistics that the vaccines were not ….. safe nor even very effective hence most of the current excess deaths of circa 200 a day. Given that clearly they should not have been giving them to anyone. They have at least finally stopped them completely in Switzerland and almost now in the UK too. But what appalling damage had been done.

          1. a-tracy
            May 5, 2023

            Testing it out on the older men and women first to see how successful it was and what health conditions appeared afterwards was more sensible then in my opinion. I would rather new controlled drugs were tested out on those over 60’s than younger men until there was a degree of success that outweighed the risks.

    6. a-tracy
      May 4, 2023

      Absolutely Wanderer, I wonder who advised Matt Hancock that was the system to invest in, what others were considered, who were the people doing the assessment, or did the government Minister just make the decision solo not seeking tenders etc.? Did the government get what they were promised.

      Personally, I believe the testing part of the operation was excellent; we all got free testing, some people went to the extreme of testing nearly every day, this has a massive cost, but that is what a majority of the public demanded. When the testing was announced as stopping there was lots of bad press wanting free testing to carry on! You people saying it was pointless, did you never take a free test, really!

      The tracing was spoiled by people not keeping track of their movements and who they were mixing with, people mixing with more people than they should, not loading the tracing on their phones etc. Why would they when it resulted in a week out of work (often without pay for those that didn’t want to trace) without transmission?

      If people had to pay for the tests as in other countries there would have been a lot less testing and cost. Would you all prefer that next time?

  4. Ashley
    May 4, 2023

    2023 deaths first 16 weeks are now 22,397 higher than for same sixteen weeks of 2022. After the high recent years deaths one would expect it to be rather lower not 200 at day higher. So why no discussion of this other than from a few like Andrew Bridgen. Is it mainly vaccine damages or NHS delays and errors?

    I assume from the appalling and totally unjustified attacks on Bridgen (from ministers) and others that the government know full well this (and the fall in fertility rates) is largely caused by the vaccines. They are thus tying to bury this for many years to come. Rather like Hillsborough, the contaminated blood scandal… but 200 excess deaths a day (when It should be lower not higher so more than 200 in effect).

    Unlikely to work as this is not just a UK problem – the truth will out.

    1. Lifelogic
      May 4, 2023

      The deluded Sadiq Khan even claimed anti-Ulez protesters were Covid-deniers and Vaccine-deniers.
      What a pathetic man he is. No one sensible denies Covid or Covid Vaccines. Though it is now surely very clear indeed the Covid vaccines did far more harm than good. As will your insane Ulez tax people to death scheme Mr Kahn. Let us hope a decent Mayoral candidate finally gets rid of this appalling man in 2025.

      Though it is surely clear the Tories want to see the ULEZ tax too – but want Khan & Labour to get all the blame!

      1. Berkshire Alan
        May 4, 2023

        But we all know that ULEZ is not about pollution and clean air, it is about raising money, if you can afford to pollute then you are allowed to as many times as you like and for as long as you likesimple.
        If it was about clean air then we would have a system like Paris, where each vehicle has to be graded with a sticker (if they want entry to the city) which shows it’s pollution rate on it’s windscreen (Crit Air vignettes) they cost £3.16 for the life of the vehicle.
        There are six grades of certification with Grade 1 being the least polluting, the air quality is monitored continuously, and if poor then only certain grades of vehicles (the least polluting) are allowed access.
        Policed by automatic camera’s you only get fined if you have no sticker, or are driving a vehicle that is restricted at the time.
        Thus it is the “air quality” in the city at the time which is important and determines access.
        Euro 6 vehicles are graded 3, and usually have access at all times.
        Not a perfect solution, but at least it is being honest about pollution

    2. David
      May 4, 2023

      The 2023 death rate (age-adjusted, per 100,000) should be compared if possible to the average rate for say the five-year period 2015 to 2019. Then the rise is even worse. Comparing it to 2022 understates the problem; a lot of deaths in all age groups have been ‘brought forward’ from say 2024 or 2025 – when that person was destined to sadly die – to 2021 or 2022. The rate now should be if anything below normal.

      1. Lifelogic
        May 4, 2023

        Indeed further understated as after a high death rate period it would normally be lower than normal not higher – as people only die once so many were brought forwards.

    3. Mickey Taking
      May 4, 2023

      Increaed deaths? Bigger population. At least 2-3 years of GPs missing cancers etc, few referrals, limited life-saving activity by the angelic NHS. Just maybe jabs have very little to do with it?

      1. Iago
        May 4, 2023

        The bigger population (such as the men we see being brought ashore, though they are only a small part of the influx) are in the first half of their lives and far less likely to die. The bigger population therefore does not account for the excess deaths.

  5. Lifelogic
    May 4, 2023

    “There are 36,000 managers in the NHS. They should be asking themselves why the patients are unhappy, struggling to get a GP appointment, and why so many of their staff are unhappy, with thousands on strike.”

    Well free at the point of use is the main reason. The NHS has your taxes already so patients are just a nuisance. They need to be deterred (as the NHS sees it as they do not pay and cost) so this is done by delays, queues and inconveniencing them as much as possible.

    Ring the GP and hold for an hour or so and they might ring you back if you are lucky. Go to casualty and wait for 12 hours or ring an ambulance and they might come eventually. Your choice for accessing what you have already paid for – our “envy of the world” NHS!

    1. a-tracy
      May 4, 2023

      A friend had needed to call an ambulance for the first time in her life at the age of 69 on Friday, 28th April; she’d had a stroke, a very fit slim woman, never smoked or drank alcohol, she’d had an MRI scan a couple of weeks ago because of a tingling in her face nothing showed up. The ambulance arrived within ten minutes, gave her a nosebleed for 3 hours to free up the blood clot, and then sent her home, bank holiday weekend, strikes perhaps, or is that normal service now?

  6. DOM
    May 4, 2023

    Your party and its MPs are to blame for handing this nation over to the Left. FACT

    John should try condemning Marxist union leaders and demand laws to prosecute those who expose patients to fatal harm but I hear only silence and read vacuous articles like this designed not to upset the Left

    Id’ prefer it if Tory MPs simply stand on a platform and admit that, yes, they have sold us down the river to the Left and that the NHS is now under POLITICAL CONTROL

    The Left demand and Tories get down on their knees in compliance like good little Socialists

    1. Lifelogic
      May 4, 2023

      Vote Conservative – appalling climate alarmists, tax to death, growth killing, wasteful, anti-car, anti-business, currency debasing socialists and now remoaners too it seems – but not quite as bad as Labour/SNP/Libdim/Plaid… this seems to be their electoral sales message.

    2. British Patriot
      May 4, 2023

      Yes, the blame rests entirely with this moronic Conservative government. I have said many times that ministers MUST have the power to hire and fire officials. But this weak and, let’s be honest, far-left government, refuses to take control of the machinery of government in order to do their job: run the country as their voters want them to do.

      That’s why I have no sympathy for the government whenever they complain that officials or quangos are not doing what they want them to do. As for striking doctors and nurses, I have said before that they should be BANNED from going on strike. They are an essential service and therefore strikes should simply be illegal. But, of course, the government refuses to follow my advice. Which is why I shall refuse to vote for them. What else can they expect?

  7. Michelle
    May 4, 2023

    While it is true there are far too many managers within NHS, (and one layer ‘Diversity Officer’ should be scrapped immediately) there are other factors at play particularly when it comes down to numbers and the pressure on resources.
    Your piece doesn’t mention the ever growing population which is an enormous part of the problem we face. That could be remedied and should have been a long time ago.
    The problem of the strain on our resources was obvious to many years ago and yet completely ignored by politicians of all stripes.
    All that seems to happen is the perpetual merry go round of creating the shortage and strain by adding more people to use to capacity all the resources. The whole mass immigration scheme was flawed in every way right from the start and plastering over the cracks just won’t do anymore.

    People are using A&E because it’s three or more weeks before they can get an appointment at their local surgery. This is in my town where I have it on good authority that one such surgery is struggling with the numbers on their books already and have been told they have to prepare to add a lot more. Well, given the huge house building projects underway here of course the local surgeries will have to cram in more. It will though be a far poorer service given and unfortunately people will suffer because of it. Some perhaps fatally, and who will take responsibility for that?
    The answer is not to bring more Doctor’s and nurses in from abroad, the answer is to slash immigration and stop handing out citizenship.

    Reply I have recently blogged on high levels of migration!

    1. Lifelogic
      May 4, 2023

      The NHS treats doctors so poorly and pay so poorly that 50% of UK trained doctors leave to work in other industries or go overseas within two years. Two people my son’s age one now a doctor after 6 years training and £150K of student debt started on £29K the other similar top A level grades (three years reading economics) is on £105K at a London bank. Plus he has only £70K of student debt and has had a wage for three years already too. Top Lawyers earning similar sums.

      Medics are perhaps not driven by money but £29K salary less £10K of student debt interest, tax, NI… is not even enough to live on (unless you live in a tent or a van perhaps) in London.

    2. turboterrier
      May 4, 2023

      Reply to reply
      It’s very much appreciated but you are a voice in the wilderness.
      The whole system completely needs draining from parliament, civil, public services and NHS.
      They cannot keep ignoring the bleeding obvious, enough is enough.

    3. a-tracy
      May 4, 2023

      The number of patients per FTE GP isn’t controlled. It must be, at the moment, the postcode lottery is ridiculous.

  8. formula57
    May 4, 2023

    “I and others have been urging the NHS to publish a manpower plan. The Opposition has taken up the cry. “ – they would though, wouldn’t they!

    To one of your posts on the economy in the last few months I made a rather obvious Comment saying that you were a more effective Leader of the Opposition than the putative one only to see a short while later Sir Starmer make a speech that included echoes of your ideas. I wonder if he knows that properly developed, it is an election-winning strategy?

    1. Lifelogic
      May 4, 2023

      Can one now still talk about “manpower”? Google bosses have asked UK staff to stop using common phrases including ‘man hours’ and ‘you guys’ also ‘whitelist’, ‘blackhole’, ‘blacklist’ and ‘black box’, as well as ‘chubby’ – and to refrain from describing people or things as ‘crazy, bonkers or mad’.

      I think they call it free speech! Even blackhole and black box and “Chubby” I suppose you just have to say “Obese” now instead?

      1. Lifelogic
        May 4, 2023

        “crazy, bonkers & mad” are surely some of the best words needed for to describe most things nowadays! Particularly the net zero, tax to death and the woke agenda.

    2. margaret
      May 4, 2023

      Good Morning John You mentioned GPS’. The nurses who work in general Practice are not paid by the NHS yet serve all NHS patients. There is no private work whatsoever, This puts the hIring GP in a position of power as the staff become his/ her employees. The practice can change from owner G P to owner GP and the staff stay but are paid by another owner. This power is used to also hire their colleagues and new starters, Some practices arranged this way have the owner / lead GP not working at the what is effectively an NHS practice and take agency shifts all over the country for their contemporaries. This is not executive level; this is giving power away.

  9. BOF
    May 4, 2023

    You describe a state sector and especially the NHS, that is essentially broken. You can add to the list, Probate, DVLA and Passport office and police that police anything but crime. Border control that consider it their duty to help as many illegal migrants as possible into the country. Woke teachers that consider their duty to indoctrinate children. Government that are addicted to wasting as much tax payer money as possible, think HS2.

    Meanwhile government wish to restrict our freedoms, speech, protest and movement. Tax us into poverty, force expensive and unreliable energy on us, ev’s that we cannot afford, restrict food supply and allow the WHO to decide unilaterally what we must be medicated with and how we must be restricted.

    Is this democracy or is it totalitrianism?

    1. Berkshire Alan
      May 4, 2023

      Indeed interesting that Woke and oil protestors can close major roads, and delay the general public whilst the police look on for hours.
      Yet one threat of protest at delaying a coronation, brings the introduction of new laws, and the threat immediate action !.

      1. BOF
        May 4, 2023

        +1 New laws. The more draconian the better!

    2. agricola
      May 4, 2023

      It is your last word, remembed how the current government came to power. The establishment just have a softer way of doing it than they do in Sudan.

    3. IanT
      May 4, 2023

      Just watched Dr ‘Art’ Laffer, he of the “Laffer Curve” (Search for “Wealthion” on YouTube)
      You are left in no doubt about his views on a range of things, both political and economic. I suspect Jeremy Hunt qualifies (in Dr Laffer’s words) as “the Southern end of a North bound horse”

    4. a-tracy
      May 5, 2023

      They don’t work for us, we work for them BOF. An extra three days paid holiday this past year, completely taken for granted, the loss of service appointments that leads to creates no loss of revenue for them so who cares, the patients but who cares about the patients and other clients of these government agencies.

      They are so brazen now they tell us they can be paid the same for a 5 day week in just 4 working days, all that says to me is they were overstaffed by at least 20%. It is disgusting.

      People that don’t work in the defined benefit pension occupations have to save more, so who does Labour want to punish savers who don’t work in the organisations with their union paymasters whilst protecting themselves. This is going to blow up soon.

  10. formula57
    May 4, 2023

    The satisfaction in even generous pay awards will of course very soon erode when “Doctors say a lot of their unease is about work patterns, shifts and availability of support staff”. Do any of the 36,000 accept that things do not have to be this way?

    1. Bloke
      May 4, 2023

      The self-employed perform their business efficiently controlled by their reputation.
      Many professionally qualified operators know what they are doing without needing managers.

  11. Paul
    May 4, 2023

    Thé 2019 Conservative manifesto stated it would produce a manpower plan for the NHS. So where is it?

    1. Mark B
      May 4, 2023

      Probably filed under ‘B’ for Bin a long with all the other promises, some going back way beyond 2019.

  12. Narrow Shoulders
    May 4, 2023

    Demarcation, empire building and diversity initiatives. That is what your 36,000 managers do. Union based from the ground up.

    Any email communication with anyone in the NHS is copied to at least four other recipients to pass the buck because it is always someone else’s responsibility.

    1. Bloke
      May 4, 2023

      Health Services exist to serve the Patient, not employers.

      Careless errors slosh toxic waste around the NHS, with billions diluted into loss among taxpayers in pain. The Treasury shrugs and accepts the numbers, gormlessly.

      Patients need control of their service. Patients go through what happens. It is the user who pays the bill, so the patient should receive their own invoice for assessment and approval.

      All approved charges would be funded from the total NHS budget allocated equally to all NHS numbers. Each person’s underused budget could be added to assist friends or family, or a personal pension. Special needs would be treated accordingly, but others who waste money would do so at their own expense.

  13. Cuibono
    May 4, 2023

    I saw the word “reassure” in the same sentence as NHS! Oh no!
    Every MP should be made to go incognito to an appointment of some sort.
    Get the full experience!

    And I do not believe that any good experiences in any way ameliorate the shocking ones!

  14. Peter Gardner
    May 4, 2023

    “The state struggles to carry out Ministerial wishes to end the small boats trade across the Channel.”

    That made me laugh. The state is encouraging and facilitating the small boats trade across the Channel. Nobody is penalised for conducting it or for using it. In fact, both provider and users are rewarded by the British state: the former by the creation of a ready market for their services and assistance with delivery, the latter by benefits in cash and kind making the UK the land of milk and honey.
    The most extraordinary thing is that half the governing Party don’t care or think it is a ‘good thing’ and the Government itself lacks the will to do anything about it apart from fiddling with legislation that will make no difference. It should be obvious that unless boats in the Channel are turned back in fair weather and in rough weather the drivers of the boats are arrested for endangering human life at sea.
    It really isn’t difficult but for the lack of the will to act. It would even win votes. Surely that, aside from the moral argument, should appeal to the Government? Why is the government so frightened of taking action?

    Reply Not true.Both the PM and Home Sec have plenty of political will to stop the boats

    1. BOF
      May 4, 2023

      Reply to reply.
      When, recently there was a discussion on the proposed legislation on this blog, I seem to remember that few of your contributors were in the least bit impressed. Barely anyone thought it would work!

    2. formula57
      May 4, 2023

      @ Reply – no doubt, but that is what you told us about Pritti Patel too and the passage of boats carried on regardless.

      @ Peter Garner – +1

      1. formula57
        May 4, 2023

        @ Peter Gardner – apologies for the transcription error in writing your name.

        Separately, as ever Sir Humphrey Appleby reveals a truism – “Things don’t happen just because Prime Ministers are very keen on them! Neville Chamberlain was very keen on peace”!

    3. majorfrustration
      May 4, 2023

      Political will counts for nothing its action the voters want – real action that can be seen not just the political wringing of hands.

    4. agricola
      May 4, 2023

      Reply to Reply
      I can believe in the Home Secretary having will, I still question the will of the PM. Why have we not rejected those parts of the ECHR that prevent us removing illegals en masse. When I see it happening I will believe. Political will is silent rhetoric, action is action.

    5. The Prangwizard
      May 4, 2023

      Reply to reply.

      Political will? Where is the action? Oh yes, it is spoken. To Sir John that is action, his world is a debating society world and that is a solution, but the boats are still coming aren’t they Sir John? Go to Dover and tell them to go back. Do you have the will?

      They will still be coming at the end of this year and probably next. Will this comment be culled like many others of mine?

    6. Peter
      May 4, 2023

      Peter G,

      Correct. Viktor Orban would stop the boats. Government is pandering to outdated agreements that Orban just ignored – with no downside whatsoever to Hungary.

      That’s what you get with a politician that believes in the nation state and the importance of borders.

    7. The Prangwizard
      May 4, 2023

      Our country, and particularly the nation of England is being destroyed by the actions and beliefs of this government. Yes, this Tory government because it is in charge. It encourages every critical activity because of the word ‘inclusive’.

      Subversives have a direct link to the top. They stop traffic and are saluted because they have a right to protest and how proud we are of that. They are not challenged – it is people like most of us who are treated as trouble. Look about you politicians, can you not see our country is no longer respected, it is falling down the world lists faster and faster but you still claim we are important. Dangerous fools to the rest of us.

    8. Timaction
      May 4, 2023

      Really. All mouth and no action. Totally useless.

  15. acorn
    May 4, 2023

    There are 36,000 “administrators” in the NHS. They are not allowed to be “managers” in the normal business sense of the word; that function is carried out, in public, loudly, by Westminster alone.

    Why is there still no COFOG 7 Level 2 spending data for UK Health. The Treasury makes a guess and splits the £217 billion (21/22) into Medical services (£192 bn) and Central and other health services plus medical research (£25 bn). Healthcare governance and financing costs are known and are believed to be a small fraction of the total expenditure on overhead and administration costs.

  16. Peter Gardner
    May 4, 2023

    There are so many aternative models to the NHS. What they all do better than the NHS is to direct funds to where they are needed by patients. That is best done by the patients having the scope and power to decide their treatment, by whom and where. It will never happen in the NHS because of the mantra, ‘free at the point of delivery’, which is preserved as untouchable in every enquiry or review to consider reform. The patient surveys are a complete waste of time and effort because the results are delivered to senior management who control the funds and the whole NHS remains a supplier oriented organisation. The solution to the NHS is both obvious and simple – patient choice contriolling the flow of funds – on the one hand and impossible on the other; being free it is paid for by a shrinking minority who are net contributors to the state. Why would the majority want to give up free health care? Of course they won’t. They will always vote against reform in a general election.
    Sorry, but unless voters give up their devotion to the creed of getting free healthcare paid for by others via the socialist construct that is the NHS, the UK is stuck with a third world health service.

    1. Bloke
      May 4, 2023

      The NHS is NOT FREE to anyone, because everyone pays tax.
      Even a 6 year old child buying a Mars bar pays tax.

  17. Nigo
    May 4, 2023

    Jeremy Hunt wrote an excellent book Zero about healthcare from his time as Health Secretary. As Chancellor he is now ignoring everything he suggested in that book. Sums up the rubbish we get from our politicos across Whitehall. Totally in the grip of the Civil Service. We have recently seen a u turn on working from home resulting from pushback from the public. We got a pathetic statement from Sunak saying the government wants more people in the office but zero on what he is going to do about it.

    Management across the public sector has been mostly poor for decades pathologically wedded to believing more money is the answer for everything and more recently making equality and diversity more important than performance.

    What’s the common denominator your Ministers, on the NHS, dancing to Labours tune. When I start to see them pushing back publicly and taking measurable actions, I will start to believe them.

    You should be aiming your fire, Sir JR, far closer to home.

  18. agricola
    May 4, 2023

    It indicates to me that in all areas where government is involved there is no plan. Apart from the flawed nett zero plan which will guarantee the impoverishment of most of the population. Even worse the opposition have no vision either baring the increased burden they would impose on the nation. When all the elements are there to take us out of the dire situation we find ourselves in, it is a condemnation of the socialist cabal masquerading as government that all the obvious steps are shunned. It is why I await Reform taking centre stage to promote a positive plan.

  19. James4
    May 4, 2023

    In the time before managers hospitals were run by matrons and sisters and all generally worked very well likewise the health system was run by health ministry officials ie. civil servants and it all ran good enough – then came the managers, time and motion men with their spin doctors? – maybe it’s time for a rethink.

    1. formula57
      May 4, 2023

      @ James4 – appropriate though some re-thinking might be, recall that the reason managers were recruited is that the NHS did not have the information systems to enable good decision making. The absence of adequate systems meant that it was not possible to say what outcomes to expect if more resources were allocated to one form of expenditure rather than another, thereby making it very difficult to know what was best to do.

  20. Ian B
    May 4, 2023

    There was once a muted plan(I think even a Conservative plan) that for the NHS the money should follow the patient.

    To most logical minded people that then meant those offering patient services were paid by the fulfilment of the service. What appears to happen now is the Conservative Government, in what is now its normal manner, just ‘gives’ the NHS money without any requirement of being held accountable or responsible for any sort of delivery.

    As you say Sir John, if you get to hire who you like for any purpose you choose you should also be the negotiator of pay rates etc. from the money you have available.

    Its the opposite to no win, no fee.

    1. Ian B
      May 4, 2023

      @Ian B
      To be ‘churlish’ – the Conservative Government and in particular this Conservative Government knows how to Tax and Tax big time. But being a Socialist Government they are happy to just give money away, especially when it has the appearance of giving money to friends-of-friends that cant find real employment elsewhere. So it no wonder that others want to just be ‘given’ taxpayer money for nought.

      I have never known a Government like this that it self and its people have just ‘refused to manage’. We have a Government a well paid Government actually on ‘strike’

  21. ukretired123
    May 4, 2023

    The NHS needs to be more transparent but is more akin to the black box mystery of how early computers were analysed by input/ output back in the 1950s. It is 75 years old but unlike the private sector subject to professional forensic scrutiny, the NHS management resembles the Civil Service hiding behind need to know secrecy.
    You can be sure there is duplication, fraud and duplicity given such incompetence and obscurity for sure . It is not fit for independence sadly.

    1. ukretired123
      May 4, 2023

      Not for for purpose.

  22. hefner
    May 4, 2023

    Maybe Sir John could read ‘Zero’, Swift Press
    ‘Extra money has little impact if there aren’t enough staff to deliver that improvement. There is no point giving an extra billion pounds to cut waiting lists or improve care, if you don’t have a billion pounds’ worth of additional doctors and nurses to spend it on.’ ‘Some have tried to get around this issue by contracting the private sector to do additional work for the NHS. Unfortunately, this doesn’t work either, because independent hospitals fish from the same pool of doctors for their workforce – indeed, they employ NHS doctors for much of their work. Over-reliance on the private sector therefore sucks doctors and nurses out of NHS hospitals, making waiting lists even longer. The only answer is to consider properly the entire capacity of the system, whether NHS or independent. Because we have failed to do that kind of capacity planning, we continue to have lower numbers of doctors per head than many comparable countries.’

    In the UK the contribution to the cost of maternity-related claims for incidents in NHS trusts in England for 2021-22 was 62% of secondary care clinical claims by value and 12% by volume. About £3 bn are spent each year providing maternity services and £8.5 bn on negligence claims resulting from them. Cumulative NHS liabilities for obstetric claims as of 2022 now stand at £41.5 bn, of which £36.8 bn is for cerebral palsy and brain damage. Those babies who survive need medical and social care, and specialist equipment, for life.

    A Royal College of Midwives report shows that there has been a massive midwife shortage for well over a decade, 2,500 short of the numbers needed (1,932 midwives and 496 consultant obstetricians).

    NHS England has just told 350 doctors training in anaesthetics that it has no job for them in anaesthesia after three years training. Yet there is a shortage of 1,400 consultant and specialty grade anaesthetists.

    According to the General Medical Council, 18,000 UK-trained doctors currently practise overseas, one in seven of the total trained and a 50% increase since 2008. 4,843 doctors left last year, seeking better training, lifestyle and wages. Specialty registrars, vital to the NHS, have suffered a £20k real-terms pay cut since 2010. In a GMC survey, the top three reasons for leaving the NHS were ‘dissatisfaction with role, place of work, NHS culture’ (35.7%), ‘return to country of previous residence’ (32%) and ‘burnout and work-related stress’ (27.2%).

    So as anyone can see, the major problem, as our dear host is telling us today, is the 36,000 managers.

    BTW, ‘Zero’ has been written by some J.Hunt.

    1. formula57
      May 4, 2023

      @ Hefner “About £3 bn are spent each year providing maternity services and £8.5 bn on negligence claims resulting from them.” – that is truly shocking.

      Has it not occurred to any of the 36,000 that the NHS would be better off ceasing all maternity services provision and just giving those in need of same a cash sum (that could even be triple the present NHS services spend and still advantage the taxpayer) to find their own supplier? Specialist private suppliers that well-funded could be expected to adhere to standards that saw negligence claims at a much lower rate than at present, surely, thereby making their insurance premiums affordable.

    2. Margaret
      May 5, 2023

      You obviously don’t know the inside story.

      1. hefner
        May 9, 2023

        I’m sure in the near future you will tell us all the details of this story from the inside of the institution, won’t you?

  23. a-tracy
    May 4, 2023

    “I and others have been urging the NHS to publish a manpower plan.” Has the Health Minister told the managers to publish their ‘manpower plans’ that they must already have in existence, SMEs have manpower plans for much smaller organisations!

    John, however this cuts the Minister needs to take action against Managers that aren’t giving him the information he needs to perform in his role.

  24. a-tracy
    May 4, 2023

    Can you become a nurse and not join one of the unions? Is there an option for them to get all the insurance required to operate in the role without all the political shenanigans? If not, why not?

  25. William
    May 4, 2023

    One other complete waste of finances was the bizarre painting of multicoloured pedestrian crossings and flags to indicate support for all the non heterosexual employees, but no Heterosexual crossings or flags!
    The NHS has constant movement of Staffs through promotion from one Trust to another. All new Managers have a strong desire to change. They love to cease working practices which have proved of value to bring about their own stamp, i.e. failures but tend to move before the obligatory hits the fan. They are constantly reinventing the wheel instead of enhancing what works for both patients and clinicians etc. In the late 70’s North Cumbria developed a Community Mental Health Team (initially with 4 personnel then progressing to 12 including Social Workers and O.T.’s), aligned to GP Practices and eventually to A&E Departments. It was well accepted by all and provide good results such as reducing the need for hospital admissions, less lost work days, reduced self harm attempts and the over prescribing of medications. All the Staffs on this Team were well experienced ex Ward Managers who attained specialist training in community working through University based Courses, but new Managers and Consultants eventually abandoned the concept of Primary attachment (Consultants of the view that any new referral should be medical to medical!) and created a ‘Crisis Service’ which was staffed by inexperienced Staff who were given little training in community care. This was without consultation with the GP’s and CMHT Members. If this sort of mismanagement is happening in every Trust no wonder the NHS is in a mess.

  26. Ralph Corderoy
    May 4, 2023

    ‘The public sector spends a lot on new computers, so where are the savings from automation?’

    It would be interesting to see how much of the ‘new computer’ budget is laptops, tablets, and phones. The modern user interfaces and applications on these flip things around so the user is driven. He has to respond to notifications and dings by tapping and clicking. Meetings are easier to convene when remote. It’s trivial to interrupt for a triviality when communal chat can be used. Don’t drop anyone from the CC list in case that’s a mistake.

    The user feels he is very busy with all this but has that nagging doubt he didn’t get much done. He learns to mute the nag. Instead he persuades himself he is excellent at multi-tasking when science — real, not ‘The’ — knows task switching destroys accuracy and productivity.

    Computers help productivity which in turn is deflationary. But the modern office use of personal computers tries hard to addict the user to the software without regard for their productivity.

  27. Bert+Young
    May 4, 2023

    I have posted before that the mess of the NHS has been in a bad state for years . Before I retired ( 1988 ) I was consulted about its leadership and announced at the time what I thought about it – having checked the records of its key individuals . No changes were subsequently made and its organization remained intact . It always was a far too large a body to be managed centrally ; it needed then – as it does now , to be broken down into locally focused units . Change must happen and that can only occur if the Government makes the decision to do so .

  28. Original Richard
    May 4, 2023

    Firstly we need to stop importing half a million net migrants into the country each year overloading all our institutions and infrastructure.

    Secondly to recognise that all public services and institutions, such as Parliament itself, the civil service, quangos, education, judiciary, police, NHS, BBC etc. have all succumbed to Robert Conquest’s 2nd and 3rd laws of politics :

    – “Any organization not explicitly right-wing sooner or later becomes left-wing.”

    – “The simplest way to explain the behaviour of any bureaucratic organization is to assume that it led by a cabal of its enemies.”

    As a result meritocracy has also been replaced by diversity.

    How we get out of this I don’t know, but if we don’t we’re heading to become a Marxist 3rd world state.

    Net Zero with expensive and intermittent energy coupled with the inferior and impractical electrification of heating, transport, agriculture and industry will provide the final coup-de-grace to our wealth, freedom and stability.

  29. Keith from Leeds
    May 4, 2023

    Your problem, Sir John, is simple. There are 36000 Managers in the NHS with no accountability for failure. That attitude pervades the public sector from top to bottom. Andrew Bailey is the classic example, a total failure but still in his job. Why not ask the Health Secretary how many managers have been sacked for incompetence or underperformance in the NHS in the last two years? My guess is the answer will be none!
    The government from the top down needs to learn that people do what you inspect, not what you expect!

  30. Mark B
    May 4, 2023

    I mentioned here before when I worked with someone who came from the Public Sector. Whenever there were decisions to be made, usually by him, he always wanted a meeting to discuss things and for everyone take collective responsibility.

    We soon got wise to his tricks.

  31. Ian B
    May 4, 2023

    @johnredwood “There are said to be planning permissions issued to build 1 million homes. New homes to buy are not being stopped by planning but by high costs and scarce mortgages”.

    Developers at all times aspire to have a Land Bank that will keep them going for the next 10 years. Makes sense to me. 2 things there, land only has value with planning permission, then having the infrastructure around it funded by local ratepayers. But the developer isn’t always required to contribute to the community they will profit from.

    Then of course you only build if you can sell at the price that allows you to buy the land needed in 10 years time.

    Governments time and time get suckered into being the root cause of market manipulation. Subsidised or mortgage help schemes seem well meaning, but just as with EV’s it is those that have money that get financed by those that don’t.

    The moral of the story, Government should keep its nose out, they become the problem – we need a lot less Centralised interference. Less Government, less State ….

  32. Ian B
    May 4, 2023

    From the Telegraph
    “How Britain’s tourism tax is killing Savile Row. An exodus of wealthy tourists has put London’s ‘golden mile of tailoring’ under threat”
    Another missed opportunity by this Conservative Government. Tax relief being given away on imported goods that most were clambering for was of course nonsense – UK taxpayer funding of those that want to buy foreign goods in the UK at the UK taxpayers expense was always a bit silly. However, visitors to the UK purchasing UK Manufactured goods has a lot of merit.
    Still no support for UK manufacturing and enterprise from this Conservative Government – just punishment. And today they want us to vote for them!

  33. forthurst
    May 4, 2023

    When will the government act to reform the NHS? Reforming the NHS does not involve discussing it with senior managers but talking to senior doctors and nurses and others and those as well who are leaving the NHS shortly after qualifying, many for a better quality of life abroad.
    There is no reason that the NHS has to be organised as a monstrous bureaucratic pyramid other than as a make-work scheme for Arts graduates whose impact on the NHS as a whole is dire. Health needs organising at the district hospital level with admin staff doing the chores which should not fall to skilled clinicians.
    Doctors complain about the time they have to spend on bureaucracy, filling in forms and attending compulsory meetings, all of it dreamt up by Arts graduates. In consequence, patients complain about the time they have to wait to see GPs and for referrals to consultants.
    The Tory party needs to have a plan to ensure that most doctors and nurses qualified here stay here to practice medicine otherwise there will be no end to the crises facing the health system. That must not involve shuffling the bureaucratic pack for the nth time much favoured by politicians. The NHS gets a lot of money and far too much is wasted by the administrative staff, mainly on themselves, who need a massive cull at every level.

  34. Mickey Taking
    May 4, 2023

    and now for something that just will not go away..
    Comments on migration by the French interior minister have triggered a diplomatic spat with Italy.
    In an interview on Thursday, Gérald Darmanin said Italian PM Georgia Meloni was “unable to solve the migration problems on which she was elected”. Italy’s foreign minister called the remarks “unacceptable” and pulled out of a scheduled trip to Paris.
    In a bid to defuse the row, the French foreign ministry said it wished to work with Italy on common challenges.
    This year Italy has seen a dramatic rise in arrivals by sea from Tunisia, where authorities have launched a campaign against undocumented migrants from sub-Saharan Africa. Most of the 42,000 people arriving from North Africa this year have come from Tunisia, prompting Italy to declare a state of emergency.
    The sharp rise in numbers came as a setback to Ms Meloni’s far-right Brothers of Italy party which won elections last year promising to crack down on irregular immigration.
    The French interior minister, speaking on RMC radio, said the Italian government was “incapable of dealing with migration pressures” and he blamed Rome for a recent influx of migrants, notably children, entering the south of France.
    Ms Meloni had run for office on a tough “just-watch-me” stance, he said: “And what you see, is that it [immigration] continues and intensifies.”

    all sounds a bit familiar.

    1. Original Richard
      May 4, 2023

      MT :

      Yes, you would have thought that the first duty of all members of the EU with its common external borders would have been to assist any country suffering an invasion of illegal migrants.

      Not sniping from the sidelines.

      The Italians/the EU need to do what we should be doing and that it is to return the illegal migrants back to from where they came.

  35. ukretired123
    May 5, 2023

    We visited an NHS hospital today after waiting 18 months for a follow-up appointment which was deemed not necessary due to a junior doctor being over-zealous from an earlier scan. In the meantime we had paid privately for scan that showed no problems.
    As there is no communication between different NHS Trusts in the South West and Gloucester unlike Durham there are gaps and costly duplication invisible to patients and doctors and tunnel vision NHS management.
    This happened today after my rightly guessing duplication and incompetence yesterday in my comments. Something needs to drastically fix the NHS.
    Patients anxieties must be unnecessarily high.

    1. ukretired123
      May 8, 2023

      Errata Not a junior doctor but radiologist, apologies!

  36. Lindsay+McDougall
    May 11, 2023

    There are too many senior managers in the NHS. The ratio of senior managers (‘gaffers’) to managers exceeds 50%. In a well run private sector company operating at a single site, this ratio is nearer 20%. Only 52% of the NHS payroll are clinical staff of one sort or another. Among the non-clinical staff there are 10,000+ equality and diversity officers. Some of the non-clinical staff are necessary support staff such as porters but by no means all of them. Overall, the NHS is typical of State organisations – top heavy, too bureaucratic and prone to favour current expenditure over capital expenditure.

    There are five bodies who think that they should be in charge of NHS policies and priorities – the politicians, the civil servants, NHS England, NHS Confederation and NHS Service Providers. Only the first three of these should be taxpayer funded.

    So if you want more to be spent on clinical staff, you know which parasites should be thinned down.

  37. a-tracy
    May 12, 2023

    I was pleased to read about nurses being able to start their training at 18 on the wards and day release again. But student doctors to begin at 18; surely this can’t be right?

    If it is planned that nurse practitioners and high-grade nurses can start to train as doctors in this way, then yes, I understand that a lot of them are competent, as Margaret often tells us here. I agree with her, and it would be a better future progression route for them rather than going into administration. Could you seek clarification because the papers specifically:

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