Hurrah for NHS bureaucrats

“I want doctors with stethoscopes not bureaucrats with clipboards”
—David Cameron, 2 April 2015, #LeadersDebate

In tolerant and inclusive twenty-first century Britain, there is still one group of people that the politicians are happy to demonise: NHS managers.  During last night’s Leaders’ Debate both David Cameron and Ed Miliband were happy to trumpet policies that would see a reduction in NHS managers and an increase in doctors.
This is obviously a vote winning policy.  It’s a simple zero sum equation that ordinary people think they understand.  When we experience the NHS, we see a front-line health professional, not a back-room manager.  So more doctors and nurses, with less bureaucrats, appeals to the natural biases we have due to the way we experience the health service.
But I was sat next to a doctor during the debates and she ridiculed the policy.  If there are less managers in the NHS, then the task of managing will fall to the doctors… Who will have less time to see patients and run clinics!  The admin load placed on doctors and nurses is already a chronic complaint.
The NHS is a vast, multi-dimensional organisation. Running it is a huge logistical challenge.  The doctors, nurses, and technicians all need to be paid, co-ordinated, and to have precisely the right equipment at their disposal when the patient turns up for their appointment.  This requires managers.  The patients themselves need to be piloted through a Byzantine network of ‘healthcare pathways’ as well as the literal corridors of the hospital.  This requires managers.
Moreover, the government and professional bodies set rigorous standards and targets for the service, which are meaningless if they are not monitored.  This requires managers.  And the facilities that power the health service are some of the biggest and most complex institutions in our society.  They need hands on the tiller to set a strategic direction.  This requires managers.
There’s no point in employing more doctors and nurses if you don’t also employ management staff as well.  Otherwise the medical staff will end up doing all the admin and that will be frustrating for everyone.
Hurrah for NHS bureaucrats!

“Amateurs talk about tactics, but professionals study logistics.”
—General Robert H. Barrow, USMC (Commandant of the Marine Corps)

1 thought on “Hurrah for NHS bureaucrats”

  1. Agree up to a point. If we didn’t have the purchaser provider split we would could do with less managers. When I was first a consultant we had excellent administrators and few managers and it all worked pretty well. Most doctors are happy to take on some management commitments if well supported by a good administrator.

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