Can we believe the NHS’s management ratios?

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An extremely well-informed source within a leading NHS trust has spilt the beans to cantankerous on how NHS trusts, and the NHS in general, have managed to hide the fact that the number of managers in the NHS has been growing out of control.

Here is how the statistics are manipulated: when compiling the number of administrators and managers within the NHS, it is considered routine to exclude personnel who come into any clinical contact with patients.  However, many of managers in the NHS have transfered into management from nursing and often wish to maintain their professional registrations, as a personal safety measure should the wheels fall off the NHS gravy train.  So, they see patients for perhaps a few hours per week.  Yet many NHS Trusts are counting them as 100% clinical staff.

Why does this matter?  Well, because the Department of Health sets targets for manager:clinician ratios.  Claiming that managers are actually clinicians increases the number of 100% non-jobs that can be created.

Does this make a difference in practice?  Cantankerous can provide an example which shows how it does.  A ‘top-performing’ NHS Trust recently asked managers to cut costs.  An admirable manager went back to the Trust executives with a plan to cut unnecessary managers.  However, she was told that the Trust was ‘undermanaged’ and that it needed more managers to achieve Foundation status; whilst she might have been expected to be congratulated on her efforts, she was in fact berated.  Quite disgracefully, as happened at Stafford Hospital, the Trust Board was more interested in achieving Foundation status than maintaining high quality standards: the manager was told to sack nurses instead, irrespective of the impact on patient care.  For the Trust Board it is statistics and their status that matters, not patient care.  The way that the statistics on management within the NHS are compiled really matters.

PS Cantankerous would really like to know what ‘undermanaged’ means.