It’s nurses we need, not more bosses

MAYBe I’ve missed something. Maybe I’ve misunderstood. All this time, I have been labouring under the belief that, in the nhS, there was a serious recruitment crisis.

There are 40,000 nursing posts unfilled. Two in three hospitals have a shortage of doctors, according to a survey last month by the British Medical Association.

We also need 12,000 extra gPs to meet demand and 3,500 midwives.

So, who is the nhS recruiting? Is it these staff — the ones who work on the coalface actually improving the lives of patients?

nope. Instead, while clinical staff shortages grow, the number of nhS managers has soared. Figures published this week show a 7 per cent rise in the number of senior managers in one year alone, while the total number of managers is now 32,000 — a rise of almost 25 per cent in four years.

The sharpest rise was among senior managers, whose pay normally starts at £65,000 a year. This is sickening.

don’t get me wrong: of course, the nhS needs managers. They are vital in ensuring the smooth running of services. But, in recent years, management has become a bloated mass, leaching money from frontline services to pay inflated salaries.

Why is a manager of a service worth three times more than a nurse, who is delivering the actual care?

Part of the reason managers have proliferated is that services are now required to collect vast amounts of data in order to show commissioners and senior nhS bods what they are doing.

This is wholly wrong and demonstrates the distorted priorities of the nhS, whereby filling out bar charts to show those higher up the food chain is deemed more important than actually helping patients.

A friend who works in a mental health service says there are now four managers in his department, yet just two clinical psychologists. As a result, patients now have to wait about a year for therapy.

UNDERPINNING much of this has been the internal market, whereby services are now in competition with each other to ‘win’ contracts.

Then, once ‘won’, managers have to harvest vast amounts of information to demonstrate they are delivering what was promised, ready for when the contract comes up for renewal.

And the spiralling cost of this bureaucracy has no discernible benefit to patients. A recent study from the Organisation for economic Cooperation and development (OeCd) suggests that around onefifth of spending on health in the UK makes no or minimal contribution to improved health outcomes.

I think there’s an element of Parkinson’s law here — that work expands in order to fill the amount of time available. As the number of managers increases, so the bureaucracy increases to justify their jobs. Put a manager in a room with a clipboard and they will find work to do.

And much of this involves those at the coalface — nurses and doctors — filling out yet more forms, which the manager can then collate.

Research from the nhS Confederation shows that clinical staff spend up to ten hours a week collecting or checking data — more than a quarter of their average week — and that more than onethird of the work was neither useful nor relevant to patient care. It is estimated that collecting this data alone costs the nhS £500 million.

And many of the managers can’t even manage properly, as evidenced by the astronomical spending on management consultants — external people paid to come in and restructure and improve a service.

It is estimated that every nhS trust spends £1.2 million a year on them.

Why? We have managers already and, if they’re unable to evaluate and restructure their services, then they have no business being employed.

My solution is simple. For every service, there can be one manager. Just one. This is exactly what it’s like in the private sector. This single manager will have to prioritise what data they collect; they’ll have to be lean and precise in their work.

Reducing managers in this way will see many jobs go, but they can be redeployed to the frontline.

For the absurdity is that many managers are former clinical staff — nurses, occupational therapists, social workers and so on.

Many were lured in to management positions by the inflated salaries, but this will stop.

They will go back on the wards and in the community, working with patients and using the skills they learned as managers to improve the quality of services.

It’s high time we reminded those in the upper echelons of the nhS that the health Service exists for one thing and one thing only: the patients. Anything else is a waste.