Doctors and managers meeting

General Election 2017: The NHS needs skilled managers more than ever

Thu 01 Jun 2017

In the fourth of his election blogs, MiP chief executive Jon Restell calls on politicians to stop manager-bashing and invest in the professional skills the NHS needs to meet the daunting challenges ahead.

Managing in the NHS and social care has never been more demanding than it is now. We’re trying to integrate two complex, fast-developing systems, both under enormous pressure, with dwindling resources and flaky political support. We’re building systems and developing relationships in ways that have never been tried before. And we’re doing all this on the back of a botched re-organisation that keeps getting in the way.

The NHS can only work properly if politicians recognise that the whole NHS team matters. It’s not about setting “frontline” doctors and nurses against “back office” management and support staff. Skilled managers matter, just as skilled porters, cleaners, administrators and accountants matter. They’re all integral to the system and they’re just as committed to the NHS as doctors and nurses.

We do need more clinicians in management, but it’s foolish to think all management can be done by clinicians. For many, it’s a waste of their skills and it isn’t cost effective – the most expensive staff in the NHS are doctors, not managers.

And healthcare isn’t just about medicine. Good planning is vital. Good relationships are vital. We need top-notch information and financial management. We need state-of-the-arts communications. These are the skills NHS managers bring to the table.

We saw that in spades in the response of the NHS (and other emergency services) to the devastating terrorist attack in Manchester last week: superb planning, selfless dedication and total professionalism – the result of skilled managers and clinicians working together across the city’s eight trusts.

Despite the track record, politicians find it easy to blame the NHS’s problems on too many bureaucrats and too many layers of management. But, when it’s not just a ploy to distract attention from the big issues, it’s a lazy and counter-productive myth.

Firstly, it simply isn’t true. Any system needs continual fine-tuning, but the plain truth is that the NHS is as lean as any health system in the world, and far leaner than British employers overall. According to the OECD, the NHS spends just 2p in the pound on administration, compared to 5p for health service in Germany and 6p in France. Bureaucracy doesn’t come much leaner and cheaper than this.

Secondly, it’s dangerous to claim – usually from a position of ignorance – that unlimited savings can be made by cutting management and back office functions. Problems on the NHS frontline won’t be solved by cutting these vital functions, they’ll be made worse. Does anyone really think our doctors and nurses need less support than they have now? If you kick the back office, pretty soon the bruise shows up on the frontline.

So what needs to change in this election and beyond?

Politicians and system leaders need to start taking NHS management seriously. When we plan new services, we rarely think about the managers we will need to run them. And when we cut management jobs, change management structures or merge back office functions we usually don’t even bother to assess the impact on patient care.

That’s not good enough. As the WannaCry cyber attack showed, short-sighted cuts simply rob the NHS of the core professional skills it needs. Hospitals rely on IT systems just as much as they rely on surgeons and dialysis machines.

We need systematic investment in management skills and roles at all levels, especially for those managers responsible for sophisticated clinical teams. Politicians can make this happen.

And then there is the endless manager-bashing. NHS managers are human. Cheap, baseless attacks by politicians hurt and are counterproductive. It drives people away and undermines those who remain, stifling innovation and pushing us back to outdated and, sometimes, frankly daft ways of running the NHS.

As Philip Dunne said at last year’s MiP conference, it’s time “to reset the rhetoric around NHS managers”. We’re not asking for kid gloves or special treatment. We’re not asking for the big pay packets and cushy benefits that top executives in the private sector enjoy. We’re just asking for NHS managers to be treated with respect as the dedicated public servants they are.

We expect companies to be well managed. We expect railways to be well run. We know to our cost that banks need experienced and robust management. We all respect the skills of accountants, architects, lawyers and engineers. In all other walks of life, we value the skilled professionals and good managers who get things done. Our NHS, its staff and the public we care for deserve nothing less. 

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