With ambitious plans but little money to spend, a Labour government will need the skills, nerve and insight of managers to make its promise of a ‘decade of renewal’ in the NHS a reality. 

One of the few political certainties out there is that there will be a general election between May 2024 and January 2025. As a union for NHS managers and leaders, MiP is politically non-aligned and works constructively with any government. But almost all pundits are betting on a Labour government. So what should we say to Labour?

The top lines are clear to me. Labour needs NHS managers to deliver its reform agenda. Your system-wide experience in operational delivery, primary and secondary settings, and central functions will be a huge asset to a government seeking change with little money to play with.

We must remind Labour that managers want what the public wants: shorter waiting lists, better access and clearer pathways between different parts of the system. You joined the NHS because you share its values, and you work to ensure it stays true to those values within the finite resources available. Your unique skills will be key to making Labour’s promise of a decade of renewal in the NHS a reality.

Talking to our members reveals three themes to which Labour must pay attention.

Managers know how to get things done

First, frontline clinicians can’t deliver eight million more appointments without strong operational managers to support them. More clinical staff will be wasted if they’re too busy dealing with paperwork and operational issues to care for patients. As Labour learned in bringing waiting lists down in the 2000s, managers know how to do things. The following challenges all need expert management:

• Patient flow: problems in social and community care block patient flow. Managers can work across organisational boundaries to maintain the steady flow of patients in and out of hospital despite limited capacity in the community.

• Resource allocation: Managers’ skills in strategy and long-term planning will be crucial to making sure each part of system has the resources it needs – it’s not just about money but also how we organise staff, equipment, estates and IT.

• Productivity: Think tanks on the left and right agree that managers are vital to boosting productivity by freeing up clinical capacity and driving performance improvements.

• Mobilising new tech and data: We know the NHS severely lags behind comparable systems in using data and new technology. Managers and non-clinical specialists will be key to catching up.

• Workforce capacity: People leave managers, not jobs. Retaining staff and recruiting our future workforce requires managers to create an organisational culture that people want to be part of.

Managers need more autonomy

Second, managers must be accountable for their decisions, but they need the agency to make them. During the pandemic, the centre struggled with logistical problems and shifts in government policy, while local health systems were busy delivering local solutions to difficult problems. A looser national grip gave local leaders a degree of autonomy they last saw in the 2000s. In the 2020s, we need:

• Local solutions to local problems: The NHS needs an effective centre – a buffer between ministers and matrons. But meeting the needs of local populations is work for local managers.

• Central support, local delivery: The centre needs to focus on support: allocating resources, investing in infrastructure and setting a few strategic priorities. Consistent planning and streamlined approval processes will free up local managers.

• Fewer central targets: Too many targets constrain skilled managers, and micromanagement by the centre leads to short-termism and skewed performance. Giving managers a small number of national targets and the levers to deliver them will allow them to meet local needs alongside national priorities.

Reforms demand skilled and active managers 

Third, managers want to make prevention, community and joined-up care a reality. For 30 years, politicians have pointed the NHS in this direction, without providing the investment to make it happen. Community-driven, preventative care demands strategic planning and active management.

• Managers make change happen: The last decade of major organisational change has destabilised the entire system. We need some stability. Managers can drive change without costly restructuring: give them direction and let them run the shop.
• ICBs are underused: their strong regional position and role in coordinating local partners make them best placed to support the shift in services.
• System co-ordination: Most hospital blockages are caused by community and social care packages being unavailable. Managers can deliver a joined-up approach that ensures NHS and council services are making best use of limited resources.

This is the long version of my one-line briefing for any government: politicians and NHS managers must hang together, or assuredly they shall all hang separately!

• Jon Restell is chief executive of Managers in Partnership.