The Budget!

No apology required, I like a good argument – just ask Grey Area:diablo:

That depends if the managers are all directly managing staff or commissioning services. The nature of the NHS has changed, certainly in the 18 years I’ve worked in it which is a consequence of 2 things. One is the change in the population who have become more “consumer aware” and don’t just accept what they are given (which is no bad thing). The result of that which means organisations need to become more savvy in the way services are organised and delivered as when people don’t get what they want they complain – usually to their MP. This has led to the NHS adopting a more business like approach – which relies on the principles of business management. The real debate is whether this is good for the NHS or not. The second is the complexity of the NHS has increased significantly – it just isn’t the same organisation it was 15 years ago. That increased complexity needs management input. Because of all of this it can appear simplistic to look at the data in such a way. During my training I have been taught that the data will only tell you so much – there is always much more behind the data to look at that gives you the full story.

The days of a single ward with Matron in charge are long gone as the NHS is much more sophisticated these days – and in those days I would argue that the NHS was under managed. I always remember the story of Thatcher trying to find out how much a particular operation cost and finding that none of the medical staff could tell her – they just carried on doing it with no regard to money. That was why the NHS required management input as, during the 80’s, it was on a very fast track to bankruptcy. Frighteningly there are elements of that still around today despite the inroads made by management.

Hospital and community services don’t just happen – the needs of the population need to be assessed, services need to be identified, contracts need to be negotiated and there needs to be real support given to the front-line to deliver this. That’s the role of the NHS manager. Vital and – I would argue – the NHS is woefully under managed. I’m not sure of figures but I’m sure that I saw somewhere that large UK businesses have a higher percentage of managers in the workforce – somewhere around 15%.

Oh and StuartH – I should apologise for insinuating in an earlier post that there was a reliance on tabloid views. Much respect for using the data – I wish some commentators on the NHS did this and argued from an informed viewpoint rather than relying on information from a friend of a friend etc etc.

I’m not having a laugh when professionaly qualified staff require to be managed so much more in 2009 than they did 15 years ago. In 2005, there was 1 manager per 24 professionaly qualified staff. In 2009, there was 1 manager per 16 professionaly qualified staff.

In 1995, there were 507358 professionaly qualified staff and 20842 managers, a ratio of 24.3 to 1

In 2009, there were 725,579 professionaly qualified staff and 44641 managers, a ratio of 16.3 to 1

That’s my rationale. Or perhaps its an error in my interpretation of the data? Data again from The NHS Information Service.

Not wishing to be pedantic or anything (ahem) however I notice from yours (and others ) comments that you mention the absolute increase in numbers for managers, yet fail to mention the absolute number of clinical staff. You do however mention the relative increases and place great store in these. This is a common error with data.

Now far be it for me to suggest that this might make a mockery of the fact that there is a statement somewhere which says the NHS is “top heavy” with managers but I do think it strange you don’t mention this.

The number of managers appears to be increasing at twice the rate of all other posts

The rate of increase is larger but it is the relative rate not the absolute numbers. If you have 1 manager and increase it by 100% (shock horror) you end up with 2 managers. If you have 1000 nurses and increase it by 1% you end up with 1010 nurses. Yet you can point to the rate and say managers are increasing at a rate of 100% which is outrageous compared to nurses increasing at 1%. Though there are still more nurses and fewer managers. The absolute and relative rates cannot be looked at in isolation. Which is actually a vital piece of information you have chosen to overlook. Absolute and relative data are different and tell a different story – remember that as it’s important.

The last time I looked, the largest occupational group in the NHS was nursing staff who, by most stretches of the imagination are actually clinical staff. Using the same source you quote, I note that in 2009 there were approx. 417,000 qualified nursing staff. Add in the fact that there were 140,897 doctors, 149,596 scientific and technical staff and 17,922 ambulance staff you have to be having a laugh if you think 44,661 managers is “top heavy”! Top heavy to me suggests that there are more at the top than the bottom – a suggestion that does not appear to be borne out by the facts.

Using the figures you have given, if we assume that this year the 417,000 nursing staff increase by a measly 3.4% that will give us 12,510 additional nurses. If managers increase by 7.4% that would give us an extra 3304 posts. Still a long long long way from being top heavy. And still giving us more clinical staff.

Interestingly using the data there, managers account for 3.12% of the workforce. A very, very small amount indeed.

Now could you please explain to me the rationale behind the statements that there are too many managers??

All data available at www.ic.nhs.uk

Pedant – I’m never sure which syllable is accented.

However, if such a word is found, and can be verified as being in common usage by the Oxford English Dictionary…

Including Supplements?

Be quiet, Creaking Door….. :p

Edit: How about a quibble of pedants? 🙂

What is the collective noun for a group of pedants, anyway? :diablo:

A forum.

What is the collective noun for a group of pedants, anyway? :diablo:

I feel I must point out that I cannot provide a definitive answer. Painstaking research into the etymology of the word in question shows that there is no collective noun for such a group. However, if such a word is found, and can be verified as being in common usage by the Oxford English Dictionary, I shall certainly adopt it into my own vocabulary.

What is the collective noun for a group of pedants, anyway? :diablo:

Yes, a specific claim was made, ‘In the NHS the number of administrators and managers has increased severalfold over the past 10 to 15 years.’

When asked by the Penguin, ‘I would be interested to see where you are getting your examples from.’ I quoted the source, exactly as requested. I also threw in example figures, which I wasn’t asked for, from the last 10 years. Anyone who disagreed with ‘severalfold’ could quite easily have checked the 15 year period. The figures support my claim perfectly, and I quoted them when specifically asked by Grey Area. If you follow the chronology you will note that I’ve backed up my arguments when asked to do so and not before.

If I were being really pedantic I’d point out that 1995 was 15 years ago, exactly the period I was discussing, but you’re probably well aware of that.

Nit-picking at the phrases used does not hide the reality of the percentage increases. And those of us who use the NHS can experience the results every time we are involved in dealing with the NHS. It is top heavy with managers….

No-one is disputing that. Well not me, at any rate.

However, a specific claim was made and figures were presented in support of that claim.

Figures which, on closer examination, did not actually support the original claim.

If I were feeling really pedantic I’d point out to Stuart H that 1995 was four years earlier than 1999, but he’s probably already well aware of that.

Couldn’t resist a bit more nitpicking:

several(a): (used with count nouns) of an indefinite number more than 2 or 3 but not many.:diablo:

Nit-picking at the phrases used does not hide the reality of the percentage increases. And those of us who use the NHS can experience the results every time we are involved in dealing with the NHS. It is top heavy with managers – exactly as is most of the public sector, so there is no case for protecting it from cuts.

In 1995 there were 20842 managers, increasing at a rate of 7.4%. Professional and support staff were only increasing at 3.4% and 3.3% respectively.

In 2009 there were 44661 managers.

OK, two and a bit fold then. Is that several?:confused:

From 1999 to 2009, the percentage increases in staff levels were as follows:

Managers and Senior Managers, average annual increase of 6.3%
Professionaly Qualified Staff, average annual increase of 3%
Total Infrastructure Staff, average annual increase of 3.3%

Interesting and thought-provoking figures but, while they do call into question the priorities of senior NHS management, I’m afraid they don’t represent a ‘severalfold’ increase in management posts over the ten year period.

So which part of the NHS do you work in then Stuart? It certainly doesn’t resemble any part I have worked in so I would be interested to see where you are getting your examples from.

As to the number of administrators increasing sevenfold – can you produce the figures as that doesn’t fit with the data that is coming out of the NHS. I used to quote around 7% of the budget was spent on management but apparently that has come down and now it is hovering around 5%. There have been increases in line with increased services which is what you would expect. Even if you cut the lot (which is impossible) you won’t save much money there. For comparison generally large private sector businesses run at around 15% management costs.

As to managers not speaking to front line staff- it may surprise you to find out that as part of the management element of my role (though I am not classed as a manager) not only have I been talking to frontline staff today but I have also been talking to *GASP* patients and potential patients to find out what services they need. And this goes on all the time.

Perhaps a little less reliance on tabloid views of the NHS and more reliance on the actual facts might shed some interesting light on what actually goes on. You may then begin to understand why the NHS has been protected.

A few points first – I wrote Severalfold, not sevenfold – hopefully you don’t work in an area of the NHS where accuracy is an issue. I obtained the data from the NHS Information Service. I do not read the tabloids, nor are my opinions formed from unreliable sources. I understand perfectly well why the NHS should be protected, and made no comment which would account for your contrary opinion, unless you believe the disproportionate increase in managers is not an issue that needs to be tackled before cutting front line staff.

From 1999 to 2009, the percentage increases in staff levels were as follows:

Managers and Senior Managers, average annual increase of 6.3%
Professionaly Qualified Staff, average annual increase of 3%
Total Infrastructure Staff, average annual increase of 3.3%

The number of managers appears to be increasing at twice the rate of all other posts, so no, this isn’t in line with what I would expect.

You will also note that my comments about Managers and Administrators refers to all public service organisations. Having had years of experience in the public services, albeit in a local authority, my comments stand.

No great arguments about our expensive nhs,they really do waste an awful lot of money on non primary care stuff.
And also it is very plain to me attending the top neuro hospital in the country is that a huge proportion of patients are foreign,not to mention the staff…a large proportion are difficult to understand…I know…different problem.
Some of the neurologists I have met are simply unbelievable…rest of post I have deleted :rolleyes:

So which part of the NHS do you work in then Stuart? It certainly doesn’t resemble any part I have worked in….

I think that is a case of ‘he would say that wouldn’t he’
The NHS needs massive cuts through managers at top and middle level, and perhaps they can start living like the rest of us.

I absolutely agree 100% with everything this government has done so far – which surprises me a bit!

Sorry but the NHS can be a very wasteful organisation.
I have had various neurological problems in the last 15 yrs and had the misfortune to be sent initially to a very dangerous consultant…he was either a very bad liar or just incredibly incompetent and yet he seems to be highly regarded !!:rolleyes:
I have been travelling to london for the last 6 years and whilst they are generally more professional – they still quibble with me about symptoms I presented to them 10 years ago :rolleyes:
They just dont listen sometimes…it isnt rocket science…generally speaking a person with a good job/mortgage etc does not go see a Dr unless they really have to.
Even the results from simple tests can be very misleading due to lack of standardisation over the test method,I hate to think about how much this all has cost me (answers I needed in 2000) and the taxpayer !!
My whole experience with the nhs has been very victorian…if I conducted myself at work in this fashion I would have been sacked years ago 😉
BTW I am an aircraft engineer very experienced at functional testing and writing accurate reports !!

rgds baz

In the NHS the number of administrators and managers has increased severalfold over the past 10 to 15 years. Any efficiency savings need to be focused there. However, in any public service organisation, administrators and managers tend to be better placed to articulate why thier jobs are ‘essential’. Management talks to management, not front line staff. They have to sit outside a closed door whilst their futures are discussed.

So which part of the NHS do you work in then Stuart? It certainly doesn’t resemble any part I have worked in so I would be interested to see where you are getting your examples from.

As to the number of administrators increasing sevenfold – can you produce the figures as that doesn’t fit with the data that is coming out of the NHS. I used to quote around 7% of the budget was spent on management but apparently that has come down and now it is hovering around 5%. There have been increases in line with increased services which is what you would expect. Even if you cut the lot (which is impossible) you won’t save much money there. For comparison generally large private sector businesses run at around 15% management costs.

As to managers not speaking to front line staff- it may surprise you to find out that as part of the management element of my role (though I am not classed as a manager) not only have I been talking to frontline staff today but I have also been talking to *GASP* patients and potential patients to find out what services they need. And this goes on all the time.

Perhaps a little less reliance on tabloid views of the NHS and more reliance on the actual facts might shed some interesting light on what actually goes on. You may then begin to understand why the NHS has been protected.