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What the NHS needs is MORE managers

The NHS needs MORE managers, says researcher: Hiring extra bosses makes hospitals ‘more efficient, improves patient care and reduces the number of infections’

  • The NHS is ‘under-managed’ compared to the rest of the UK economy
  • It has 31,000 managers to 1.36million staff – three per cent of the workforce
  • Experts said more managers would improve patient experience and efficiency
  • And they would also lead to a drop in rates of infections caught in hospitals 

The NHS does not have enough managers and thousands more are needed to boost the quality of patient care, a researcher has argued.

Professor Ian Kirkpatrick, from Warwick University, said bosses in the health service deserve more credit than they currently get.

Hiring more has been proven to improve patient satisfaction, hospital efficiency and reduce infection rates. 

Professor Ian Kirkpatrick, an expert in healthcare improvement, said the NHS is under-managed when compared with the UK economy as a whole (stock image)

Professor Kirkpatrick claimed the NHS is under-managed with 31,000 of them to a staff of roughly 1.36million.

He calculated this to be roughly three per cent of the workforce, less than the national average of 9.5 per cent.

For the NHS to meet the national average, it would have to convert nearly 100,000 members of staff into bosses. 

In a piece for The Conversation, Professor Kirkpatrick argued NHS managers had been unfairly ‘bashed’ by the media and politicians.

‘Our latest research suggests that this negative view of managers is unwarranted,’ the healthcare improvement lecturer wrote.

‘Far from representing a “bureaucratic burden” on the NHS, we found that having more managers increases performance.’ 

He based his argument on the results of study he undertook alongside two other experts from the universities of Bristol and Leeds.

They looked at data from 160 English hospitals between 2007 to 2012 for the study, published in the Journal of Public Administration Research and Theory.

Scores on the NHS Adult Inpatient Survey, rates of infections with the hospital bug C. diff and internal efficiency data were compared between hospitals.


Hospitals are in crisis all year round, not just in the winter, the British Medical Association warned in November.

An analysis of recent data showed the summer of 2018 delivered worse levels of care to patients than five out of eight recent winters. 

In July, August and September this year, 125,215 patients were left waiting on a trolley for more than four hours. This was worse than every winter between 2011 and 2015. 

And compliance with the four-hour A&E waiting time target was lower in the summer of 2018 than the winters of 2011 to 2015, with new lows recorded in the last three winters.

Dr Simon Walsh, an emergency care doctor and member of the BMA’s consultants committee said: ‘Behind these figures lie real stories of misery. 

‘Tens of thousands of patients are being left in crowded, cramped corridors, waiting for treatment while others are having to endure longer waits to even see a doctor or nurse. 

‘We cannot and should not allow this appalling state of affairs to continue.’ 

This allowed Professor Kirkpatrick and his team to compare scores on each of the measures with how many managers each trust had.

‘The results showed that, across all trusts, having a higher proportion of managers had a statistically significant impact on performance,’ said Professor Kirkpatrick.

He revealed even a ‘small’ increase in managers, from two per cent to three per cent of the workforce led to improvements.

They found such a jump was linked to a one per cent increase in patient satisfaction scores.

While the results showed having more managers improved efficiency by around five per cent and led to a 15 per cent reduction in infection rates.

Professor Kirkpatrick said raising the proportion of managers in the NHS by just one percentage point would cost the NHS less than £500million each year. 

He wrote: ‘This seems like a small price to pay, given the size of the NHS budget (£130 billion, annually) and the benefits reported in our study.’ 

Professor Kirkpatrick said managers in the NHS may get a bad rap because doctors blame them for growing amounts of paperwork.

This paperwork is generated by policies and regulations which, often, managers will be responsible for enforcing.

Doctors argue the admin work takes away valuable time they could be spending with patients.

And the Mid-Staffordshire scandal, in which 400 to 1,200 people may have died because of poor care, could also have contributed.

Managers at that hospital trust took some of the blame for the scandal, which happened between 2009 and 2012.  

They were criticised for being remote and fixated on financial targets, Professor Kirkpatrick said.


Part of the bias against managers in the NHS could be down to comments made by Jeremy Hunt, the Government’s former Health Secretary. 

In 2016 he said doctors and nurses should be put in charge of hospitals, in an attack on the ‘manager class’ which has taken over the NHS.

Mr Hunt admitted creating non-clinical hospital managers in the 1980s may have been ‘a historic mistake’, and announced a wave of reforms to train doctors in management skills.

Speaking at the NHS Providers conference in Birmingham, he said only 34 per cent of NHS chief executives have a clinical background.

‘What is striking when you look at the pool of potential NHS leaders of the future is just how few have a clinical background, with clinicians representing a third of CEOs,’ Mr Hunt said.

‘Only 54 per cent of all managers in our hospitals are clinicians – compared to 74 per cent in Canada and the US, and 94 per cent in Sweden.’

He added at the time: ‘We should today ask whether the NHS made a historic mistake in the 1980s by deliberately creating a manager class who were not clinicians rather than making more effort to nurture and develop the management skills of those who are.’