Bureaucracy, management and the NHS

Last week, it was announced that the workforce in the National Health Service had increased to 1,368,200 by September 2008, a rise of more than 27 per cent in a decade.

This should be of little surprise to anyone, given the fact that we are all living longer and that there is increased pressure on the health service to provide more staff to cope with the higher demand from patients.

The critical question, of course, is whether the additional resources for staff is going on front line services or on supporting the bureaucracy that has become the byword for the health service up and down the land.

For example, the census by the NHS Information Centre showed that whilst the number of nurses employed went up by 2.1 per cent, the proportion of managers increased by 9.4 per cent. Indeed, there are now 5,000 more managers employed to care for the organisation than there are actual consultants to care for the sick.

A small fortune is being spent on senior management. Executives within the NHS have just enjoyed an inflation-busting salary increase of 7.6 per cent, reaching an average salary of £158,000.

The question is whether this inflation in executive pay across the sector has resulted in a similar increase in the quality of management across the service. Some critics would doubt this, pointing to disasters such as the 400 deaths at the Mid-Staffordshire NHS Foundation Hospital Trust where managers spent too much time filling in paperwork to cover their backs rather than dealing with key problems.

In North Wales, there has certainly been a growth in the bureaucracy within the health service. During the Assembly election campaign, I undertook detailed research which showed the massive increases in the cost of administration and bureaucracy within the NHS in North Wales at a time when local hospitals were being downgraded or shut.

During the period 2003-2006, the overall cost of managerial, administrative, facilities and maintenance staff increased by £24 million, representing an increase of 41 per cent in non–medical staff costs over three years.

The cost of administrative staff alone has increased by over £12 million pounds, with 230 new administrators and clerical staff employed as compared to 156 new doctors and 268 new nurses. Worst of all, the cost of senior management of all three trusts had risen by £5.2 million pounds, an increase of 53 per cent.

At that time, it was clearly wrong that hospitals were being downgraded by an NHS that had spent over £24 million on increased administration costs and only time will tell whether the recent reorganisation of health services in North Wales will have any effect of reducing red tape within the hospital sector.

Whilst professional management systems within the NHS are important to its operation, this should not be at the expense of vital medical services within local hospitals.

With the Welsh Assembly Government suggesting that it will need to save half a billion pounds from its budget next year and the health department being the single biggest spender of public funds in Wales, it would be expected that any focus on cutting costs would be on the tens of millions spent on bureaucracy within the NHS every year.

However, I wouldn’t hold my breath although if there are any cuts in frontline services before addressing the spiralling management costs across the NHS, then yet again the support of Ministers for our health service will be just empty rhetoric.

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