GHP September 2015

ghp September 2015 | 59 health and social care Growing Management Numbers in the NHS. Is This Fact or Fiction? In the build-up to the 2015 general election, David Cameron referred to NHS Management as “a bureau- crat with a clipboard”. Media coverage has questioned the comparison between the numbers of doctors, nurses and other clinical staff with the high numbers employed in management of the NHS. National re- ports show that the perception of bullying behaviours is increasing in the NHS. Could this behaviour in any way be connected to the increased disparity between the numbers employed in management and those responsible for the medical and clinical needs of the NHS? Is it also one of the reasons for an abundance of whistleblowing cases? What happened to the NHS structure and culture? How could an organisation that was launched in 1948 out of the ideal that good healthcare should be avail- able to all, regardless of wealth, reach a position of so much negative publicity and behaviours? Is the growing number of clipboard holders fact or fiction? Has the growth of managerial bureaucrats been responsible for a growth in perception and belief of bullying behaviours? Above all, would the NHS be better for patients and the tax payer if non-clinical managers were instead replaced with clinicians who were empowered with leadership skills? To answer these questions we need to take a step back, remove the rhetoric and consider some of the facts. The NHS Confederation stated in their July 2015 sta- tistics that managers and senior managers accounted for 2.67 per cent of the 1.388 million staff employed by the NHS in 2014. It stated that the number of managers and senior managers increased slightly in 2014, having declined in each of the previous four years. This data suggests that the growth of managers in the NHS is not significant. In contrast, the findings from a 2014 survey of two thousand NHS staff by the King’s Fund revealed a consistent disconnection between the views of exec- utive directors and of other NHS staff. For example, 63% of executive directors said there was a “pride and optimism” among staff although only 20% of nurses and 22% of doctors felt these emotions. Alongside national reports, social media contains a plethora of personal experiences about bullying in the NHS. According to the findings of a 2015 inquiry led by some of the most senior British doctors, infighting amongst overworked departments and disciplines in Trusts has led to trainees feeling “bullied and under- mined”. When the word “whistleblowing” is used we see a similar effect. Lord Rose, in his June 2015 NHS Leadership Review titled ‘Better Leadership for Tomorrow’ demonstrat- ed that the level and pace of change in the NHS is unsustainably high. This demonstrates that significant, often competing, demands are placed on all levels of its leadership and management. The administra- tive, bureaucratic and regulatory burden has already become insupportable and shows no early signs of abatement. With David Cameron’s electoral pledge to make the NHS a truly 24/7 service surely the pressure In the build-up to the 2015 general election, David Cameron referred to NHS Management as “a bureaucrat with a clipboard”. Media coverage has questioned the comparison between the numbers of doctors, nurses and other clinical staff with the high numbers employed in management of the NHS. National reports show that the perception of bullying behaviours is increasing in the NHS. Could this behaviour in any way be connected to the increased disparity between the numbers employed in manage- ment and those responsible for the medical and clinical needs of the NHS? Is it also one of the reasons for an abundance of whis- tleblowing cases?