Managers and the NHS

This short overview has been developed to further explore the themes around management and leadership in the NHS.

How many managers are there in the NHS?

It is difficult to establish historical trends in the number of non-clinical managers employed in the NHS as the definition of a managerhas changed over time.

Earliest workforce data from The Office of Health Economics shows that in 1951 there were 29,021 administration and clerical staff, including general and senior managers. This made up about 7 per cent of the total workforce.

The NHS Information Centre has separate figures for general and senior managers from 1995. These figures showed that in 1995 there were 20,842 managers and senior managers, which was 1.9 per cent of all workforce including GPs and practice staff.

In 2009, the NHS employed the full-time equivalent of 1,177,056 staff (1,431,996 headcount), of whom 42,509 were managers or senior managers. While the total number of NHS staff increased by around 35 per cent between 1999 and 2009, the number of managers increased by more than 82 per cent over the same period, from 23,378 to 42,509.

Changes in numbers of certain groups of NHS staff 1999-2009

How many managers is 'too many'?

The NHS Confederation, in its report, Management in the NHS: The Facts, argues that the proportion of NHS managers is relatively low given the size of the organisations that they run. They point out that it is lower than the proportion of managers in the whole of the workforce in the UK (NHS Confederation 2007), which in 2009 was 16 per cent (Office of National Statistics 2009).

Who can be considered an NHS manager?

The NHS Careers website lists 78 categories of manager, including clinical management, human resources management, IT and financial management. There is no data available to show which of these broad categories of management has seen the most growth. Recent reforms to the NHS, including delivering waiting time targets, changes to the hospital payment system (payment by results), the electronic booking system (choose and book) and other IT projects, are likely to have increased the need for managers in hospital trusts.

Why has the number of managers increased?

For primary care trusts (PCTs), the recent Health Select Committee Report into Commissioning identified a continuing rise in administration costs dating from the purchaser-provider split in 1991 and was critical of the government's inability to supply 'clear and consistent data about transaction costs' relating to billing and commissioning.

The regulatory framework for health care in England has also become more complicated. A report in 2009 by the Provider Advisory Group, made up of NHS and independent sector providers, concluded that there was unnecessary duplication in the information NHS providers in England are required to submit to the 35 key regulators, auditors, inspectorates and accreditation agencies. Supplying this information has led to an increase in the number of non-clinical staff employed by the NHS.

Do more managers equal better quality?

There have been few systematic attempts to measure the quality of management in the NHS. A recent study published by the LSE (Bloom et al 2010) found a relationship between the quality of management – as measured by surveys – and the quality of clinical services in hospitals, as measured by the Healthcare Commission. The Department of Health recently launched the National Leadership Council to improve the quality of senior management in the NHS, which has traditionally spent a very small proportion of its training budget on managers.