The NHS needs MORE middle managers, Tom Harwood says

Why is all this money not making things better?

Published

Two days of strikes over Christmas. The Government must really be starving the NHS of funding, right? Right?

Well let's look at the numbers.

This is from the independent health experts at the Kings Fund.

Adjusted for inflation, in 2009 we spent 116 billion on the NHS.

In 2022/23 we will spend 174 billion. A 50% real terms increase in money.

But where has that money gone?

Well we have more nurses: from 2010 to 2021 the number of people per nurse fell from 166 to 161.

People per GP fell from 1,312 to 1,246.

People per medical/dental staff fell from 507 to 417.

That's data from the independent Nuffield Trust.

So more doctors, more nurses, more money, what is there less of?

This is a question that was posed by Ben Zaranko, an economist at the IFS. He said:

Even compared to 2019, spending is 12% higher.

There are 13% more doctors.

10% more consultants.

11% more nurses.

10% more clinical support staff.

So... why doesn't it feel like there are.

More staff and more money over the last three years. Indeed, more money and staff over the previous decade too. And yet services are getting worse. Waiting times are appalling. Why is all this money not making things better?

Well here is perhaps a part of the answer. While cash and clinical staff has been rising, in one area staff have been severely cut.

The number of managerial staff in 2009 sat at 42,509. In 2021 there were just 33,531.

A drop of 25%.

Why does this matter?

Well, while it is politically popular to say we should have more and more frontline staff at the expense of the backroom, in reality that leads to huge inefficiencies within the system.

More doctors and nurses doing their own paperwork, instead of treating patients. Deployed to the wrong places without enough logistics staff to say where they would be most effective. A clogged-up system devoid of specialisation, where medical staff spend too long inputting data on terrible IT systems and are not properly deployed for their own skillsets.

Yes, I'm going to say something politically unpopular.

Even when adjusted per head of population, the NHS has never had more money. Never had more doctors. Never had more nurses.

So before we say it's time to pour ever more billions of taxpayer cash into the system, we might need to look at the least populist answer I can think of.

The NHS needs more middle managers.