Are there too many managers in the NHS?
No. This is a widely held myth.
There is little evidence the NHS has too many managers, and many (including MyHSN) thinks the NHS is actually undermanaged.
All large organisations need management to organise them, and keep the organisation focused on the primary task – i.e. for the NHS, the health of 67m people in the UK.
In February 2024, of 1.5m NHS employees, there were approximately 39,800 NHS managers (Kings Fund, 2024), which is therefore around 2.65% of the workforce.
This compares to, as the same time, 140,700 doctors and 377,600 nursing staff (including midwives and health visitors).
Recent research by Institute for Public Policy Research suggested that the healthcare sector is under-managed, and this increases the burden of bureaucracy that falls on frontline professionals. They also found clinical staff needed managers to do the ‘managing’, freeing them up to do the ‘caring’.
Supporting this, we know the following:
- The NHS is under managed compared to international health systems and compared to other parts of the UK workforce
- The UK spends less on management compared to comparable international health systems – it spends 2p in the pound on healthcare administration, compared to 5p in Germany and 6p in France
- At the time of the coalition government’s NHS reforms in the early 2010s, there was a major cut in management of 17.5 per cent over the following five-year period. This led to re-investing in management in recent years, with NHS workforce statistics up to the end of July 2023 showing a 6.7 per cent year-on-year rise in senior managers and a 7.4 per cent rise in general managers
- There are about 13,500 senior managers and 25,500 more junior managers at present (FTE); however, the data over time shows the increase in roles is merely starting to fill some of the gap created in the early 2010s
- Increasing management roles could lead to less spending on management consultancy which has been over £300 million a year
- Managers have been among the slowest growing groups of staff in NHS over the past 15 years being only 2.9 per cent higher than in September 2009
- Numbers are expected to decrease in some parts of the health system as Integrated Care Boards (ICBs) have been mandated to reduce their running costs allowance by 30 per cent by the end of 2025/26. This is resulting in further reductions in management capacity and costs. This is robbing Peter to pay Paul, and long-term will have to be reversed, and managers re-recruited.
Comparison to other large organisations
As stated above NHS managers make up 2.65% of the workforce (in 2023) compared to 9.5 cent of the general UK workforce in 2017.
In larger organisations – e.g. a JLR or Marks and Spencer – management may be over 10% of the workforce.
What are NHS managers paid?
The average salary for an NHS manager in the UK is around £39,441 per year, which is the national average. However, salaries can vary depending on the role and level of management.
This compares to the approximate £120,000 salary of a senior hospital consultant. Actually they can be paid alot more with bonuses, and private practice. Over £250,000 is not unusual.
There is an NHS Graduate Management Training Scheme. Its starting salary is £27,701 per year, which increases to £29,832 after 12 months. Graduates also receive a study package and NHS pension.
So. How many managers does the NHS need?
If 10% of the NHS were managers, there would be 150,000 not 39,000. I.e in MyHSNs view, the NHS needs 110,000 more managers to function well. If this means less doctors, nurses and AHPs, so be it.
Summary
We have answered the question whether there are too many managers in the NHS. No, there are not enough. We think the NHS needs 110,000 more managers.
If we had more (and better paid) managers, productivity would be likely to improve – especially if NHS managers had better pay and were paid productivity bonuses.
