Here we consider two of the most stubborn NHS management myths and explain just how misleading they are.

Myth #1- The NHS is overmanaged

This is probably the most repeated myth about NHS management. Yet, research suggests the NHS has fewer full-time managers than the broader UK economy. Separate estimates from the University of York and the Office for National Statistics indicate managers make up approximately 2-3% of the NHS workforce, compared to 10-11% of the wider UK economy. This mismatch alone should suffice to put the myth to rest. 

This narrative of over-management might arise from the conflation of ‘management' with ‘bureaucracy'. Overcomplicated operational processes, time-consuming procurement, superfluous reporting  and overly prescriptive legislation are increasingly recognised as sources of waste within the system. They should not, however, be mistaken for management; in fact, eliminating redundant tasks could free up management capacity to deal with challenges, such as soaring waiting lists, or deficient care pathways.

On top of this, we simply don't know enough about how frontline NHS services are managed and whether managers have the skills, time, permission and resources to do their job. 

For this reason, The Health Foundation commissioned the University of York to assess the  management capacity of the NHS: this research will provide the data to help address the misplaced perceptions of NHS managers. 

Myth #2- Management does not matter

Miscommunication, duplication, delay and administrative failing are common in NHS organisations. Seeing them, one could be forgiven for thinking managers are not adding much to the service. New clinicians, for instance, often arrive in hospitals and perform out of hours on-call duties with next to no understanding of hospital procedures, access to IT or even an ID badge. 

Yet, the absence of good management is not an argument for cutting it back even further. If healthcare providers are to deliver high quality care, they must have enough management capacity to deliver core services, such as payroll, rostering, procurement and IT. Sufficient management capacity is also needed for organisations to engage in quality improvement and innovation. 

It doesn't help that managers' work often goes unnoticed and is poorly understood. At a recent event organised by The Health Foundation, the University of York and Bayes Business School, senior managers stressed that while the public can picture what doctors and nurses do, the role and positive impact of management remains obscure.

Yet large scale studies of management, such as the World Management Survey, clearly show good management improves economic productivity. As such, managers are key to efforts to help the NHS recover from its post-pandemic productivity slump.

Shedding light onto the dark side 

The perception of management as the ‘dark side' remains live both among NHS staff and the public. More needs to be done to boost the reputation of NHS management.

Formal recognition of the management profession through, for instance, an accreditation scheme or regulation by the HCPC, might be part of the solution. 

The new NHS management and leadership programme and the proposed College of Executive and Clinical Leadership, both highlighted in the 10-Year Health Plan, are welcome and much needed initiatives. 

With sufficient funding and political backing, they offer an opportunity to improve how NHS management operates. 

They must go hand in hand with an effort by senior policy makers to talk up management and guard against further erosion of management capacity. Action to address problems like excessive workloads and low professional autonomy among some managers and poor organisational cultures is also vital.

Managers are among the most important resources in the NHS and not an asset to be stripped with impunity. Only by transforming the narrative around NHS management, and investing in the profession will managers' potential to drive the scale of change envisaged in the 10-Year Health Plan be finally unlocked.

This column has been informed by The Health Foundation's research with the University of York. To find out more contact Lukasz Zielinski: lukasz.zielinski@health.org.uk.