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Re: National Health Service

How many of the medical staff are managers?

Re: National Health Service

It's how the Civil Service manages to thrive.

Re: National Health Service

it is very dangerous to bandy around the "BIG NUMBER" and imply that the NHS non medical side is entirely superfluous.
I believe there can be absolutely no doubt that at least five of these people are essential. This number may be conservative and for safety should be doubled.
I should add that there are a great number of lowly positions that are included in this number that, if properly filled with suitably qualified candidates, would add a great many to the number of essential non-medical positions. We do need laundry, cleaning and cooking employees. It would be nice if the wards really were clean and good wholesome food served to the patients. I understand this is indeed the case in some hospitals so we may need to increase our justifiable numbers into the tens or even hundreds.

No one who has recently visited a hospital anywhere in the country can fail to be impressed with the Tracey Emin style artworks they have invested in to amuse us while we wait for hours/days in A&E for attention (why are there no medical interpreters on hand when you need them? I get on fine with my local GP because we both speak English.)
Speaking of GPs, in my youth they were much given to pipe smoking, tweeds and elbow patches and old Wolseys. Today's GP has lots of holidays, drives a Mercedes or BMW sports car and spends a lot of time on the golf course.
Now they giving hospital doctors and interns sop much free time they will have to pay them more to enable them to indulge in these past times also. Why not? it is not uncommon in some branches of industry for golf club membership fees to be paid by the employer.

Re: National Health Service

I'm generally with Frank on this one. While the point that support staff are necessary is a good one (we reckoned there were eight support troops for every front-line soldier), the problem comes when they are organic to the enterprise. Since the tendency of bureaucrats is always to increase their numbers it is very difficult to get rid of surplus 'managers' when they have been superseded or become useless.
Robert Heinlein in his more militaristic 'space operas' always maintained that a military force should always be made up of military personnel (Everybody jumps: everybody fights) but this only really works in the peculiar circumstances of the armed forces. In civilian life many functions are far better supplied by specialists (per Adam Smith) who can be retained on contracts, avoiding all the employment protection bull that bedevils all enterprise in this septic isle.
You will note that when Maggie tried this, Sir Humphrey neatly castrated the scheme by ensuring that there was a NHS 'Internal Market', which meant that the REMF were all on the staff. This must not be allowed to happen again. Funds must be supplied to medical staff who are clearly and enforcibly at the top and who hire administrators and support staff as subcontractors. That way they can, with minimal trouble, get value for (our) money.

Re: National Health Service

The problem with management is that it is always costed as an overhead. In a private company, competition with other businesses dictates what an acceptable overhead is. In an institution run by a government that can't technically go out of business, there is no limit to such overheads.

If instead management was costed out of the increased productivity resulting from its presence, you could easily determine how much is needed. In theory, management in the NHS should actually be productive to the extent it gives other staff more time to do what they do, be it brain surgery or making beds or cooking. Instead, as in private enterprise, the net effect is probably to find increasingly ingenious ways of loading up the underlings with more and more time-consuming ways of measuring what gets done in the productive time left after the demands of management have been met.

Re: National Health Service

JMW, the full horror of the situation is that the NHS does not employ the cleaners, laundry staff and cooks. All of those services were long since contracted out. The managers don't even have to manage them.

It's so simple. Any group of people who decide their own staff levels, pay and conditions without external constraint will favour themselves - such as directors of large corporations, MPs and public-sector administrations.

Re: National Health Service

Actually, contracted out services require two managers, one at the customer to liaise with the supplier manager. Which means every time, for example, the NHS cleaning manager wants something doing he first has to sign a change order and pay extra for it. Apparently it's a lot more efficient than having cleaners in-house who can respond to the manager's needs at two minutes notice without demanding change orders get signed, the worst case scenario for extra costs being a bit of overtime pay.

On overheads, If the fading memory of my time in UK academia serves correctly, the overhead charged on grant income by the university I worked at was 46%. That includes rent, utilities and the like, not just administration - in fact departments were lucky to get any centrally-funded administrative support out of their overhead, usually if anything there was a secretary who was unsackable having been there for 30 years working for a professor on an unsackable contract. The odd office manager was assigned to the superstar profs bringing in a million quid a year or more in grant, because they could go elsewhere if the university didn't give them what they wanted. Such an overhead would be the death of a lot of businesses, though it might be tolerable in a really large company with massive economies of scale. A "small business" of a research group certainly can't cope with it. Perhaps it's no surprise that small research groups are a thing of the past and grand hierarchical constructs with superstar prof at the top and 30 or more various lecturers, postdocs and graduate students lower down the pyramic are now the norm.

And leading on from that, with a <1/30 chance of getting the superstar job (being the only secure one), who would bother with trying to work out new stuff on low wages for the benefit of an ungrateful to downright hostile public in the first place? Especially when you can instead fill your boots at Goldman Sachs for being just a little more publicly hated?

Re: National Health Service

I worked for a company that provided outsourced services for the NHS and I have to fully agree with JamesV.

It is worse than he stated. When contracts for outsourcing are let it is quite common for much of the work which is carried out by the area being outsourced to be omitted from the specification. Therefore the price quoted by the outsourcing company will often be much lower than the existing internal costs, but the ultimate cost of the extras, which will have been done by the internal workers at no (or little) extra cost, is likely to be astronomical. I have known these extras to far exceed the costs in the basic contract and this is where the outsourcing company gains its profits.

Add to that the inefficiencies of outsourcing. The outsourcing company will ensure that it employs staff to specifically work on charges for the extras and maximise them. The NHS then has to employ a similar group of staff to check the costs for extras, at even more expense, or will pay considerably more in fees.