The NHS is regularly battered by upheavals in management structures and cuts to its specialist managers. Often badged as ‘reform’ or ‘protecting the frontline’, in reality they neither reform nor protect. They are the product of a fundamental lack of political seriousness, exhibited over decades, about the management capabilities needed to make the NHS work. This damages the NHS model, massively supported by the public, and does nothing to improve satisfaction with the NHS, now at a record low. We badly need a change of approach and we need parliament to make it happen.

Ministers tend to see their re-organisations as like re-laying a model train set. Yes, unpinning the track is finicky, but once the new set-up is in place you push the button and off the stupid little trains go again. That, unsurprisingly, is not how complex human organisations work.

In their NHS management career, a typical MiP member will have worked through a dozen major re-structures and myriad smaller ones. This builds some resilience, but the personal impact on individual managers can still be devastating. And it’s just as damaging for the rest of the NHS team and for the safety, efficiency and quality of services to the public.

Take the government’s ongoing NHS financial re-set. It is ripping through the management capabilities of every part of the service, including the NHS trusts delivering care to the public. While targeted at managers and other support roles, cuts to trusts also mean ward closures, clinical vacancy freezes and reduced access to services.

As management jobs are axed, the remaining specialist managers are seeing their portfolios of responsibility doubled or trebled. Much of the work done by departing managers and admin staff is being offloaded onto clinical managers—a very costly option if they’re doctors—taking them away from clinical duties, service improvement and their frontline colleagues.

Micro-management, fire-fighting and burnout are the order of the day. You can work out for yourself what is happening to investment in staff relations, digital and information systems and the estate, and the specialist managers those functions need. These are all key components of any organisation’s management capability, and all supposedly critical for the government’s reform plans. 

Let’s decide on the model of management and stick with it. MiP doesn’t have a set view on what that model should be (just choose one!), although we believe in devolving decision-making as close to patients as possible, and empowering frontline managers and clinicians to deliver the improvements everyone wants to see.