Ministers and the top brass have forgotten why they need managers
In 2025, the UK government took us into the habitual NHS dead-end: cuts to management and non-clinical staff, disruptive system change and unexpected, complex legislation—leading to the NHS losing the skills, experience and goodwill of many dedicated public servants. All this in a service widely seen as needing more good management to solve its problems. We may have crawled at a snail’s pace into that dead-end, but that’s where we’ve gone.
The decisions in March were a big mistake and a big gamble. The execution since has been “terrible”—Jim Mackey’s word, not mine. Stand by for a post-mortem book called Never Again… Again and whack another five years onto the Ten-Year Plan.
We hear ministers are worried about the planning for key goals like neighbourhood healthcare. But they shouldn’t be surprised. We know from experience that the opportunity cost of a major NHS ‘reform’ is extremely high in terms of doing the things the public actually wants done.
I don’t believe this is where Wes Streeting wanted to be when he became health secretary. Most MiP members will support a smaller, more strategic centre, more freedom for local managers and broadening the planning horizon with multi-year settlements. On the other hand, his record on manager-bashing is far from perfect—especially talk about “unnecessary bureaucracy”—and even worse are the arbitrary cuts to management and the system chaos he’s unleashed.
Management regulation, the VSM pay framework and a leadership college are evidence that ministers are more interested in management than their predecessors. But they don’t yet add up to a comprehensive workforce plan for managers. So before they make any more fateful decisions, let’s remind ministers and the top brass why they need managers. Here’s a list to help.
Managers get things done. They make sure money is used better, organise services to reduce waiting lists, improve patient access and safety and deploy potentially-transformative technology like AI. The core balancing act between quality, safety, effectiveness, the proper stewardship of public money and a good workplace is down to managers.
I don’t believe this is where Wes Streeting wanted to be when he became health secretary. His record on manager-bashing is far from perfect, but even worse are the arbitrary cuts to management and the system chaos he’s unleashed.
Managers protect the front line. They make sense of a thicket of regulation and directives, shielding staff from the worst effects. Managers support and co-ordinate clinicians’ work and ensure the burden of administration does not fall on doctors and nurses.
Managers back the workforce. They solve problems for staff. Report after report has clocked good leadership–especially line management—as critical for an inclusive and diverse culture, flexible working, career development and better performance. Managers are leading the response to the growing racism directed at NHS staff.
Managers take a system view. They plan sustainable improvements and support clinicians in improving patient care and experience, and in reducing inequalities. Managers are the NHS workers who lead the effort to turn the government’s ambitions for transformation into reality.
Managers are experts. The NHS nurtures management in all its forms. Managers come from many disciplines and walks of life, bringing their particular skills, knowledge and experience to their management roles. Many talented clinicians go into full-time management or have a management element to their job.
Managers are NHS workers. Studies show NHS managers are motivated by a strong public service ethos and dedication to improving patient care. The strength of the NHS model, still backed to the hilt by the British public, depends uniquely on managers’ work.
The evidence is there if ministers want to look. Kirkpatrick and Maltby’s 2022 study found even a small increase in managers (from 2% to 3% of staff in an average acute trust) “had a marked impact.” Larger management cohorts in trusts “were associated with higher patient satisfaction scores, a 5% rise in hospital efficiency and a 15% reduction in infection rates.” The study showed these improvements were driven by having more managers, not the other way round.
MiP wants 2026 to be the year when the NHS and its political leaders finally accept the case for investing in, valuing and supporting managers. Everyone in your union thanks you for your work and wishes you a peaceful and enjoyable festive season. //
- Jon Restell is chief executive of Managers in Partnership.
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