Comment / In defence of the managerial realm

It is time, once the election is out of the way, to openly acknowledge the value of NHS management and address recruitment and retention issues

Politicians pay a high price for their manager-bashing. A few know they are paying the price, but most don’t. NHS managers are easy and popular targets – and, beautiful politics, they don’t hit back.

The votes will soon be counted and the election campaign will be water under the bridge. Most politicians believe they will then get on with running the service (better than the last lot!), pulling the strings, ringing in the changes – supported by obedient managers who know the score, even if they might not like it much.

These politicians are wrong and reckless. Too late in the day, in office, they will discover that their endless and unqualified attacks on ‘penpushers’ have fashioned a rod for their own backs. If they try to break free from the bear-pit they happily entered, the media, their political opponents and the public will beat them with their own words.

So here are some thoughts for a new health secretary. You are going to need show some bottle on three fronts. First, you must make it easier to recruit and keep talented managers. Second, you must value management as a resource in implementing your own policies. Third, you need to promote the idea that good management is essential to good healthcare.

It has become difficult to recruit and keep managers, especially at board level and in finance. Key jobs are not getting the field they need and in some cases no candidates at all. The lack of supply is partly about reward.

The very senior managers’ (VSM) pay framework, for example, is neither competitive nor fair. But it is also down to the perception that the responsibilities and risks associated with directorship are just not worth the candle.

It is telling to look at good clinicians who would make excellent managers. Loss of professional status, damage to reputation among colleagues and poor job security are among the issues that scare them off.

Medics additionally laugh at the pay. You yourself can do something about the non-pay problems. On executive pay you can stop it soaring away from the pay of other health workers and make it fair and competitive – you have the expertise and objectivity of the Senior Salaries Review Body; use it and implement its recommendations.

Second, get on the front foot about management numbers. Only in the NHS is the number of managers a perennial headline. Yes, the number of managers has grown rapidly in the past 10 years, as spending has doubled in real terms and hundreds of thousands of new staff were added to the payroll. Yes, there are too many managers in some parts of the NHS and not enough in others. Yes, we should review and cut posts – fairly and decently – when they are no longer needed. But the fact is they represent 3% of the workforce, so you should simply be ready to say that management numbers are not the burning priority.

Third, promote the strong link between quality healthcare and good management. I’ve heard ministers booed for gently suggesting this, so it won’t be pretty. But in our fiscal climate there is no way quality and productive services can be maintained without good management. Cut too many managers too rapidly, and slash and burn will be the only option for savings to the health service.

Finally, most managers see you as the ultimate bureaucrat. Free managers to decide things locally and trust them to do it their own way.

Good luck - the scars will be worth it.