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Comment by rcarr | Hacker News Reader

From what I read it’s not the equipment, but a bloated layer of bureaucratic management on massive salaries that is the real issue. The front line staff get pittance in comparison.

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NHS management overhead takes up approximately 8% of the total NHS budget [1] In the US that number is more like 15-20% [2].

[1] https://www.kingsfund.org.uk/projects/health-and-social-care... [2] https://jamanetwork.com/journals/jama/fullarticle/2785479

> It is extremely difficult to find an accurate figure for the number of managers in the NHS, and most sources of information use different definitions for who is counted as a manager.

I’m not sure I can take the report seriously after that. You can’t write a report on management in the NHS and refuse to give a definition of manager. Also, how many of these managers are directly employed by the NHS and how many are employed as consultants?

I’m not saying you’re necessarily wrong but that report is hand wavey.

The Kings Fund is a credible source of information about the NHS systems in England, Scotland, Wales, and NI. One of the reasons that they're credible is because they're cautious about definitions. In your quote they're saying "lots of people have written about this, and they all use slightly different definitions for management, and so they all give different numbers".

What is a manager? Are you only including non-clinical staff? Or do clinical staff count too? If you're including clinical staff, how many hours of their working week are you counting as clinical hours and how many are you counting as managerial hours? Are you converting people who work part time as managers to Full Time Equivalent positions, or not?

If you want to poke the data it's here: https://digital.nhs.uk/data-and-information/publications/sta...

If you want more description of the complications of counting managers in the NHS I found these useful (if a bit old now):

https://www.kingsfund.org.uk/publications/future-leadership-...

https://www.kingsfund.org.uk/projects/general-election-2010/...

https://www.kingsfund.org.uk/projects/health-and-social-care...

Looking at the chart on https://www.kingsfund.org.uk/projects/general-election-2010/... it looks like consultants are taking more than their fair share

Thank you I will look into this.

I think that's the problem with "what I read". I think the "man on the street" would probably agree but not necessarily from hard data, just from the fact it is easy to blame inefficiency rather than structural or human problems.

"The NHS is full of bureaucracy" but it is a bureaucratic system so of course it is. People to charge hospital costs back to GPs, people to investigate trends and make sure that some GPs are not under-referring people to hospital, etc. but when I worked in the NHS many moons ago, it didn't seem particularly disproportionate to the size of the organisation. There were many more problems with people not doing their jobs properly but that was everyone, not just this nebulous "middle management" that everyone likes to cite!

Certainly, some hospitals under-perform and have issues with culture and discipline but that's the same as any business.

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