NHS management is back firmly in the spotlight amid significant operational pressures (including long waits for care), poor patient satisfaction (at its lowest levels since the early 1980s), high-profile cases of abuse and anaemic productivity growth since the pandemic.

This new report from Policy Exchange – based upon more than forty interviews and the findings of FOI requests to every trust and Integrated Care board in England – considers the role that management and leadership can play in enhancing NHS performance and productivity.

It argues that a greater focus on the competencies, permissions and placement of management is required, noting that a weak and anecdotal evidence base has often defined the public debate.

Policy Exchange found:

• The majority of managers working in Acute Trusts are below Band 8a on the Agenda for Change payscale, suggesting that many ‘managers’ are more akin to administrators. 

• There is a negligible correlation between the percentage of total staff who are managers and overall performance as rated by the regulator, the CQC, revealing that a focus solely upon increasing the total volume of managers working across NHS organisations is unlikely to enhance performance.

• Only a fifth of NHS Trusts dismissed a single manager either for gross misconduct or poor performance during the last year single year.

The report sets out sixteen recommendations to improve NHS management, including:

• A reduction to vertical, tiers of NHS management, including the abolishment of NHS England and  (re)merging  its functions with DHSC (but for a delivery function to exist in the form of an NHS Management Board);

• For a new unified feedback and complaints system called ‘NHS Patient View’ to be developed;

• For the Government to jettison plans for manager regulation and to focus on implementation of a  disbarring system;

• For a comprehensive overhaul of the NHS’s current leadership/management training functions to ensure the development of a core set of competencies are defined at national levels, but with greater devolution and responsibility for Integrated Care Boards in the delivery of training and professional development for both clinical and non-clinical staff.