Exclusive: Darzi will highlight underinvestment in NHS managers
The imminent review of NHS performance by Lord Ara Darzi will highlight the need to invest more in NHS management and leadership, HSJ understands.
The former minister, eminent surgeon, and academic, was commissioned by the new government to carry out an independent review of NHS performance.
His report is due in the next fortnight and will seek to paint a hard-hitting picture of the severity and breadth of the service’s problems.
One trust CEO who had been briefed by the review team said it would “highlight low manager and leader numbers compared to other health services” – a message, they predicted, that the government “won’t want to hear”.
Another well-placed source said the review was likely to make clear that the NHS needed to invest more in good management, particularly in managers with the right skills and capabilities, and that it should not use reduced management costs as a barometer for success.
Recent years have seen central demands for cuts in admin costs in NHS England and integrated care boards; while many trusts are also now turning to cutting non-clinical posts to balance budgets.
Previous reviews and international comparisons have usually shown the NHS is undermanaged, but health and social care secretary Wes Streeting told HSJ in June he was sceptical of this finding; and thought there were “far too many layers in NHS management structures”.
Flatline funding
Several well-placed sources said they had been told the review would highlight that the NHS was underfunded compared to many other health systems, with its budget severely constrained in recent years despite steeply rising prices.
That jars with comments from Mr Streeting and his advisors stating the NHS doesn’t need more funding; and with a very tight public spending round in the 30 October budget.
Mr Streeting told NHS CEOs at a meeting on Tuesday there would be no more funding for the service this year, despite large deficit forecasts and political ambitions to do more to cut waiting lists.
One trust chief who had been briefed said a “big message” would be to highlight the NHS had received “flat-line revenue funding and reduced capital funding”. They predicted it would also note a “loss of grip due to the distractions of constant organisational change”.
Another health policy source said they expected the review would highlight the United Kingdom’s healthcare spending was lower than in comparable countries.
Some patient and user groups have raised concerns, however, that the review work seen so far appears focused on well-reported indicators like spending and performance targets, and may miss gaps in experience, access and outcomes which are often not measured.
The issue has been raised at engagement sessions for the review, and National Voices CEO Jacob Lant wrote last week: ”Our ask of [the review team] is to take a moment and ask hard questions of whether there are important gaps in what they end up reviewing. Ask ‘what is the data not telling us.’”