NHS has too few managers but too many admin staff, Hewitt suggests

International comparisons suggest the NHS has too few managers but too many administrative staff, former health secretary Patricia Hewitt has claimed.

Ms Hewitt has been commissioned by government to explore increasing the autonomy of integrated care systems.

In her first interview since beginning the review, Ms Hewitt told HSJ she wanted to end “the very prescriptive, detailed top-down management” of recent years, but also said some ICSs still required tough national oversight (read full piece).

The review’s terms of reference ask her to examine how national oversight of ICSs might be reduced.

As a result, Ms Hewitt’s review has been linked to moves by health and social care secretary Steve Barclay to cut down on NHS manager numbers,  particularly in national bodies and ICSs themselves.

Ms Hewitt told HSJ she planned to look early in 2023 into the “really interesting question” of whether there were too many managers in the service. She continued: “All the OECD figures I’ve seen suggest that actually the NHS has a low ratio of managers to frontline staff. Significantly lower than many roughly comparable countries including France and Germany.”

However, she added: “If you look at a broader range — not managers but non-patient-facing administrative and support staff — then I think the picture is less comfortable for the NHS.” She is currently taking evidence.

Ms Hewitt, who is also Norfolk and Waveney Integrated Care Board chair, continued: “There are some really significant reasons why I suspect we have too many administrative staff. [One is that] too many parts of the NHS are still way behind where we all need to be on data and digital.” She said the lack of electronic patient records, and automated data flows, meant a lot of work went into manual form filling and reporting.

As well as cutting down on manual and paper-based processes, Ms Hewitt indicated admin staff could be reduced by system or region-wide moves to share back office systems. In her ICS, NHS providers are currently taking this step, she said.

Addressing the number of managers needed in the NHS, she said “there are obviously non-patient facing roles that are critical”. These included “good logistics managers and procurement people”. She also emphasised the role of operational managers in improving elective productivity, by “making sure the right staff are in the right place so that you can do the maximum number of procedures in an operating session that it is safe to do, instead of significantly less, which is what’s happening at the moment for various reasons”.

Ms Hewitt said NHS England should be “be a lot smaller” and praised it for having already “embarked on a significant change process… along with [a] headcount reduction of 30-40 per cent”.

NHSE’s workforce is swelling to more than 20,000 with the acquisition of NHS Digital and Health Education England. Some senior figures including NHSE directors believe it must make deeper headcount cuts and return to the size it was before the pandemic. Ms Hewitt said she did not yet have a view on this.