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Trusts with more managers, perform better, research finds


By Carolyn Wickware
10 July 2017

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NHS trusts with a higher management to staff ratio perform better, according to a six-year study by researchers at the University of Warwick.

The researchers found that a 1% increase in the management to staff ratio at acute trusts, would place them in the top third of trusts in terms of performance.

Managers currently make up just 2% of the workforce with 40,000 general managers working in the NHS, within a total workforce of 1.36m.

NHS trusts with a higher management to staff ratio perform better, according to a six-year study by researchers at the University of Warwick.

The researchers found that a 1% increase in the management to staff ratio at acute trusts, would place them in the top third of trusts in terms of performance.

Managers currently make up just 2% of the workforce with 40,000 general managers working in the NHS, within a total workforce of 1.36m.

The researchers said having managers make up 3% of the workforce would create ‘statistically significant’ improvements in ‘outcomes in terms of infection rates and hospital patient experience scores’.

The research looked at publicly available statistics to measure the outcomes of around 150 acute hospitals in England between 2007 and 2012 and found that those with a higher level of managers had better outcomes.

The analysis stopped ahead of the Health and Social Care Act in 2012, when David Cameron’s coalition Government put cutting managerial positions and bureaucracy at the heart of the reforms.

Professor Ian Kirkpatrick, a researcher in healthcare improvement, said the findings ‘call into question many of the assumptions about the failure of general managers in the NHS’.

He said: ‘On the contrary, they suggest that despite being relatively few in number – compared to, say, private businesses – managers are making a very significant contribution to the performance of health services, at least in the hospital sector.’

However, he added that general managers don’t always do a good job, as seen through the problems at Mid Staffs and other failing hospital trusts.

He said: ‘Nor do our findings rule out the possibility that the NHS has become overly bureaucratic with too much time devoted to administration and form filling to comply with targets.’

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