Tuesday, February 01, 2005

How many managers does it take to treat one patient?

According to a Kings Fund briefing in 2001, "The number of hospital beds has been declining ever since the establishment of the NHS. The total number of hospital beds in Great Britain fell from around 550,000 in 1959 to 450,000 in 1979, to 250,000 in 1999" (http://www.kingsfund.org.uk/pdf/ebhospbed-6.PDF). I have even seen a figure of 149,000 in a BBC report in 2000 (http://news.bbc.co.uk/1/hi/health/637055.stm). It may well be that changes in practice (e.g. shorter stay, day-case surgery, etc) means that the modern NHS needs fewer beds, but it is equally true that this cull in beds has been over zealous. Not surprisingly, an inquiry in 2000 concluded that 4,000 beds need to be introduced in the short term and a further 25,000 beds by 2020 just to maintain the status quo.

What about hospital clinical activity? The Department of Health publishes Hospital Episode Statistics annually, and recent reports are available at their web site (http://www.dh.gov.uk/PublicationsAndStatistics/Statistics/HospitalEpisodeStatistics/fs/en). For instance, a comparison between the financial years 1998/99 (A) and 2003/04 (B) shows the following changes:

Finished Consultant Episodes (FCEs): A=11,983,893 B=13,174,480 (+9.9%)
Ordinary admissions: A=8,563,098 b=9,417,004 (+10.0%)
Day cases: A=3,420,795 B=3,757,476 (+9.8%)
Total admissions: A=11,016,652 B=11,699,163 (+6.2%)
Total discharges: A=11,060,510 B=11,757,022 (+6.3%)

So, we are treating more patients in fewer beds. Fine.

But there is more. Binley's is a health & care information specialist who has been delivering specialist health and care information solutions to the public and private sector for over a decade. They provide analysis about the NHS, including data about staffing. This makes interesting reading. If you look at staff trends between 1997 (A) and September 2003 (B), you will find the following*:

No. of hospital doctors and dentists: A=62,048 B=77,210 (+24.4%)
No. of hospital and community nurses: A=300,468 B=364,692 (+21.4%)
No. of general practitioners: A=29,389 B=32,593 (+10.9%)
No. of dentists (excluding hospitals dentists): A=18,296 B=20,984 (+14.7%)
No. of managers and senior managers: A=22,175 B=35,321 (+59.3%)

So, we are treating more patients in fewer beds with more clinical staff. Fine. I am sure that patient treatment and care has improved as a result. But do we really need a 60% increase in managerial staff when there has only been a 10% or so increase in hospital clinical activity? Do we really need one manager/senior manager for every 3.7 doctor or dentist. I don't think so. Wouldn't the millions spent on increased management costs have been better spent paying our nurses the salary they deserve? I think so.

* Data taken from http://www.binleys.com/nhsstructure.asp