Reflecting on the swingeing cuts at the Royal Free and having done a bit of homework with various medical experts, I have come to the conclusion that many of the problems stem from the fact that management make decisions about which jobs to cut, and doctors are relatively expensive compared to, say, nurses.
However due to the way medicine works, it requires several nurses on the ward for every doctor. At the end of the day it is clinical staff – not managers – who see, assess, treat, take responsibility for, and discharge patients. The biggest growth area in the NHS is middle management. It would be virtually impossible to find a clinician who has any idea of the purpose/reason for this management ‘growth industry.’ Conversely managers often start interfering with clinical decisions based on a lack of medical understanding – for example pressure to discharge patients prematurely, thereby increasing their chances of rapid readmission.
Admittedly most doctors are patient-centred and not management-trained, so those hard-working managers who keep our cupboards stocked and pay the bills are crucial. The rest, who sit in pointless 9-5 meetings and hypothesise about meeting targets, while there are not enough clinicians to possibly do so within the limits of physics, should be redistributed.