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Trusts with more managers yield better patient outcomes, research finds

Trusts who have more managers tend to have better patient care and outcomes, new research released this week has found.

Academics from Warwick Business School, the University of Bristol and the University of Leeds looked through six years’ worth of NHS data to measure the performance of 150 acute hospital trusts in England from 2007 to 2012.

Their findings revealed that trusts with a higher level of managers tended to perform better than trusts with less managers.

This is despite David Cameron’s government cutting managerial positions at trusts to reduce bureaucracy and make trusts run more efficiently through the implementation of the Health and Social Care Act 2012.

There are currently around 40,000 general managers in the NHS within a workforce of 1.36 million people. Clinical professionals in management roles make up about 30% of this number, the remainder comes from administrative backgrounds like accounting and business.

Researchers found that a 1% increase in the management-to-staff ratio of acute trusts – with managers rising from 2-3% of the workforce – would place those trusts in the top third of trusts in terms of performance for efficiency and patient experience (satisfaction) scores. This equates to having 39 more managers in the trust and translates into a 3% improvement in trust efficiency and a 2% improvement in patient experience (satisfaction) scores.

“Contrary to what many policymakers and media commentators would have us believe, our research suggests the NHS is not ‘over-managed’ and that managers, as a group, are making significant contributions to efficiency and improved patient care,” said Warwick’s Professor Ian Kirkpatrick, an author of the report.

“The evidence shows, overall, the positive contributions of general managers appear to be greater than the costs and risks associated with ineffective management.

“We found that higher levels of managers in a trust had a statistically significant relationship with improved outcomes in terms of infection rates and hospital patient experience scores,” Prof Kirkpatrick continued.

“Further tests exploring the impact of management pay and stability levels also yielded positive results, showing that when average levels of pay and stability are higher, managers can have an even stronger positive impact on patient experience and efficiency.”

The professor added that the new findings called into question many of the assumptions about the failure of general managers in the NHS.

“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,” said Prof Kirkpatrick.

However, he conceded: “Of course, this is not to suggest that general managers always do a good job. The experience of Mid Staffordshire and other failing hospital trusts is testimony to that fact.

“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. But the evidence suggests that overall managers make a positive contribution to the running of trusts.”

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