Why the NHS is failing.

Dr John Sydenham

The failure of the UK’s National Health Service has three causes: non-clinical management, part time working and use of overseas staff.

Clinical management of hospitals is clearly superior to using clinically unqualified administrators. This has been shown in multiple studies in the NHS, USA , Denmark, Australia, Switzerland and Germany. Managers and doctors appear to be at war within the NHS. Clinicians understand the demands of the job and can plan for new treatments and changes in the health of the nation. NHS Administrative Managers have a completely different perception of what is happening in the NHS to NHS Clinical Managers.

See Why the best Hospitals are Managed by Doctors.

Part time working has spread throughout the NHS. 76% of NHS staff are women and about a third to a half of these are part time. Any manager will recognise that this is a very difficult workforce to manage (although part time workers always claim they are more effective than full time workers, but they would, wouldn’t they?). (See NHS Failing, Civil Service Useless)

The poor management of the NHS has resulted in a massive loss of staff to Australia, USA etc. These staff have been replaced by staff from overseas. This is a vicious attack on poorer countries, for instance during the Ebola outbreak as many medical staff from Sierra Leone were working for the NHS as remained in Sierra Leone which had a disastrous effect on the ability of Sierra Leone to deal with the crisis.

Overseas doctors have little idea what is in store for them. They imagine they are joining a first world organisation and are thrown into a disaster area. Historically a large proportion of overseas staff have returned home, probably disillusioned.

There are 220,000 overseas staff in the NHS. The turnover of overseas staff is very high. In 2016 as many staff joined the NHS from overseas as left:

See NHS Staff from overseas: statistics.

The emigrating doctors, the part time women and the huge flux of overseas staff mean that the NHS has a totally unreliable foundation. Its workforce is like dry sand, collapsing as fast as it is built.

The NHS is appalling badly managed. The solution is obvious: it should be managed by senior clinicians who have attended management training. This would be a return to the pre-1970s when the NHS was run fairly well and became beloved by the population. The reason a professional management class was introduced in the 1970s was that doctors had too much power in wage negotiations and were keeping their pay and conditions up to first world norms. Had the doctors been able to continue maintaining standards for their staff the NHS would have been more expensive but a success.