The management of the NHS in England

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e928 (Published 08 February 2012) Cite this as: BMJ 2012;344:e928
  1. Chris Ham, chief executive
  1. 1King’s Fund, London W1G 0AN, UK
  1. c.ham{at}kingsfund.org.uk

Loss of experienced managers creates a risk that performance will suffer

The shape of the reformed NHS has become much clearer since the recent publication of papers on the role of the NHS Commissioning Board and the sources of support available to clinical commissioning groups.1 2 These papers sound the death knell for strategic health authorities and primary care trusts, which are destined to be abolished in April 2013. Most of the functions of the strategic health authorities and primary care trusts will be taken on by the Commissioning Board and clinical commissioning groups, with the board being organised into four sectors with a total of 50 local offices.

On the surface the proposed arrangements may look similar to the four strategic health authority and 50 primary care trust clusters that exist currently, but in reality the new organisation will be very different. Each sector office and each local office will employ only 50 staff compared with the many more currently employed, so thousands of jobs will be lost. Redundancies among managers will contribute to a 50% reduction in management costs in the new organisation as the government seeks to fulfil its promise to put more resources into front line clinical care.

These changes build on work already done to cut back on the number of managers working in the NHS in anticipation of the controversial Health and Social Care Bill …

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