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The King’s Fund Commission urges politicians to value the role of management in the NHS

A nine month inquiry by The King’s Fund’s Commission on NHS Leadership and Management finds the NHS in urgent need of a new style of leadership to overcome unprecedented financial pressures and adapt to future challenges. The report from the Commission emphasises the crucial role excellent general and clinical managers can play in delivering the productivity improvements and service transformation that the NHS requires.

The Commission finds high-quality, stable management to be key to high-performing health services. Yet across the NHS, the average chief executive spends just 700 days in post. In part, this reflects a culture where ‘heroic’ leaders grapple with problems only from the top of the organisation, or are ‘parachuted in’ to replace individual managers and ‘turn around’ troubled NHS services. The report advocates a new type of ‘shared leadership’ involving leaders at different levels of the workforce working collaboratively with all those involved in patient care to lead change and improve services, rather than only tackling problems inside specific institutions.

The Commission examined evidence from UK and international health care and other sectors, finding that given its size and complexity, the NHS is under-managed, but over-administered. Key issues were that

  • no assessment of the future needs of the NHS has been made, yet the coalition government has imposed a 45% cut in NHS management posts and 33% cut in administration costs
  • a large cohort of NHS administrators has developed over time to respond to extensive and often duplicated requirements from multiple regulators and performance managers; an urgent assessment of the information demands placed on the NHS is needed
  • each NHS organisation should take responsibility for its own leadership development and quality of management, including dealing with failing managers.
  • the work that has started to strengthen leadership and leadership development should be taken forward through the creation of an NHS Leadership Centre.

The report highlights the important contribution that both doctors and nurses and allied health professionals (clinical leaders) and general managers (non-clinical leaders) can make to these improvements.

Professor Chris Ham, Chair of the Commission on NHS Leadership and Management and Chief Executive of The King’s Fund, said of the findings

‘We know there is public support for reducing the number of NHS managers. But given the immense challenges facing the NHS, politicians of all parties must resist the temptation to denigrate the value of management in delivering excellent and efficient services.

‘The priority for the future NHS must be to deliver the best care possible to those with chronic and long-term conditions. That needs a new style of NHS leader, as adept at building partnerships to deliver care across boundaries as they are at managing their own services.'

Notes to editors

For further information or to request an interview, please contact The King’s Fund media and public affairs office on 020 7307 2585. If you are calling out-of-hours, please ring 07584 146035. An ISDN line is available for interviews on 020 7637 0185.

The report The future of leadership and management in the NHS: No more heroes was launched at the NHS Leadership and Management Summit at The King’s Fund on 18 May with a keynote presentation by Rt Hon Andrew Lansley CBE MP, Secretary of State for Health. The summit will be live streamed at from 9.40am and you can follow the event on Twitter by using the hashtag #nhsleaders

The Commission evaluated national and international evidence from health and other sectors to gather information about:

  • the current state of leadership and management in the NHS
  • the leadership and management capabilities the NHS will need in the future
  • how current capabilities can be strengthened to meet these needs.  

The Commission is chaired by Professor Chris Ham, Chief Executive, The King’s Fund.

The members are:

  • Professor Ross Baker, University of Toronto
  • Dame Jacqueline Docherty, Chief Executive, West Middlesex University Hospital NHS Trust
  • Dr Peter Hockey, Deputy Medical Director, NHS South Central and former Harkness Fellow
  • Lord Tugendhat, Chair, The Imperial College Healthcare NHS Trust
  • Professor Kieran Walshe, Manchester Business School
  • Kate Lobley, Director of Leadership, The King’s Fund.

Nicholas Timmins, Public Policy Editor of the Financial Times acted as Secretary to the Commission and wrote the final report. For more information, please see the NHS Leadership and Management Commission pages on The King’s Fund website at:

  • The NHS officially has around 45,000 managers although this figure is not definitive. Many clinical managers (medical directors and directors of nursing) are excluded from this definition.
  • The NHS sees more than 1 million patients every 36 hours, spends more than £105 billion of public money each year (nearly £2 billion per week) and employs around one and a half million people.
  • Aside from the banks, the only companies with a larger turnover in the FTSE 100 are the global oil giants, BP and Shell.
  • If the NHS was a country it would be around the thirtieth largest in the world.
  • Sir David Nicholson, the NHS Chief Executive, is on record as saying: ‘We find it very difficult to recruit people who want to be chief executives – the average time they spend in post is just 700 days’ Santry C (2007). ‘Clinicians should be groomed for top jobs, says Nicholson’. Health Service Journal, 1 January.
  • A review in 2009 showed that NHS organisations were subject to 35 different regulators, auditors, inspectorates and accreditation agencies requiring information from different parts of the system. This may have reduced since then with changes in regulation (NHS Confederation and the Independent Advisory Service, 2009)
  • A survey of 2,000 people in July 2010 by the Local Government Association found that the public’s top choice for spending cuts was NHS managers (69% approval). Despite this, the main services respondents wanted to protect from cuts were ‘Doctors, nurses and other hospital staff ‘(56% approval)




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