About the research

Accordingly, policies aimed at controlling the growth and remuneration of managers are often very popular, conforming to media stereotypes of unproductive “fat cats”. For example, the former Secretary of State for Health Alan Milburn famously described managers as “men in grey suits”, pledging to reduce their numbers. When in a similar role, Jeremy Hunt suggested that “the NHS made a historic mistake in the 1980s by deliberately creating a manager class who were not clinicians”.

The findings show that, contrary to popular belief, managers do not engage in empire building activities in relation to growth in their numbers and lower managerial turnover. A higher proportion of managers to staff is also associated with a higher average salary per manager.

Furthermore, the results reveal that higher manager-to-staff ratios in hospital trusts have a statistically significant positive impact on the efficiency and effectiveness of services provided. Thus, despite some high-profile cases of incompetent management practices and organisational failures, our research does not offer evidence that managers engage in self-serving behaviour.

In fact, it emphasizes the overall net positive contribution that NHS managers make to healthcare. As such, along with clinical staff, investment in managers should be a key priority in implementing the NHS Long Term Plan.

This research used a longitudinal database of 160 English NHS acute care hospital trusts spanning six years (from 2007 to 2012). We selected those years because it was easier to collect and combine data on managers and the performance of hospital trusts and the data was consistent.

We employed multiple regression analysis to investigate, first, whether managers engage in self-serving behaviour expressed as increases in their relative numbers, salary levels, and stability in the role. Second, we wanted to know if a larger management function has any (negative) implication for organisational performance. Here, we looked at three separate indicators: relative financial efficiency, overall patient experience, and the rate of infection for C. difficile.