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Don't believe it when they say front line services won't be cut.

There is an assumption often made in debate on the NHS. It is said there are too many managers. It is an assumption rarely supported with any kind of evidence. It is one of those ideas we just have to go along with. If you suggest otherwise people will think you are an idiot. So, we just go along with it. But is it true? The truth is I have no idea, but I suspect neither does anyone else, although there may be one or two 'experts' in the field of man management who do. But it is a very dangerous assumption.

It is important of course because the other idea we hear a lot is that 'cuts won't affect front line services'. The truth is, despite pledges given by the government, the NHS has already lost over 6000 nurses. But why would anyone take seriously the idea that cuts would not affect the 'front line'? The reason is the assumption, you see, that there is so much management and 'back office staff', that these could be shed instead. Now if you believe that, then you are...mistaken. We hear it for the police too; 'back-room staff'.  If only we could get rid of these useless cretins then all would be well. They don't really do anything, so getting rid of them would be painless. We hear it in relation to the 'bobby on the beat'. It is all a load of political twaddle, and it is said with such gravitas. And the reason they can get away with it is because, of course, we always go along with the 'too much management' idea. The truth is we have lost over 9600 front line police. In Greater Manchester they have lost a third of their traffic police. 

The other idea is 'form filling', as if this was totally unnecessary. But imagine if the police never filled in any forms, or the doctor never made any notes, or if a nurse never ticked a few boxes. I would be very concerned. "Can I see my notes?" "What notes?" Not a good scenario for effective clinical management. 

There are of course different kinds of manager. In one sense the person whose job it is to make the tea could be said to be a manager, if only because they manage. Anyone who organises anything is a manager. IT managers manage...IT. Clinical managers manage...clinics. Not difficult is it? And that brings me to my next assumption. All managers are overpaid. 

Now the assumption that all managers are overpaid stems largely from the assumption that they are not really necessary; in which case they shouldn't be being paid at all! It is easy to accept one assumption once you accept another. They tend to arrive in sets. A set of assumptions often underlies debate and unfortunately decisions. We tend to take the highest paid as our example of the public service gravy train. We rarely consider the lower paid or how many of them there might be. Here is a list of types of manager posts in the NHS: Porter team leader, Cook team leader, finance team leader, General office manager, business manager, catering manager, clinical team leader, finance team manager....Chaplain team leader....Perhaps I had better not list them all. There are about 87 of them with increasing degrees of seniority.  Now you might say "there you are then, 87, far too many!" But what would be a good number? 50? 60? And why? Also, not all of them are by any means highly paid. 

The truth is that if there weren't any managers then we would have to invent them. If you want to make a complaint anywhere the first thing you think of asking is 'who is in charge?'. Who is responsible for arranging the deck chairs? Who is responsible for things being in the right place at the right time and in working order? If the answer was 'nobody' then I expect you would call that ridiculous. And who would be processing your complaint? Someone in the 'back office'. 

Even when we are not talking about managers there is an assumption that back-office staff can be culled without real effect on services. But this is clearly ridiculous. Without the back-office staff the the front line staff would be more overloaded with paperwork than they are. In a recent survey 88% of social workers feared that vulnerable lives were being put at risk because of the cuts. Cuts had increased workload and social workers were not able to spend sufficient time with vulnerable children and parents.  Lives are put at risk by these silly and unsubstantiated assumptions made by politicians. But do we really believe the politicians believe these assumptions? 

Now remember I am an agnostic about all this. I don't know if there are too many managers or too much form filling; but if you are going to use the assumption that there is then I would ask that you present more than odd snips of anecdotal evidence. And I would advise caution when politicians tell you that cuts won't affect front line services. They will. They will because of another assumption; that the front line can work without back-office support or management.

Postscript

The Royal College of Nursing  has identified 61,276 NHS posts which have either disappeared or are set to go as a result of cuts in spending and warn that the NHS is "sleep walking into a crisis." Nurses say that they "do not have enough staff to deliver good quality care. Demand for services is continuing to rise, however staffing levels are being slashed."  

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