If the NHS's cheerleaders and detractors can agree on one thing, it's this: we need fewer backroom staff. If the health service's doctors, nurses and cleaners are heroes, the pen-pushers, middle-men and legions of drab men in drab suits are sucking the vital lifeblood out of the NHS, while droning on about synergies in management. All this while claiming a salary that could have paid for another two nurses.
This debate has re-emerged after it was reported that almost half of all NHS staff are managers, administrators or unqualified assistants. Helen Whately, the care minister, spoke for many when she said she feels 'strongly that the money we put into the NHS needs to go to frontline'. But she's wrong: if there is one thing that would help make the NHS better, it's more bureaucrats.
In fact, the health service needs far more back office staff. So do our police forces, and other vital public services. If you suggested to a supermarket that in order to improve service it let go of its logistics specialists in favour of more floor workers, you would get exceptionally short shrift once the laughing stopped. And you certainly wouldn’t blame the empty shelves on the staff in the store.
With policing and healthcare, there’s no good visual shorthand showing you that something’s gone wrong up the chain of production. All there is to see is a crowded waiting room, and clinical staff rushed off their feet. Assuming the issue is a shortage of frontline workers is a natural logical step. In reality, the problem is more often one of management.
The point that ‘fund the frontline’ misses is that the number of frontline staff hired isn’t the number of frontline workers available; if your police officers or doctors are spending four or five hours of their day managing the burden of administration, they aren’t available to respond to a burglary or treat a new patient.
A lack of administrative staff means that police officers who should be out on the beat find themselves putting together files for the CPS, or entering reports onto parallel computer systems that still aren’t integrated. Meanwhile, doctors find themselves spending hours of their day phoning to chase results, copying drug charts word for word, printing blood stickers, or handling the administration involved with following up on discharged patients.
The burden of this lack of administrative firepower doesn’t just end up with doctors, but with patients who end up having to coordinate their own treatments; making sure doctors have the results of their scans, booking follow-ups, and generally taking on responsibilities that by definition they may not be capable of meeting.
The fix for this isn’t reducing paperwork. We need this administrative work to be done so that we can track outcomes, make sure people are given the right drugs, get the right treatment, get moved from department from department, or are given a fair trial. We just don’t need it to be done by frontline workers.
The confusion arises because people equate frontline staff with services, when frontline workers are just one part of the production process for these things. Being treated in a hospital isn’t just a matter of getting to see a doctor or a nurse, it’s a function of everything that goes into that; your medical records being up to date and available, different departments handling your treatment and the results of your scans over to one-another, bloodwork being correctly labelled, medicine being ordered and administered, and the machine generally ticking along as best it can.
When frontline availability is low because frontline staff spend their time on administration, hiring more doctors so that they can do their own paperwork is clearly an insane use of resources when you could hire specialist administrators at vastly lower cost. Doing so would free up time across the organisation, improve working conditions, and often fix gaps in management that arise when people are left to improvise for themselves.
But an obsessive focus on frontline services and staff ratios makes it hard for politicians to put in place the support staff doctors and police officers actually need to do their jobs. Pointing out that non-frontline staff effectively work for frontline staff – taking busy work and drudgery off their hands to allow them to focus on patients – seems to fall on deaf ears.
When the problem is a lack of administrative support, hiring more doctors or police officers won’t fix it. In fact, it might make it worse. If an organisation builds frontline capacity without the right support in place, things start to slip through the cracks. You wouldn’t open a supermarket without making sure supply chain capacity was in place; why would you hire more doctors without making sure they had the support they need to do their work?