The State of NHS Management Today

On 22nd January, 2025, the first in a series of events linked to the Health Foundation funded project ‘Management capacity and capability in NHS trusts and system-level partnerships’, led by the School for Business and Society at the University of York, was held.

This inaugural event, titled “The State of NHS Management Today,” was hosted by Bayes Business School and brought together policy-makers, academics, and healthcare professionals for a rich discussion about the challenges and opportunities facing NHS management. This thought provoking session explored some of the most pressing issues confronting NHS leaders today, and how they might be addressed.

Ian Kirkpatrick (Professor in Public Management at York, and the Project Lead) and Amanda Goodall [1] (Professor in Leadership at Bayes) set the stage for an engaging and, at times, provocative conversation.

Professor Goodall began proceedings by drawing on her own research,  explaining how the quality of line management is associated with employee turnover. Using data from 400,000 individuals and 130 trusts, she found that a one-unit increase in line manager quality is associated with a 17% decrease in NHS employee intention to quit. Prof Goodall emphasised the importance of good management and need for expert leaders at all organisational levels to enhance organisational performance, job satisfaction and staff retention.

Prof Kirkpatrick presented some of the history of NHS management, referencing a number of key reports (Griffiths, 1983[2]; Messenger, 2022[3] and Darzi, 2024[4]) and the methods that will be used in this Health Foundation funded project to determine whether the NHS has sufficient managers (management capacity)  and whether they are capable and effective in their roles. These reviews (Darzi in particular) have critiqued the ongoing negative perceptions of managers and called for restraint in ‘management bashing’ . These perceptions persist, however, and there continues to be a view  that the NHS is over-managed, despite current data which suggests the NHS has fewer managers than other health systems.

The panel discussion that followed featured key insights from Alistair McLellan (Editor, Health Services Journal), Charlotte Williams (Deputy CEO, North West Anglia NHS Foundation Trust), Dr Sanjiv Sharma (Deputy CEO and Executive Medical Director, Great Ormond Street Hospital), and Robin Bagchi (Independent Consultant). Each speaker brought a unique perspective on what effective NHS management looks like today:

• Alistair McLellan discussed the role of politicians and the media in shaping perceptions of NHS management, sharing anecdotes about Tony Blair and Jeremy Hunt.

• Charlotte Williams, an experienced health service manager, highlighted the negative perceptions of NHS managers, including being overpaid, bureaucratic, and ineffective.

• Dr Sanjeev Sharma, a paediatric and neonatal intensive care consultant, discussed the challenges of being a medical leader and the importance of making difficult decisions with limited good options.

• Robin Bagchi, with experience in investment banking and technology, compares the perceptions and realities of management in different sectors, emphasizing the need for decentralized decision-making and empowered managers.

Following presentations from the panel, a lively Q&A session with audience members generated a large number of comments and debate. A central theme that emerged from the discussion was the persistent negative perception of NHS managers. As several panellists noted, public and clinical narratives often reduce management to bureaucracy, failing to recognise its vital role in ensuring patient safety, nurturing innovation, and driving system-wide improvements. The panel highlighted that changing this perception is not just about public relations—it’s about creating the conditions where managers are seen as integral partners in delivering healthcare excellence. This can be demonstrated by connecting management to improvement efforts and patient outcomes.

Another critical point of reflection was the balance between leadership and management and the necessity of both to navigate complex decision-making. As one panellist aptly observed, “My job is not to make everyone happy; it’s to make the least-worst decision in difficult circumstances.” The ability to navigate clinical, financial, and reputational risks while remaining compassionate and attentive to staff and patients is at the heart of good NHS management.

The conversation also touched on the NHS’s management structures and the tension between centralised and decentralised decision-making. Attendees heard how the NHS’s design, resource constraints, regulatory and political pressures and focus on compliance sometimes makes it almost impossible for managers to do their jobs effectively, stifling innovation and reinforcing risk aversion rather than enabling innovation and continuous improvement. Cost-cutting measures which lead to fewer managers and increasing administrative burdens on clinicians were not considered a viable solution. Comparisons were made with industries such as technology and investment banking, and countries such as the USA and Germany, where structures differ and management is seen as more integrated and essential. The panel called for a redesign that empowers local leaders while maintaining accountability.

One of the most powerful takeaways of the evening was the clear need for a different narrative about NHS management and the importance of public support for professionalisation of NHS management. The Chartered Management Institute’s work on establishing common standards and competencies for managers at all levels was welcomed, as was the acknowledgment that management—like any other healthcare discipline—requires investment in training, career progression, support networks and recognition. The involvement of the workforce in all aspects of professionalising management was agreed to be important. The panellists and audience also explored whether management should be considered a profession and regulated accordingly. One panellist noted that as a senior leader in the NHS they are already subject to significant regulation from various regulatory bodies. Colleagues in the audience suggested that the emphasis on the individual may send the wrong message and that leadership should be viewed collectively and systemically.

The event concluded with reflections from Professor Ian Kirkpatrick, who underscored the importance of building a positive narrative around NHS management, grounded in evidence and lived experience. Bryan Jones (Senior Improvement Fellow) and Lukasz Zielenski (National Medical Director’s Clinical Fellow), both from The Health Foundation echoed this, highlighting the organisation’s interest in this in-depth analysis of management capacity and capability and the importance the Health Foundation is placing on recognising how managers (from frontline to clinical) are key drivers of change, innovation and improvement, yet often lack the space, skills, and support to thrive.

The audience demonstrated shared commitment to not only confronting the challenges of NHS management but also reshaping its future. Events like this play a critical role in fostering dialogue, building communities of practice, and ensuring that NHS managers have the recognition and resources they need to support both their teams and the patients they serve.

The University of York and The Health Foundation look forward to continuing the conversation in future events and drawing on the insights shared on 22 January to inform the research project and future policy, practice, and management development across the health sector.    

The second event in the series will explore NHS management capacity and will take place at the University of Birmingham on 29 April 2025. Registration for the event will open in the co

Written By Kirsten Armit

[1] Bäker, A., Goodall, A.H. and Serra-Sastre, V. (2025) ‘Managing to stay: Does line-manager quality affect employees’ intention to quit in the NHS?’, Working Paper, Bayes Business School, City, University of London.

[2] Griffiths, E.R. (1983) NHS Management Inquiry: Griffiths Report on NHS, October 1983.Socialist Health Association (SHA),      https://sochealth.co.uk/national-health-service/griffiths-report-october-1983/

[3] HM Government (2022). Health and social care review: leadership for a collaborative and inclusive future,.https://www.gov.uk/government/publications/health-and-social-care-review-leadership-for-acollaborative-and-inclusive-future.

[4] HM Government (2024) Independent investigation of the National Health Service in England,