Strengthening NHS Management Capacity: Reflections from the Birmingham Panel Discuss

Attendees and Panelists during a talk at the Conference

We were delighted to hold our second in a series of events exploring the state of NHS management on 29 April 2025. Linked to our ongoing research, the event was organised in partnership with the Health Foundation and the Health Services Management Centre (HSMC), at the University of Birmingham. We were pleased to have diverse group of academics, policymakers and healthcare leaders joining our discussion.

A timely gathering

The event was kicked off by a warm welcome from Professor Ross Millar (Director of HSMC) and Professor Mark Exworthy (Professor of Health Policy and Management at HSMC) . In his opening speech, Ross highlighted that strengthening management in the NHS comes at a critical moment. The current debates over management capacity in the NHS are also at the centre of our ongoing project funded by the Health Foundation.

Bryan Jones, senior improvement fellow of the Health Foundation, then focused on how management within the NHS has long been undervalued. He noted the tendency—particularly in moments of crisis—for media and political discourse to target managers, often casting them as “bureaucrats” or “checkers” rather than vital enablers of change. This, he argued, is at odds with a strong evidence base that consistently links effective management to better organisational performance, patient outcomes, and innovation. “Managers are the glue,” he said. Managers connect the top of the organisation to the frontline, enabling information flows, and supporting change. The challenge now is to ensure this contribution is properly valued, supported and sustained.

Next, Dr Lukasz Zielinski, clinical fellow of the Health Foundation, challenged a simplistic understanding of management capacity purely defined by numbers. Lukasz argued that today’s managers work is carried out in an increasingly collaborative, data-driven, place-based NHS. Capacity, therefore, isn’t just about headcount, but about autonomy, digital literacy, and the ability to work across organisational boundaries. In fact, managers played a critical role in supporting innovation, fostering learning and complex collaborations across skill boundaries. Yet many do so under immense pressure, in what is called “extreme jobs”—fast-paced, high-intensity roles with little room for reflection or strategic thinking.

Insights from practice: different perspectives

Following the opening speeches, we came to our panel discussion. Professor Leo McCann of the University of York chaired the panel discussion. Leo set the scene for the discussion by reminding us of the major challenges faced by NHS managers, including frequent change, unclear expectations, performance scrutiny—have remained consistent over decades. Drawing on current research, Leo warned that over-regulation and excessive managerialism can become counterproductive, leading to burnout, inefficiency and disengagement. He also reflected on the chronical problem of “invisible management,” where the complexity of what managers do is not understood, recognised, or championed, even within their own organisations.

In the following discussion, based on their experience in the NHS, four panellists shared their insights regarding the key capacity that NHS management needs.

Richard Kirby, Chief Executive of Birmingham Community Healthcare NHS Foundation Trust, reflected on 30 years of NHS management experience. He described the evolving character of NHS management—from administered bureaucracy to commercial Foundation Trusts, to today’s focus on system working and collaboration. Each phase brought different expectations of managers, contributing to a lack of clarity about their role and purpose. Richard strongly advocated for professional regulation of NHS management, arguing it would bring greater consistency, accountability, and credibility. He noted that managers need not just data, but capability, support, and compassion to lead through complexity. Richard also stressed that metrics such as the staff survey must be taken seriously, explaining that if staff wouldn’t recommend their organisation as a place to work, something must change.

Sharon Malhi, Executive Chief People Officer at the Royal Orthopaedic Hospital NHS Foundation Trust, turned our attention to cultural aspect of management in the NHS. She offered a personal reflection on the cultural barriers that led her to leave the NHS early in her career. Feeling unsupported and stifled, she sought experience outside the sector before returning with renewed resilience. Sharon urged for a rebalancing of NHS leadership development—beyond technical skills, to include resilience, emotional intelligence, and talent management. Crucially, she argued that the NHS still lacks a shared definition of what good management looks like. “We put people into roles,” she said, “but don’t always put the infrastructure around them to thrive.” Without a common understanding of management standards and expectations and talent management we will continue to struggle to achieve the changes the NHS requires.

Focusing on workforce development, Jon Freegard, Director of Client Delivery at the Workforce Development Trust, was alerted to recent cuts in NHS England and ICB management roles as a sign of undermining current management capacity in the NHS, given that the service demand hasn’t reduced. Jon pointed out that without a plan to redistribute or redesign the work, expectations remain—and often fall back onto frontline clinicians. This, he argued, risks increasing burnout, reducing confidence, and worsening outcomes. Jon called for greater use of activity analysis, logic models, and workforce planning to guide decisions on restructuring. He urged us to reflect not only on what is being cut, but what is being left behind—and who will be expected to carry it.

From the perspective of general practice providers, Dr Mina Gupta, Group Clinical Chair of the Modality Partnership, emphasised how important integral management is to delivering sustainable primary care. Based on her own experience of managing Modality, which has 1,800 staff, 480,000 patients, 53 sites and a national footprint and delivering a mixture of primary care, outpatient services and research, she illustrated that management plays an essential role to maintain financial stability, workforce well-being, and service transformation in complex organisations like Modality. Particularly, Mina raised concerns about the lack of structured management pathways for primary care. “The NHS graduate management scheme doesn’t cover primary care at all,” she noted. Instead, most of their managers are internally developed and trained through experience. She called for investment in primary care-specific management development, and shared practical examples of innovation, such as the use of AI-powered tools like ambient scribes and large language models, that have significantly reduced administrative burden and released time for leadership.

Reframing the narrative

In a nutshell, our second event reinforced the urgent need to rethink how NHS management is understood, supported and developed. The calls were clear:

Reframe perceptions of NHS management as a science and a profession—not an administrative burden.
Define what good looks like, through national standards and professional regulation.
Invest in development pathways across the NHS, including for primary care and generalist managers.
Protect time and space for managers to reflect, learn, and lead—not just firefight.
Use evidence and planning tools to inform decisions, particularly restructuring risks unintended consequences.

As the NHS continues to navigate economic, political, and service pressures, one thing is certain: the system cannot succeed without capable, confident, and valued managers.

This blog summarises the event ‘NHS Management Capacity’, held on 29 April 2025 at the University of Birmingham. The event was part of a wider research initiative led by the University of York and supported by the Health Foundation.

For further information please contact:

Professor Ian Kirkpatrick

ian.kirkpatrick@york.ac.uk
+44 (0) 1904 326444

Information about the project is available on: https://www.york.ac.uk/business-society/research/management-capacity-and-capability-in-healthcare/management-capacity-and-capability-in-the-nhs/

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