An in-depth analysis of the factors behind the problems being experienced in many A&E departments points to problems with patient flow as a result, at least in part, of insufficient staff in non-clinical managerial and other roles.
‘The A&E crisis; what’s really driving poor performance’, published by Reform, aims to identify the true nature of the problem so that the crisis can be tackled. The analysis supports the argument that delayed discharges are a big cause, but disputes the theory that these delays are wholly as a result of problems in social care. Instead, Reform’s analysis of data released by NHS England for delayed discharge of patients who were deemed medically fit to leave hospital during December 2022 finds that in 43% of cases the reasons for this lay within the responsibility of the NHS.
Largely, this is an operational issue – such as delays to the discharge summary being written, take-home medicines provided, diagnostic tests and transport. These factors are all down to the vital role that managers play in co-ordinating discharge so that patients can return home as quickly as possible.
“Despite the popular myth that the NHS has too many managers, it is actually under-managed – given the complex logistics involved in delivering healthcare, it is odd that NHS managers make up roughly 2% of the workforce, compared to 9.5% in the UK workforce as a whole,” the report states.
The Reform analysis believes long hospital stays may be driven by internal failures of co-ordination. Whilst focus is continually placed on the numbers of frontline clinical staff, which are increasing in numbers, there has not been a commensurate increase in the number of managers in the system. In spite of their increasing numbers, the productivity of clinical staff is diminished if they are having to perform administrative tasks that managers would normally take care of.
The analysis also believes that challenges in management may be contributing to the high levels of variation in performance being seen between NHS Trusts. Where other factors remain constant, shortcomings in operational management, such as failure to manage admissions, bed flow and discharge appropriately can have a major impact on performance.
Management workforce percentage figures from Ian Kirkpatrick and Becky Malby, ‘Is the NHS Overmanaged?’, NHS Confederation, 24 January 2022
