Post 51 Hospital management tricks

‘Too many chiefs and not enough Indians’ has been a common criticism of the Health Service for many years. Certainly, those at the coalface, if I may be allowed to mix my metaphors, frequently complain that there are too many managers and insufficient doctors, nurses, and paramedics, a theme that has frequently been picked up in the popular press.

Working as a consultant on a surgical unit at the time, Bernard Wilkins was therefore delighted to hear at a committee meeting, of a Government initiative to increase the proportion of clinical staff in the hospital. Great, he thought, a chance to improve staffing levels on the ward.

Bernard therefore, raised the matter under ‘Any other Business’ addressing his question to the Chief Executive.

‘Yes’, he was assured, ‘such a directive has indeed been issued by the Department of Health; the ratio of clinical staff to managerial staff is to be adjusted in favour of the clinical staff. All hospitals are required to become compliant within a fixed time period.’

‘And how long is this fixed period?’ Bernard asked.

‘Six months’.

‘And are we compliant at present?’

‘No, we aren’t. We have some work to do to address the problem.’

Bernard was delighted. Here was a chance to bolster the staff on the wards.

 During the next couple of weeks, with the help of his Nursing Sisters, he wrote a formal business case to increase the complement of nurses by two on each of the surgical wards and submitted it to the Chief Executive. Working on the assumption that his request would not be granted in full, and certain that others would be hoping to take advantage of this opportunity, he added a request for a theatre nurse and theatre orderly as well. His submission was acknowledged, so he sat back and waited expectantly.

Three months passed. Then another three and still Bernard had heard nothing, so at the next meeting, again under ‘Any Other Business’, he asked for a progress report.

‘I’m pleased to say that the requirements of the NHS Directive have now been met,’ the Chief Executive announced.

‘You mean we are now compliant and have improved the ratio of clinical staff to managers?’  

‘That’s correct.’

Bernard was puzzled, his application for more nurses hadn’t been granted, he wasn’t aware that any new clinical staff had been appointed elsewhere in the hospital, and there seemed to be just as many managers as before.

‘So how many extra nurses do we now employ?’

‘We didn’t find it necessary to increase their number.’

‘So presumably we now have some additional paramedical staff: physios, dieticians, or healthcare assistants?’


‘In that case, you must have reduced the number of managers.’

The CEO was starting to look a bit shifty. ‘Not necessarily,’ he said.

‘Well, if you haven’t increased the number of clinical staff, and haven’t reduced the number of managers, how can we be compliant with the Directive now, if we weren’t before?’ Bernard demanded.

‘We decided to classify the consultant’s secretaries as clinical staff!’


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