As the NHS celebrates its 75th anniversary, all is not well. Alongside the familiar list of ailments – chronic staff shortages, decaying infrastructure and waiting lists longer than the average lifespan – are doubts about the spiralling costs of managers. As the Tory MP, Philip Davies, glibly informed one of his constituents: ‘The problem is that the NHS is appallingly run with far too many overpaid and utterly useless senior managers who wouldn’t be able to get a similar job in the private sector’ (McKay, 2023). Such claims are a recurring and depressing theme in contemporary public debate (Kirkpatrick, Veronesi and Altanlar, 2017a; Kings Fund, 2011) and, if anything, seem to have become increasingly common. Most recently, with great fanfare, the Daily Mail heralded a ‘Bonfire of the pen pushers’, reporting plans by Health Secretary Steve Barclay to ‘Crackdown on NHS bureaucrats costing taxpayers £2.8 billion a year’. The government will ‘root out waste, wokery and deadwood to cut costs and free doctors from red tape amid backlog crisis’ (Huskisson, 2022). Even the political opposition are getting in on the act, with Kier Starmer, leader of the Labour party, pledging to slash ‘nonsense bureaucracy in [the] NHS’ (Turner, 2023).

Hence, for many concerned observers, NHS managers have become part of the problem. The dominant view is that the NHS employs too many managers and back room administrators, soaking up resources, stifling creativity and interfering with the work of frontline clinicians. Of course, some have challenged this view. According to Managers in Partnership (2015), ‘[NHS] Managers make a distinct contribution as the people who organise care, fix problems and ultimately take responsibility for the services people depend on’. Ultimately, ‘Managers are the people who keep the show on the road, day-in day-out’. Claims about unsustainable management costs have also been subject to critical scrutiny by researchers (Kings Fund, 2011) as has the very idea that an organisation as large and complex as the NHS could ever function without managers to coordinate things (Mintzberg, 2017). This is especially in light of current plans to re-organise around integrated care and continuing problems associated with workforce planning, unequal access to services and ‘unwarranted variation’.