Does the NHS need more managers than nurses?

There are so many people available to take notes, but so few to provide actual medical care

One of the minor horrors of war is the way it transfixes all attention and stifles other debates. Two years ago we witnessed an astonishing budget that promised to stop the years of decline in the National Health Service and restore it as the world's pre-eminent provider of health care.

Back then, this project seemed groundbreaking, something that would dominate political debate. This was the policy that the Blair Government wished to be judged by.

Now it's boring old background noise, seized upon only by Tories who hope that one day we'll all wake up to find that, as Michael Howard put it, "Labour is taxing and spending and failing". Mr Blair, in response, appears to be doing nothing more than crossing his fingers in the hope that one day we'll wake up to find that all has been fabulously transformed without having to pay much attention to it himself.

The stakes are surely too high, though, for this great experiment to meander on, especially when those who are observing do not much like what they see. The Office for National Statistics is only the latest body to question how all the money is being spent. It is concerned about how fast the money being pumped into the NHS is disappearing, failing to reach the front line but being eaten up instead by wages and management.

I'd certainly question whether money spent on wage rises was actually money not being spent on the front line. Only the most blinkered of free-market ideologues will not admit how much the NHS has been damaged by low wages, and how much money is spent on hiring agency staff to plug the gaps left by those who, understandably, have resigned to join agencies. Wage rises are the very first thing the NHS needs if it is to regain its own health, and the public understands this even if the Conservatives don't.

But, likewise, it is widely understood that one dreadful aspect of the Thatcherite decline in the NHS was the focus on management rather than health care. Sadly this doesn't seem to have been a lesson learned by government.

Michael Barber, the head of Number 10's own delivery unit warned last January that the risks of extra NHS money being squandered were "immense". His concern was with "management incompetence". In December, Sir Andrew Foster, the outgoing controller of the Audit Commission, warned that NHS workers were in danger of becoming "slightly punch-drunk" from the "sheer mass" of structural changes. He said: "People become preoccupied with establishing them [new institutions], and politicians become impatient, and before you know it there are calls for further change."

That's three bodies, all part of the Civil Service rather than biased think-tanks, pointing to the very same difficulty in achieving NHS reform. But still, the amount of managers in the NHS remains dizzying, unbelievable.

Can it really be true that there are more managers in the NHS than there are beds? More managers than there are qualified nurses? Apparently it is. There are now record levels of administrators beavering away in a record number of offices – not just bureaucrats, but also secretaries, receptionists and support staff assisting them as they do so.

Sometimes you do have to ask what it is they are all helping to run. Hospital admissions may not tell the whole story, but all the same, it is worrying to know that hospital admissions have fallen by half a per cent in the two years since extra cash started to flow into the NHS.

Anyway, while the Government claims that this reflects an increase in treatment outside hospital, the statistics don't back this up. The health budget has been increased by 21.5 per cent since 1999, but general activity levels have increased by only 1.6 per cent. That is, of course, if you don't count management activity.

On a recent stay in hospital, the consultant who had treated me had come to Britain from Prague. She told me that while there was not enough money for decent health care in Prague, the money that was wasted here drove her mad. Sweeping her arm across the beds in the ward, she declared that there could be double the amount if there were not so many offices.

She is not the only one. NHS consultants, who one hopes are in a good position to observe what's going on, also concluded in a recent report that it is "vast numbers of managers" that are soaking up the extra funds. Users of the service are noticing that, too.

A friend of mine, who has a one-year-old with severe brain damage, has spent the last year attempting to secure for her daughter the specialised care that will make a huge difference to her child's development. To that end she has played host to a never ending succession of NHS administrators, who have spent hours on end in her home and in their offices, questioning her about her difficult pregnancy, the premature birth, the months in intensive care and the progress of the baby since she came home.

The constant retelling of this information is traumatic for my friend, who has had plenty of trauma in her life already. But the best she gets in return for these endless revelations is sympathy and hand-pats. Although there appear to be inexhaustible hours for her predicament to be discussed, and endless processes by which my friend's daughter is registered as blind, epilectic and so on for help with future educational "statementing", administrators have nothing much to offer except talk.

Sometimes the talk isn't that sympathetic either. One professional visitor to my friend's house asked her what practical difference there really was between having a special-needs baby and having a normal baby. All babies need round-the-clock care anyway, was the message.

This attitude, that specialist care of children should always be provided by auto-didactic parents who are willing to train themselves up as amateur adjuncts to the health service, under managerial rather than medical supervision, appears to be followed through at policy level.

The sprawling borough that provides this army of assessors and managers runs only one nursery for children with special needs (complete with gargantuan waiting list) and one physiotherapist working two days a week (utterly over-subscribed). If you can't – and believe me, you can't – get access to these meagre resources, then all that can be offered is three hours a week of respite care.

How can it be that there are so many people available to ask questions, take notes and file reports, when there are so few people available to provide actual medical help?

It strikes me that this obsession with management grew up precisely to provide a smokescreen at the time when the service was being ruthlessly run down. The management was put in place 20 years ago to prove that the health service was inefficient. Instead, it has come to be the main provider of inefficiency itself.

Now, paradoxically, new layers of management are being recruited in order to provide a smokescreen against investment in the health service. The primary care trusts, the strategic health authorities, the foundation hospitals, all these have been brought into existence to show that the NHS isn't getting money for nothing. If we're not careful, though, they could ensure that the NHS might as well not be getting any money at all.

d.orr@independent.co.uk