Letter: A rash of bureaucracy in the NHS

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Sir: I was not surprised to read letters from Ray Rowden of the Institute of Health Services Managers and Rosey Foster of the Association of Managers in General Practice (5 August) following your report on the massive increase in management and administration within primary care ('Managers in family doctor practices rise by 41 per cent', 3 August). They clearly have a job to do - to defend their members.

Mr Rowden suggests I do not understand today's health service because 'the rise in managers is nothing to do with . . . Mrs Bottomley'. In the very next paragraph, the unsustainability of this curious defence becomes apparent when he contradicts himself by saying 'primary care has become more complex since the introduction of fundholding'.

Exactly] Mrs Bottomley's reforms - with the internal market, purchaser-provider split and fundholding - have created the need for more managers at every level in the National Health Service: 12,000 extra managers within secondary (hospital) care, 2,000 in primary care, and along the way, 1,000 additional staff in Whitehall.

Of course the Labour Party supports good management in the NHS. It is not criticising individual managers but the Conservatives' 'reforms' which logically and inevitably have led to a burgeoning bureaucracy; and there are legitimate questions to be asked about the correct use of scarce resources. Mr Rowden is wrong to suggest I am insulting anyone, just as he is wrong to suggest that Labour does not have an alternative to fundholding.

Our plans for joint commissioning will be cheaper to run, will be more popular with GPs, will eradicate the two-tier system from the NHS and will not corrupt the doctor-patient relationship: it will also reduce the need for bureaucracy, but perhaps that is why Mr Rowden finds them unconvincing.

Yours sincerely,


MP for Bristol South (Lab)

House of Commons

London, SW1

5 August

The writer is Shadow Minister for Health.