Are there fewer NHS bureaucrats under the Coalition?

Published: 7th Jun 2013

"We promised that the number of doctors would grow faster than the number of bureaucrats"

David Cameron, Prime Minister's Questions, 29 February 2012

"That is why there are 18,000 fewer administrative staff [in the NHS], but there are almost 6,000 more doctors. That is what the Government have a record on"

David Cameron, Prime Minister's Questions, 5 June 2013

The state of the health service has become something of a mainstay at Prime Minister's Questions. This week was no different, with the PM championing the Coalition's record on reducing NHS bureaucracy.

The Health and Social Care Information Centre publishes experimental statistics on the NHS workforce. The national dataset provides estimated numbers for each month since September 2009.

The statistics show staff numbers for 'headcount', 'full-time equivalent' (FTE) and 'role count' staff. The FTE measure is the most commonly used indicator, although each set of figures tells a similar story.

More doctors?

If we look at the full-time equivalent statistics, the total number of NHS hospital and community doctors, as of February 2013, is 103,197. For May 2010 (at the time of the previous election) this figure was estimated at 97,729. Based on these figures, there are around 5,500 more doctors in the NHS since the election.

Whether or not this increase in doctors is the Coalition's doing is, however, another matter. Some have claimed that, given that new doctors are trained over several years, any increase in doctor numbers since 2010 may be the result of measures taken by the last Government, or may be due to other factors unrelated to policy.

Fewer bureaucrats?

When it comes to counting the number of NHS 'bureaucrats', it's a little more complicated. Unsurprisingly, the available statistics offer no category for 'bureaucrats' but instead list a number of categories under 'NHS Infrastructure Support'. This comprises 'central functions', 'hotel, property and estates', 'senior managers' and 'managers'.

Managers and senior managers are likely to count in the Prime Minister's definition of 'bureaucrats'. The data shows that, for full-time equivalents, the number of managers has fallen by 4,850 since the election. The number of senior managers has fallen by just over 2,000.

The NHS Information Centre clarified that people employed in 'central functions' were mainly involved in financial management. It suggested that the 'hotel, property and estates' category (which covers catering and maintenance) shouldn't be understood as 'bureaucracy'.

For central function staff, the total FTE currently stands at over 95,800, while in May 2010 the count was 104,110 staff. This represents a reduction of over 8,000 since the election.

Because of the vagueness of the description 'central functions', and the fact that some clerical staff work in 'hospital, property and estates', we can't precisely capture every NHS staff member who could be classed as a 'bureaucrat'. And, of course, there's no fixed definition for this term, which is often used perjoratively. 

NHS data shows that there are just under 7,000 fewer managers and senior managers in the NHS since the election. However, including those involved in 'central functions' could put the total reduction as high as 15,000 staff.

David Cameron has looked at the total number of people employed in 'NHS Infrastructure Support' when he claims that there are now "18,000 fewer administrative staff". This means that he has included the number of people working in 'hospital, property and estate', who might fairly be described as administrative staff (even if they're less aptly termed bureaucrats).


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