Are there too many NHS managers?

In times of hardship, the value of NHS managers is often scrutinised - what do they do and are they worth it?
Sonia Nosheen

16 February 2024


The NHS has a range of managers at different levels working across healthcare to help ensure processes are in place to allow services to function. When NHS pressures are high, there can be increased attention on the role of NHS managers and how many there are, what value they add, and how much they get paid. This piece explores these points in more detail to understand more about the role of NHS managers.

Exploring the evidence 

What do NHS managers do? 

When commentators refer to NHS managers, they are in fact referring to numerous roles across the health service that perform a variety of functions.

    • Lead on service improvement.
    • Manage budgets.
    • Manage demand and capacity.
    • Have an overview on patient experience and patient safety.
    • Investigate complaints.
    • Work with regulators.
    • Manage staff.
    • Work with clinical staff to ensure smooth daily routines.
    • Assess risk.
    • Monitor targets/performance.

Many requests are also driven by national bodies, mandating range of audits, policies, procedures and plans. A review of NHS leadership by Sir Ron Kerr concluded the sheer volume of requests, many of which are duplicative, can distract from the good work leaders can do. Managing all these responsibilities also ultimately allows frontline healthcare professionals to do their jobs and support patients to get the care they need.  

Are there too many managers in the NHS?

With pressures in NHS growing, it is vital that clinical staff can do their role and not be overburdened with administrative and operational business. Recent research by Institute for Public Policy Research suggested that the healthcare sector is under-managed, and this increases the burden of bureaucracy that falls on frontline professionals. They also found clinical staff needed managers to do the ‘managing’, freeing them up to do the ‘caring’. 

Supporting this, we know the following:

  • Professionally qualified staff

    • Nurses and health visitors: 26.2%
    • Scientific, therapeutic and technical (ST&T): 12.8%
    • Doctors: 10.5%
    • Midwives: 1.8%
    • Ambulance staff: 1.5%

    Support to clinical staff

    • Support to doctors, nurses and midwives: 22.5%
    • Support to ST&T: 6.3%
    • Support to ambulance staff: 2%

    NHS infrastructure support

    • Central functions: 8.5%
    • Hotel, property and estates: 4.9%
    • Managers: 2%
    • Senior managers: 1%
  • The UK spends less on management compared to comparable international health systems – it spends 2p in the pound on healthcare administration, compared to 5p in Germany and 6p in France.
  • At the time of the coalition government’s NHS reforms in the early 2010s, there was a major cut in management of 17.5 per cent over the following five-year period. This has led to re-investing in management in recent years, with NHS workforce statistics up to the end of July 2023 showing a 6.7 per cent year-on-year rise in senior managers and a 7.4 per cent rise in general managers. 
  • There are 13,257 senior managers and 25,417 managers recorded (FTE); however, the data over time shows the increase in roles is merely starting to fill some of the gap created in the early 2010s. 
  • Increasing management roles could lead to less spending on management consultancy which was over £300 million (2018/19).
  • Managers have been among the slowest growing groups of staff in NHS over the past decade being only 2.9 per cent higher than in September 2009. Overall, there are approximately 39,000 NHS managers which makes up around 3.7 per cent of the workforce (figures do not include all clinical staff with managerial roles as part of their job).
  • Numbers are expected to decrease in some parts of the health system as integrated care boards have been mandated to reduce their running costs allowance by 30 per cent by the end of 2025/26. This is resulting in further reductions in management capacity and costs. 

Typical management salaries in the NHS

Middle managers
Bands 7-8b 
Clinical and non-clinical roles, eg as laboratory, strategic, physiology, nursing and finance managers Senior project managerCivil service 
middle manager
Leading supermarket store manager
£43,742 - £68,525*£62,500*£59,341*£48,190 - £62,850*
Very senior managersComparisons  
Eg, chief executives, executive board or directors; NHS England policy aligns salaries appropriate to recruiting skills and experience necessary for running a £158 billion organisation, while recognising pay restraint at a time of NHS financial pressures.Vice-chancellorsSenior civil servants  and senior officials in departments, agencies and non-departmental public bodies 
£140,531*£269,000*£150,000 - £300,000
average: £183,000*

Looking at these comparison, we can see that NHS managers are paid within the region of or less than managerial roles outside the health service. 

The bottom line

NHS managers play a pivotal role in supporting the daily running of the NHS, covering a range of roles and demands that support clinical colleagues to do their jobs, and help services transform and improve care for their patients. 

The evidence suggests the NHS is an under-managed sector compared to the UK-wide economy. Comparing investment to international systems it is only 2p in the pound spend on healthcare administration, compared to 5p in Germany and 6p in France. 

Pay rates vary dependent on level of management role but in comparison with other roles outside of the NHS, the evidence does not support the view that they are overpaid. 

NHS organisations are complex and multifaceted with an immense amount of pressure and demand which requires careful and responsive management. NHS managers need support, investment and leadership training to enable them to perform. 

Read more from our series of explainers, providing facts and figures to challenge common misconceptions in health and care.