The National Health Service (NHS) urgently needs more managers to reduce the administrative burden on doctors and nurses, according to new analysis by The King’s Fund. The leading health think tank found that front-line medical staff are spending excessive time on paperwork due to a shortage of skilled administrative and managerial support.
The King’s Fund said the long-standing perception that the NHS is “over-managed” is a myth. Its research revealed that the number of employees per manager has risen sharply over the past 15 years, leaving clinicians to handle routine tasks that should be carried out by support staff.
Fewer Managers, More Staff
According to the analysis, the NHS now has one manager for every 33 employees, compared to one for every 27 staff in 2010. While the overall NHS workforce has grown by 37 percent — from 975,000 employees in 2010 to around 1.33 million in 2025 — the number of managers has increased by only 12 percent, from 35,696 to 40,021.
These figures exclude regional and national management teams, such as those employed by NHS England, which was established in 2012 and is currently being disbanded under wider health service reforms.
Doctors ‘Plugging Gaps’ in Administration
Suzie Bailey, director of leadership and organisational development at The King’s Fund, said the widespread criticism that the NHS has too many managers “does not survive contact with reality.” She argued that clinicians are forced to fill gaps in administrative functions, diverting their focus from patient care.
“What we’re seeing is an absence of the right operational support structures that leaves clinicians plugging gaps in the system that should be filled by skilled administrative and managerial staff,” Bailey said.
She added that the Government “must value” hospital managers for helping keep clinical staff focused on patients rather than overwhelmed by bureaucracy. “Doctors and nurses joined the NHS to change lives, not to spend hours chasing paperwork, managing rotas, or navigating broken administrative systems,” she said.
Bailey warned that this inefficiency contributes to staff burnout, low morale, and reduced productivity. She urged the Government to invest in management development and leadership training instead of “denigrating” the role of managers.
‘Ever More Challenging to Run the NHS’
The King’s Fund report described the “growing scarcity” of trained managers as a major obstacle to effectively running “the massive and complex organisations that hold our NHS together.” The shortage has made it increasingly difficult to oversee daily operations, budgets, and patient flow across hospitals and community services.
Government Reforms and Accountability Drive
Health Secretary Wes Streeting, who took office in 2024, has previously pledged to tackle what he called “failing NHS managers” — individuals who have advanced in their careers despite poor performance. In early 2025, Streeting launched NHS league tables to hold underperforming trusts accountable and warned that hospital bosses could lose pay rises if they failed to improve patient outcomes or financial management.
He is expected to address these reforms again this week during his speech at the annual NHS Providers’ conference in Manchester, where health leaders from across the UK are gathering to discuss the service’s future.
A spokesperson for the Department of Health and Social Care said the Government’s focus is on ensuring “skilled managers in the right roles.” The spokesperson added, “We are reforming the NHS to make it fit for the future — attracting, supporting, and developing the best talent to boost productivity and redirect resources to the front line.”
As part of ongoing reforms, the Government has announced plans to establish a College of Executive and Clinical Leadership and introduce professional standards for NHS managers. The new framework aims to reward top-performing trusts with greater investment and autonomy while providing targeted support for struggling ones.
Workforce Pressures and Bureaucracy in the NHS
The findings come amid renewed debate over NHS efficiency and workforce morale. In recent years, a combination of rising patient demand, staff shortages, and mounting administrative tasks has placed enormous strain on healthcare professionals. According to NHS Staff Survey data, nearly half of all NHS employees reported feeling burnt out in 2024, with many citing excessive paperwork and lack of support as key stressors.
Experts have long argued that empowering hospital managers could free up clinical time, improve decision-making, and enhance patient outcomes. However, political narratives about “bloated management” have often led to cuts rather than investment in leadership and operational expertise.
With the NHS facing mounting financial pressures, The King’s Fund warns that undervaluing management risks worsening efficiency, staff wellbeing, and patient care at a time when the system can least afford it.
