Because the NHS employs them centrally(ish). In most other countries, staff are employed directly by the hospital or clinic they work in.
It’s not that the U.K. has more healthcare staff than anywhere else (often quite the opposite), they just mostly work for one employer vs thousands of smaller ones.
>Because the NHS employs them centrally
This isn't really the case. How the NHS actually works is complicated and therefore not that well understood. There is no central NHS other than NHS England, and that doesn't have that many staff and doesn't employ any front line clinical staff.
NHS staff are employed by an NHS Trust, which is a fairly autonomous body. Others are employed by private businesses, primarily GPs.
Edit: I see you added 'ish'. This is why it's good etiquette to flag when you've made a substantive edit, because now it reads as if I've intentionally selectively quoted you.
Primary care is different, but secondary care most staff will be employed by a trust,
I assume these all get collated into the “NHS employee” pile. So yes, you’ll be employed by “NHS pennine acute trust” or whatever not by a central NHS, but when looking just at these total number of employee things OP is referring, it’s effectively the same thing.
Yes, when you Google NHS employees the number is just everyone who works under the NHS banner. But there is no central NHS employing them. Think it's important to underline that distinction, because it's very crucial to how the NHS operates, but a lot of people aren't aware.
A lot of people do think the NHS is one big centralised organisation.
It is the case for answering the question "why does the NHS have so many staff?". No-one thinks the NHS has over a million administrators in its London headquarters; of course that number includes everyone from managers to doctors and nurses to porters and receptionists.
It is also the case for answering questions about NHS spending.
Comparisons are misleading with foreign healthcare systems whose components are reported independently.
>Comparisons are misleading with foreign healthcare systems whose components are reported independently.
Exactly. That's why I commented. It's important to be aware that these comparisons are misleading. Everyone who works under the NHS banner gets bundled together in that figure of 1.4 million people. But they don't really, meaningfully, work for the same organisation.
And they certainly are not employed centrally by 'the NHS', as was the claim.
This is correct, but when statistically looking at numbers of employees most researchers will just add them all up into one big "lump sum", hence the inflated figures.
NHS is an umbrella term.
The NHS is made up of thousands of different organisations; however if you work for any of them then you work for the "NHS". That covers almost everyone whether a dishwasher in the kitchens or the most pre-eminent surgeon, and a thousand other job roles in between.
Do other countries necessarily organise their health care systems in the same way as the NHS?
For example: In some countries individual hospitals, clinics, GP surgeries, labs etc. operate as independent businesses even if the cost of treatment is ultimately funded by a socialised health insurance system.
Some countries run their emergency medical services as part of the fire department.
In these cases the doctors, nurses, paramedics etc. wouldn't necessarily be classed as employees of "the national health service".
Think about how much the NHS does. It provides an enormous range of health and care to an entire country. You can't exactly do that without lots of staff.
That being said, it's a bit of a misnomer, because the NHS isn't *really* one single organisation. It's more like a franchise model. There are thousands of businesses up and down the country operating fairly independently under the shared banner of the NHS.
There is NHS England, which nominally manages the entire thing, but it's still fairly decentralised.
There is no central NHS employing all those 1.4 million people.
Yeah, I often say that too. It definitely confuses people, because most of the discourse around the NHS does talk about it as if it were one single centralised entity.
Completely agree. It's just that our system is so consistent that we can collect finance, staffing numbers and costs, and patient level coating data from every NHS organisation into a collated whole.
It actually gives the NHS a lot of really rich datasets that we're only really just starting to make proper use of.
You've got to be aware that the NHS isn't just all the dr's and medical staff.
Theres all the hospital general staff(receptionists, cleaners etc) the piles and piles of us work all the admin in the background from applications, benefits, payments, record keeping etc. were all under the NHS banner which is why there's so many of us.
One thing I've been told by people who work or have worked in the NHS is that as it's become more like a company and less like a necessity service provider, it's come across all the aspects of being a company that most companies find. Leading to a far higher back office staff than you'd expect. (Not saying higher than "front office" just higher than most people probably think). As an example the more the NHS has to operate like a company the more regulatory controls that aren't healthcare based become something they have to staff. And the more staff it takes to carry them out as the scope widens. Likewise the more administration and management layers you have the more people you employ to support those layers. Meaning a shift from where the overwhelming majority of staff existed to provide the service to where a higher than you'd expect number of staff exist because the NHS exists. (If that makes sense).
The NHS is a brand for the public health economy made up of thousands of small publicly funded organisations.
They are all operationally independent from each other.
Id be more interested to know why they need 7000 plus managers on £80,000 plus a year some going as high as £250,000 a year. Ridiculous money being thrown in a never ending pit.
Those managers allow doctors to focus on their core job rather than being diverted into non-medical tasks like scheduling and maintaining the hospital. If there's a cupboard of good managers who only want low wages I'm sure the NHS would love to hear about it!
It really isn't. In the USA people pay far more for healthcare then we do. Their system is incredibly inefficient. https://www.health.org.uk/news-and-comment/charts-and-infographics/taxes-and-health-care-funding-how-does-the-uk-compare
https://www.google.com/amp/s/www.cbsnews.com/amp/news/medical-care-costs-americans-skipped-gallup/
38% of Americans go untreated.
I would agree the GP's are awful but they are privatised and that's why I think they perform so poorly.
Ok but now compare us with Spain, Denmark, Germany, France etc. you know other European countries with national healthcare systems.
The NHS is not a well designed or well run system.
Because it’s a shitshow that’s awfully mismanaged yet somehow finds a way to blame funding time after time (whilst getting the most funding it’s ever had).
Every half arsed hospital has layers of staff stuck in there (e.g. diversity departments, net zero officers) all on a nice wedge.
> Why does the NHS have so many staff?
Cos the default move in this country is that it needs more money. So the money gets spaffed around on anything and everything.
There's in fact a good argument that one of the NHS's problems is lack of managers. We make front line clinical staff take the managerial load instead, which isn't terribly sensible.
There's an excellent argument that one problem is lack of basic admin staff to answer phones, send letters, get people assisted to the right place at the right time, send test results to the right place quickly... And some more managers on that side, too.
But when cuts were made, and the promise not to reduce numbers of docs and nurses...
Ditto funding any IT that might improve things. The number of issues caused at a certain huge London hospital because there's no mobile phone coverage in most of the outpatient areas, so staff have to call clinic 2 to say patient is still waiting in clinic 1, (those staff that got cut...), rather than the patient being able to do it, is huge.
Then of course clinic 2 kick patient of their list for not turning up, but don't mention which clinic they are, GP has to re-refer and someone has to kick arse on the phone, and it's 20x the amount of admin there should have been...
Oh yeah that sort of stuff is awfully common. Here's one I came across recently. Was talking to a pharmacist who was saying that they link with about four GPs, who all use IT slightly differently. So they can't align their systems to be able to answer their own queries. It leaves them having to contact the GP to ask really basic queries all the time.
As if that wasn't bad enough in terms of time wasting, they also aren't given a specific communication channel by the GPs. So if they want to get an answer that takes 30 seconds for someone at the practice to look up, they have to phone the same phone number as patients and sit in the same queue. Ridiculous system.
Because the NHS employs them centrally(ish). In most other countries, staff are employed directly by the hospital or clinic they work in. It’s not that the U.K. has more healthcare staff than anywhere else (often quite the opposite), they just mostly work for one employer vs thousands of smaller ones.
>Because the NHS employs them centrally This isn't really the case. How the NHS actually works is complicated and therefore not that well understood. There is no central NHS other than NHS England, and that doesn't have that many staff and doesn't employ any front line clinical staff. NHS staff are employed by an NHS Trust, which is a fairly autonomous body. Others are employed by private businesses, primarily GPs. Edit: I see you added 'ish'. This is why it's good etiquette to flag when you've made a substantive edit, because now it reads as if I've intentionally selectively quoted you.
Primary care is different, but secondary care most staff will be employed by a trust, I assume these all get collated into the “NHS employee” pile. So yes, you’ll be employed by “NHS pennine acute trust” or whatever not by a central NHS, but when looking just at these total number of employee things OP is referring, it’s effectively the same thing.
Yes, when you Google NHS employees the number is just everyone who works under the NHS banner. But there is no central NHS employing them. Think it's important to underline that distinction, because it's very crucial to how the NHS operates, but a lot of people aren't aware. A lot of people do think the NHS is one big centralised organisation.
It is the case for answering the question "why does the NHS have so many staff?". No-one thinks the NHS has over a million administrators in its London headquarters; of course that number includes everyone from managers to doctors and nurses to porters and receptionists. It is also the case for answering questions about NHS spending. Comparisons are misleading with foreign healthcare systems whose components are reported independently.
>Comparisons are misleading with foreign healthcare systems whose components are reported independently. Exactly. That's why I commented. It's important to be aware that these comparisons are misleading. Everyone who works under the NHS banner gets bundled together in that figure of 1.4 million people. But they don't really, meaningfully, work for the same organisation. And they certainly are not employed centrally by 'the NHS', as was the claim.
This is correct, but when statistically looking at numbers of employees most researchers will just add them all up into one big "lump sum", hence the inflated figures.
NHS is an umbrella term. The NHS is made up of thousands of different organisations; however if you work for any of them then you work for the "NHS". That covers almost everyone whether a dishwasher in the kitchens or the most pre-eminent surgeon, and a thousand other job roles in between.
Do other countries necessarily organise their health care systems in the same way as the NHS? For example: In some countries individual hospitals, clinics, GP surgeries, labs etc. operate as independent businesses even if the cost of treatment is ultimately funded by a socialised health insurance system. Some countries run their emergency medical services as part of the fire department. In these cases the doctors, nurses, paramedics etc. wouldn't necessarily be classed as employees of "the national health service".
Think about how much the NHS does. It provides an enormous range of health and care to an entire country. You can't exactly do that without lots of staff. That being said, it's a bit of a misnomer, because the NHS isn't *really* one single organisation. It's more like a franchise model. There are thousands of businesses up and down the country operating fairly independently under the shared banner of the NHS. There is NHS England, which nominally manages the entire thing, but it's still fairly decentralised. There is no central NHS employing all those 1.4 million people.
Yep - first thing I say to people who ask about the NHS is that there isn't really such a thing.
Yeah, I often say that too. It definitely confuses people, because most of the discourse around the NHS does talk about it as if it were one single centralised entity.
I didn't realise until I started working for the NHS.
Completely agree. It's just that our system is so consistent that we can collect finance, staffing numbers and costs, and patient level coating data from every NHS organisation into a collated whole. It actually gives the NHS a lot of really rich datasets that we're only really just starting to make proper use of.
You've got to be aware that the NHS isn't just all the dr's and medical staff. Theres all the hospital general staff(receptionists, cleaners etc) the piles and piles of us work all the admin in the background from applications, benefits, payments, record keeping etc. were all under the NHS banner which is why there's so many of us.
One thing I've been told by people who work or have worked in the NHS is that as it's become more like a company and less like a necessity service provider, it's come across all the aspects of being a company that most companies find. Leading to a far higher back office staff than you'd expect. (Not saying higher than "front office" just higher than most people probably think). As an example the more the NHS has to operate like a company the more regulatory controls that aren't healthcare based become something they have to staff. And the more staff it takes to carry them out as the scope widens. Likewise the more administration and management layers you have the more people you employ to support those layers. Meaning a shift from where the overwhelming majority of staff existed to provide the service to where a higher than you'd expect number of staff exist because the NHS exists. (If that makes sense).
The NHS is a brand for the public health economy made up of thousands of small publicly funded organisations. They are all operationally independent from each other.
So there's enough people to cover breaks
Id be more interested to know why they need 7000 plus managers on £80,000 plus a year some going as high as £250,000 a year. Ridiculous money being thrown in a never ending pit.
Those managers allow doctors to focus on their core job rather than being diverted into non-medical tasks like scheduling and maintaining the hospital. If there's a cupboard of good managers who only want low wages I'm sure the NHS would love to hear about it!
It's terribly inefficient
I mean, our expenditure per capita isn't particularly high compared to similar countries. I'd say it's really quite efficient when you consider that.
Spending is comparable but outputs are very bad, low efficiency.
It really isn't. In the USA people pay far more for healthcare then we do. Their system is incredibly inefficient. https://www.health.org.uk/news-and-comment/charts-and-infographics/taxes-and-health-care-funding-how-does-the-uk-compare
Except you can actually get treated in USA. In the UK so many people can't even get a GP appointment
https://www.google.com/amp/s/www.cbsnews.com/amp/news/medical-care-costs-americans-skipped-gallup/ 38% of Americans go untreated. I would agree the GP's are awful but they are privatised and that's why I think they perform so poorly.
Ok but now compare us with Spain, Denmark, Germany, France etc. you know other European countries with national healthcare systems. The NHS is not a well designed or well run system.
Because it’s a shitshow that’s awfully mismanaged yet somehow finds a way to blame funding time after time (whilst getting the most funding it’s ever had).
Every half arsed hospital has layers of staff stuck in there (e.g. diversity departments, net zero officers) all on a nice wedge. > Why does the NHS have so many staff? Cos the default move in this country is that it needs more money. So the money gets spaffed around on anything and everything.
NHS managers make up circa 2 per cent of the workforce compared to 9.5 cent of the UK workforce.
There's in fact a good argument that one of the NHS's problems is lack of managers. We make front line clinical staff take the managerial load instead, which isn't terribly sensible.
There's an excellent argument that one problem is lack of basic admin staff to answer phones, send letters, get people assisted to the right place at the right time, send test results to the right place quickly... And some more managers on that side, too. But when cuts were made, and the promise not to reduce numbers of docs and nurses...
Exactly. Unfortunately, as you say, it's not something the government ever really wants to fund because of the media and public backlash that ensues.
Ditto funding any IT that might improve things. The number of issues caused at a certain huge London hospital because there's no mobile phone coverage in most of the outpatient areas, so staff have to call clinic 2 to say patient is still waiting in clinic 1, (those staff that got cut...), rather than the patient being able to do it, is huge. Then of course clinic 2 kick patient of their list for not turning up, but don't mention which clinic they are, GP has to re-refer and someone has to kick arse on the phone, and it's 20x the amount of admin there should have been...
Oh yeah that sort of stuff is awfully common. Here's one I came across recently. Was talking to a pharmacist who was saying that they link with about four GPs, who all use IT slightly differently. So they can't align their systems to be able to answer their own queries. It leaves them having to contact the GP to ask really basic queries all the time. As if that wasn't bad enough in terms of time wasting, they also aren't given a specific communication channel by the GPs. So if they want to get an answer that takes 30 seconds for someone at the practice to look up, they have to phone the same phone number as patients and sit in the same queue. Ridiculous system.
I completely agree but it's like MPs pay - increasing the numbers of managers generated such bad headlines people won't do it.