Placing the cart before the horse: proposals to regulate NHS managers

Doubts about the performance, value and conduct of healthcare managers continue to stir public debate. In the UK, the denigration of NHS managers as an unproductive, bureaucratic overhead is a longstanding theme in political and media discourse. 1 Likewise, in Australia, senior doctors have railed against the ‘huge amounts of taxpayers’ money … misallocated to pay for massive and unnecessary growth of the health bureaucracy’.2 If anything, concerns about over-management are even more acute in the USA, where, according to one recent report, ‘administrative costs’ now make up a staggering 40% of the total expenditure on service delivery.3