‘Labour can build an NHS fit for the future, but it must start working with us, not against us’

When Labour came to power, I felt something I hadn’t experienced in the NHS for a long time, genuine optimism.

As a Labour member, a senior NHS manager in a London Hospital Trust, and a National Committee member of Managers in Partnership (the NHS Managers Union), I felt that optimism. I believed we finally had a government that understood the scale of the challenge and the need for long-term reform. After fourteen years of Conservative underinvestment and short-termism, it felt as though we could finally move away from crisis management.

The mood amongst colleagues was similar. Nobody thought the problems would be solved overnight. Waiting lists remained stubbornly high, staff were exhausted and NHS finances were under immense pressure. But there was a sense that we had a government prepared to engage honestly with those realities and work with the people responsible for delivering change.

Labour has much to celebrate so far, including settling the resident doctors’ dispute, waiting lists having fallen by over 400,000 and nvestments in the workforce – particularly in GP’s and mental health. Most importantly, the publication of a ten-year plan provided a clear path to an NHS fit for the future (if a little light on the detail)

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These are not insignificant achievements. They demonstrate a government serious about improving healthcare rather than simply managing headlines.

That is why the announcement to cut Integrated Care Boards by 50% and abolish NHS England came as such a shock when it was announced in March 2025.

Nobody working in the NHS would deny that duplication and inefficiencies exist. But successful reform depends on bringing people with you. Instead, many of us learnt about changes that would fundamentally affect our work and, therefore, patients at exactly the same moment as everybody else.

There was no meaningful consultation with staff or trade unions and no detail on which functions would remain or go. Even now, significant uncertainty remains about what the final structure will look like.

Perhaps most damaging was the language used during the debate.

Managers were portrayed as bureaucrats standing in the way of progress. For a workforce that had spent years navigating the pandemic and subsequent recovery, the message landed badly.

The reality is very different. From my own experience, I see examples of outstanding management every day. My colleagues work incredibly hard to ensure patients get the best care as quickly as possible. 

Every patient waiting for a cancer appointment, diagnostic test or treatment needs answers, reassurance and hope. Managers work tirelessly to make sure those appointments happen on time because we understand every day spent waiting can add anxiety felt by patients and their families. We ensure NHS resources are used efficiently so more money can directly fund patient care. We embrace innovation and technology, giving clinicians more time with patients. If you cut management you pull clinicians away from clinics and operating theatres to do that work. 

The claim of NHS over-management is repeated so often it’s now accepted as fact. In reality, managers account for 2% of the NHS workforce compared with 9.5% in the wider UK workforce. Health policy experts consistently argue that the NHS is under, not over managed. The number of managers has fallen in recent years whilst challenges facing the NHS become more complex.

NHS managers are not sitting behind desks generating paperwork. We coordinate patient pathways, control multi-million-pound budgets, lead service redesign, resolve workforce issues, plan capacity and ensure organisations remain safe. When management is ineffective we’ve seen in recent news how badly things go wrong. 

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Another system restructure has stalled programmes focused on prevention, health inequalities and partnership working. Responsibilities may be transferable in theory, but in reality NHS trusts simply lack the capacity to absorb them whilst also effectively performing their current duties. 

The good news is that it is not too late to change course.

A new Prime Minister and Health Secretary creates an opportunity to rebuild trust and reset relations with NHS leaders and managers. If Labour wants its ten-year plan to succeed, it needs the support of the people who will actually deliver it.

That starts with three simple commitments.

First, stop the manager-bashing. Constructive challenges are healthy. Scapegoating is not.

Second, provide clarity and security for staff affected by restructuring. You cannot expect people to lead transformation while simultaneously worrying whether they will still have a job.

Third, take the growing challenge of leadership retention seriously. Too many experienced NHS leaders are considering leaving a system where expectations continue to rise while support often feels absent.

NHS managers are up for the challenge ahead. We want the Labour Government to succeed because our patients need Labour to succeed. But reform is something done with people, not to them. If ministers choose partnership over confrontation they will strengthen their chances of delivering the world-class health service that patients deserve.

For the sake of my party, my colleagues and the communities we serve, I hope they do.

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