NHS managers fight back

Managers in Partnership (MiP), the trade union organisation for health service managers, may only just have been launched, but the idea has been floating around for about five years.

Public sector union Unison and the senior civil servants’ union, the FDA, began discussions in 2000 after they realised that the health service had a large non-unionised management community. Managers were not getting a voice in either organisation, said Jon Restell, MiP chief executive.

“Unison was never going to prioritise managers on its agenda because it has a bigger membership to look after,” he told Personnel Today. “And the FDA is very much a civil service union, engaged with policy making, which is not the same as having a voice on management issues.”

So why did it take so long to set up the new group? According to Restell, there needed to be a slow build-up of trust between the two ‘parent’ organisations.

“In most cases, where you have unions looking at poor organisation of a group of workers, their normal response is to merge into a position of greater strength,” he said. “Merger here was never an option. So it was a slow process that had to be based on trust and confidence.”

MiP launched at the start of June with more than 4,000 founder members from Unison and the FDA. However, Restell, a white-collar trade unionist for 12 years, expects membership to grow significantly because of the climate health service managers work in.

“The higher up you go in NHS organisations, the less likely you are to have use of procedures and due process,” he said. “It is partly cultural. This aspect of the health service, for some reason, has not evolved for its senior leadership groups and still has a quite casual approach.”

‘Small-p’ politics

This makes health service managers prone to ‘small-p’ politics, Restell said. “They are in a uniquely exposed position because there are no structures for dealing with problems at senior level,” he said.

“It is very much votes of no confidence and then quiet departures. It is not unusual to have the ‘resign by 5pm or be sacked’ approach.”

Over the next decade, health will be high on the political agenda, in turn creating huge pressures. As the government continues to invest huge amounts of money in the health service it will want to see results. This means managers will continue to be held accountable for any supposed failings – unfairly so, according to Restell.

In his opinion, ministers and civil servants need to take more responsibility. “Ministers are in the luxurious position of being able to tell the world at large that individual service problems are down to management on the ground,” he said.

“Ministers and civil servants can push that accountability down the line very quickly to board level. It just seems to be an accepted part of the culture.”


This view is backed up by research conducted by MiP for its launch. It revealed that 80% of health service managers believe that ministers, the media and the general public do not understand their role in delivering change.

One of MiP’s aims is to be more vocal about the issues affecting managers. Evidence of that comes with its recent stance on financial management in the NHS and infection control.

“Ministers and policy-makers seem determined to create a climate where policy is never the problem, only ‘under-performing’ managers,” Restell said at the time. Managers will take responsibility for delivery and what they can control – but should not be set up to take the rap for problems with policy, he said.


Restell admitted that although there are a significant number of HR professionals interested in joining MiP – with some HR directors helping recruitment within their trusts – there are a number who have some reservations.

Jonathan Porter, HR director at Royal Berkshire Ambulance Trust, pointed out that trusts are increasingly appointing senior managers from outside the NHS, to gain a broader skills base.

“Typically, these new entrants from the private and voluntary sectors do not see the need or the reason to join a union,” he said.

But it is not as simple as that, said Restell. “Over a period of time, we will build up a picture about why [HR managers] are reserved about joining,” he said.

The approaching 30 September deadline for assimilating staff on to the Agenda for Change harmonised pay system makes this a good time for managers to sign up, Restell said. “As we start to see Agenda for Change not working that well for managers, here is an organisation that can stand up for them,” he added.

“[Managers] will come in for criticism if it’s not done and dusted by 30 September. When the flak starts to fly, here is an organisation that will defend them against unreasonable criticism.”

The acid test for MiP will be the line it takes on policy as it may have to comment critically on the actions of civil servants, most of whom will be FDA members. This is not a problem, said Restell.

“The national committee will set our policies on management issues, representation and health service reform,” he said. “The model is designed to ensure some kind of independence.”

What is MiP?

  • A trade union organisation developed through a partnership between Unison, the largest public service union, and the FDA, the union for senior civil servants
  • MiP is a separate organisation, with its own staff and run by its own members
  • It has a potential membership of 40,000-plus health service managers. Membership criteria set to Agenda for Change pay band eight – about £34,000

HR Feedback

Steve Barnett
Director, NHS Employers

“Managers are a vital part of the NHS team and it is important that they can get access to strong representation in the same way other healthcare workers can.”

Jonathan Porter
HR director, Royal Berkshire Ambulance Trust

“Given that contracts and remuneration packages are decided by committees with no room for negotiation with unions, I see the prime motive for joining being effectively redundant. I cannot see this union penetrating into trust boardrooms. It will struggle to remain viable or at least exist in any meaningful way.”

Mike Pyrah
Chief executive, Central Cheshire PCT, and president of the Healthcare People Management Association

“Trade unions are good things and we should encourage staff who want to join this new organisation to do so. On the whole this is a positive move, as managers are no different to any other groups of staff. Because of Agenda for Change, relationships between staff side representatives and management have improved considerably.”

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