Patient care has suffered repeatedly because of poor management and bureaucracy in the NHS, according to a report by the healthcare watchdog.

A lack of leadership, inadequate team-working and focusing too much on government targets emerged as common themes in the Healthcare Commission’s review of its 13 major investigations between 2004 and 2007. It concluded that some boards were focused on mergers between organisations after a shake-up of NHS trusts, or on meeting targets at the expense of patient care.

At Maidstone and Tunbridge Wells Hospitals NHS Trust, appalling hygiene standards contributed to more than 90 deaths from the bug Clostridium difficile, and at Sutton and Merton Primary Care Trust serious neglect of people with learning disabilities was found. In areas such as mental health services, the number of managers and administrators has doubled since 2000, hindering patient care and wasting resources, said Sir David Goldberg, an emiritus professor of psychiatry.

Writing in the British Journal of Psychiatry, Sir David said that there were 6,275 managers and administrators in mental health services, and 99,052 other staff — a ratio of one manager/administrator for every 15 staff.

There is now more like one for every ten, as the number of managers had grown to 12,013 and 116,035.

“Something is seriously wrong. The Department of Health is constantly introducing new regulations that require a report.”

He said that medical staff spent a growing proportion of their time attending meetings with managers, clinical governance meetings and carrying out audit activities.

Gill Morgan, of the NHS Confederation, said: “Organisations must be given the real autonomy necessary to enable them to take ultimate responsibility, rather than . . . being dominated by central targets.”

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