Profit replacing patients, students: Managerial virus in UK hospitals, classrooms

By Bhabani Shankar Nayak* 

Many years ago, a doctor friend who had worked for decades in the National Health Service (NHS) in the United Kingdom shared his frustration with the rise of managerialism in his workplace. “The NHS is hiring highly paid managers who know nothing about health systems or medical science,” he told me. “These over-glorified managers have been brought in to run the service despite having not an iota of training in healthcare or human welfare. Ironically, they are tasked with making the NHS more efficient.”

That same friend retired last week. When I asked him about life after the NHS and whether he would consider part-time consultancy, his response was blunt: “I’m glad to be out of it. Managers have replaced the medical fraternity and relegated them to a small common room. Doctors are squeezed like sardines, while managers occupy entire floors. They have ruined the NHS and its purpose, squeezing every penny from the system to increase their own salaries.”

This was a man who had devoted his life to treating patients and who once loved the NHS. His disillusionment reflects the corrosive effects of managerialism in healthcare — a system that increasingly prioritises bureaucracy and profit over care and compassion.

The privatisation of healthcare has turned illness into a business. It generates profits for private corporations, pharmaceutical companies, and health insurers, but at the expense of people’s well-being. Far from improving efficiency, managerial control has bureaucratised patient care, delaying treatment under multiple layers of appointments, investigations, and reporting. Profit-driven privatisation has only expanded the empires of corporate healthcare while undermining timely, humane medical treatment.

The same pattern is evident in education. Universities and higher education institutions are now riddled with managerialism, often justified under the banner of industry–academia collaboration. A class of individuals with little or no experience in teaching or research has entered universities as managers of “teaching and learning.” Many have never taught a class or written a single page of research, yet they shape policies that define the quality of both. Under the guise of efficiency and austerity, they profit while undermining the teaching and learning environment, leaving students and staff more precarious.

Even more troubling is the rise of university managers who claim professorial titles without contributing to knowledge production. Promotions are handed out based on personal networks and clientelist relationships rather than merit. As one colleague told me, “The idealism, hope, and creativity that once defined academia no longer exist in these manager-led universities.” The erosion of critical scholarship in favour of managerial metrics is stifling teachers, researchers, and students alike.

This problem is not confined to the United Kingdom. Across the world, managerial culture in higher education is one of the greatest threats to knowledge production, skill development, and the free exchange of ideas. It transforms curricula into products, teachers into sellers, and students into consumers, hollowing out the very purpose of education.

Managerial bureaucracy thrives on hierarchical control and compliance cultures. Far from guaranteeing quality, it undermines academic freedom and curtails the transformative role of education. Universities must be reclaimed as spaces where students and staff are accountable to each other, not to profit-driven managers. Academic freedom is central to creativity, critical thinking, and the democratic spirit of education.

The assault on health and education is no accident. It is designed to produce compliant bodies and minds — individuals unable to question the powers that dominate their labour and creativity. At its core, managerialism is a capitalist assault: one that sustains an exploitative, rent-seeking system by weakening both the health of citizens and the critical capacities of students.

If society is to flourish, it must resist this assault. Health and education are not commodities to be managed for profit. They are collective goods, essential for nurturing creativity, critical thought, and the well-being of all.

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*Academic based in UK