NHS problems from the horses mouth

I posted on another thread that a close relative who works in the NHS said that there are an unbelievable amount of managers thinking up 'initiatives' which cost a fortune. Someone called it manager bashing.

Consultants and medical staff should be autonomous and managers who are not clinically trained should not be in charge of anything involving medical decisions... In my experience the MH service was hugely overloaded with managers...

volver

Luckygirl3

I think the letter-writer is complaining abut the fact that managers are taking decisions that need to be taken by those with on-the-ground experience.

Clearly you need administrators to put decisions into practice - recruitment, buildings etc. but those who take the decisions need to be people who know what they are talking about.

Managers are not administrators.

signed, a former manager

(Who generally knew what she was talking about. Not NHS)

I know managers are not administrators! - that was my point!

Someone needs to take the policy decisions (managers) and administrators need to administer these.

The person writing to the paper was querying the nature of the decision-makers. As do I.

The letter writer literally wrote, they don't need managers. They do need managers, because however good their training is as a surgeon (for instance), they probably don't know much about GDPR implementation (for instance).

When the NHS started in 1948, my aunt was the head of the nursing school in a big London hospital. She said the first thing that happened was that a second storekeeper was employed. The one they had did not consider himself over worked. Then as there were now 2 stock keepers, they appointed a third person to manage them.

Similarly, I was phoned last week to be told I had an appointment in January. The nurse gave me the details verbally, but when I asked her to wait while I got my online calendar up, she said not to bother as everything she had told me was also being sent to me in a letter. The letter has now arrived. It tells me everythig about the appointment - that it will be a telephone appointment, that I need several tests beforehand. The one thing it doesn't contain is the date and time ofthe appointment. My DD and DH, who have both been seriously ill in the last couple of years could recite whole lists of times they were double informed - or not informed at all - about all sorts of matters.

If managers are cut, it doesn't need to mean that those remaining are then overworked. What is needed is for hospitals to look at their systems and organisations to get them running smoothly and efficiently and reduce the plethora of systems, constantly doing the same thing twice. I am beginning to suspect that a lot of the problem with the NHS, is lots of managers scurrying round all doing the same thing, but in different ways for different reasons.

The letter did not say they don’t need managers, it said they don’t need the numbers they have, a number which is ever increasing.

I have just picked up a thread headed 'Bonkers new rule at our GP's surgery. Says it all really.

especially as the government imposed more initiatives and targets

That's a pertinent point growstuff

Should the NHS be subjected to evermore initiatives and targets imposed by politicians?
Is it too politicised?

I have heard medical staff say that decisions which they had undertaken for years were taken out of their hands, the system slowed down because the medical staff had to await decisions from middle managers.
Rooms which were formerly used for patients were being converted into more offices. The Sister who told me that was in despair as she said those rooms were desperately needed for patients.

LadyGracie

The letter did not say they don’t need managers, it said they don’t need the numbers they have, a number which is ever increasing.

It literally says, they do not need managers

Literally. In writing.

What a lot of out of date rubbish.
Hospital Secretaries vanished in the 70's.
As a ex Clinical manager I know it needs mix of people with proven skills. I'm still working so, I am aware of the current situation.

Look at a hospital management board, it has a mix of professionals, including Doctors, Nurses Accountants,, Health professionals, as well as experienced Managers, Solicitors, Estates professional to name just a few. They keep the Hospital running, it's a big set up.

I have a old girlfriend who is the Chair of her local Heath Board, she is a ex - journalist/TV producer, that brings interesting results.

Total disaster if left to Doctors.

What is needed is for hospitals to look at their systems and organisations to get them running smoothly and efficiently and reduce the plethora of systems, constantly doing the same thing twice

The more layers of management there are, the more inefficient the systems appear to become.
I say that from my own and others' experiences.

I have just picked up a thread headed 'Bonkers new rule at our GP's surgery. Says it all really

Because the GP service is no longer efficient, people go to A&E where the staff work relentlessly but still remain cheerful.

So many medical staff are leaving because of stress due to overwork.
How many managers can say the same?

One nurse was on television yesterday. He has emigrated to Australia where he said working conditions are so much better. He said he is in charge of a very small number of patients there whereas in the UK he had sole care of 18-20 patients. He said that was illegal in Australia.

How many more qualified medical staff do we need to lose to other countries before we have a sea change?

Visgir1

I agree that managers are needed - it's obvious that there are many jobs where a qualified manager is needed.

However, while the number of managers has increased, medical staff are leaving and not being replaced.

Would the Health Service survive without so many managers?
Will the Health Service survive if medical staff leave in droves through overwork and stress? I think we know the answer.

And, lots of services are not being offered because there isn't the money to pay for them. Put there are no fewer managers and admin staff.

Of course they need managers but not so many layers of management. Anyone who knows anyone who works in admin in the NHS will know of their frustration at the mismanagement and waste.

Not all of the non medical staff in the NHS work in hospitals. Most work in office blocks spread around the country. Where I live in South Wales there has been a proliferation of office blocks now used by the NHS. The newest one is Health Education Wales. This is where the money goes, not where it is needed in Hospitals. The NHS is a typical bureaucracy it invents new problems that can only be solved by extra staff and new premises. This also is apparent in other parts of the government again with the proliferation of Quangos that interfere in all aspects of our lives.

I could go on at length, but suffice to say the NHS is not over-managed, blaming managers is a political tool used because somebody within the NHS has to be clearly to blame for the mess the NHS is in, it’s absolutely nothing to do with increasingly hysterical government targets which are an attempt to deflect from the endemic underfunding, and constant structural reorganisation which they pretend will make a difference.

Manager bashing happens within the service too, because nobody thinks their own team is at fault, and blaming people who are close at hand is more satisfying than railing at politicians who you can’t influence.

Seriously, I thought Gransnetters were a more discerning bunch of people who could see through that.
www.nhsconfed.org/long-reads/nhs-overmanaged
There are lots of research studies about this, they all reach similar conclusions.

I don’t know why I bother because I know people who are on the bash the managers bandwagon don’t want to hear it, but don’t forget that the majority of managers are also clinicians, managing departments, including consultant led services. The only ‘bureaucrats’ in the NHS are those who have been appointed to make sure that political targets are met - there are thousands of targets, and they all have to be administered, reported on and monitored.

I'll join your anti-bash bandwagon Casdon. I've seen what being an NHS manager did to my sister.

Shove up. I want to get on too.

It's not manager bashing. It's bashing a system that appoints too many managers.

Kate1949

It's not manager bashing. It's bashing a system that appoints too many managers.

So what do these managers do all day?

If the managers didn't do the work, it would mean that clinicians would end up doing more admin.

Hmm. A letter from the horses 'something' anyway. I'm ex NHS too. I don't know how we could have had enough time for direct patient work without the management and admin staff.

growstuff

So if hospitals don't need managers, who is going to be responsible for recruitment, maintenance, the appointments and record keeping systems, cleaning, catering, ordering equipment, prioritising patients, making sure that budgets aren't overspent (and all the other tasks I've forgotten)?

I note that the gentleman whose letter is quoted by the OP is retired and, judging by the letter, has been for some time. There is so much legislation these days that the styles of management that he mentions are no longer viable.

All these maligned managers are enablers, allowing those with the hands-on skills to do their jobs and not spend time away from the patients, who, after all, are the reason we have a health service.

One of the reasons you need more managers is because so many "services" have been farmed out to private companies, who need to be monitored, changed, have contracts drawn up, tout for the cheapest etc. A mammoth task.

I am not manager bashing, but I do have experience of the NHS before all this started, when hospitals were institutions with clear aims and clear lines of responsibility. When, if something was amiss, you could speak to the person responsible and something would happen. When everyone from cleaner to consultant was pulling together as a team. The whole ethos was a shared desire to do the best for the patient.

The fragmented service we have now leads to the need for more management. It is mad, and stems from political dogma - the idea that farming services out leads to money-saving via competition is nonsense. It leads to more work for the managers, who have to be paid. It leads to complex structures. And very very poor communication.

I have the most vivid memory of the changeover to outsourcing. One of the corridors had a long brown stain all the way along it - it was probably dried blood. No-one took responsibility for getting rid of it. There was no clear line of responsibility; no-one among the outsourced cleaning service dealt with it (it was probably not scheduled for cleaning that day) - no doubt the appropriate hospital manager was contacted (or left a message if out at a meeting) who then would contact the cleaning company in their far-away office and that communication had to make its way past various people in their organisation and back through the hospital management system - it certainly did not get as far as the corridor!

Before, whoever had seen it first, or seen it happen, would have knocked on the door of the cleaning team and they would have arrived within minutes. Job done!

Work expands to fill the time available, the amount of red tape is just unimaginable, it would not surprise me if half the NHS budget is spent on admin.

Sigh