NHS problems from the horses mouth

pascal30

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...

So doctors should be free to order unbelievably expensive tests and procedures? What happens when they've ordered expensive drugs or scans for the first patients in the financial year and they've run out of money for all the rest?

It's naive to think that medical staff can be autonomous.

MOnica I am a patient at Addenbrooke's in Cambridge. I have never been "double-informed". All information, including appointments, goes directly into an online system called "My Chart". Automatic text messages are sent before appointments, but they are computer generated and don't anybody to spend time sending them.

It is possible for people to opt to have traditional letters, but it's not the default.

Katie59

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.

No, it's not. It's about 3.4%.

kittylester

I do know that casdon.

But, actually, a junior doctor typed my discharge letter and it was checked and signed by the ward consultant.

So it wasn't errors by clerical staff, but by a doctor ie a member of clinical staff.

My recent discharge letter was written and signed by a senior nurse and went straight into my online record.

Callistemon21

Luckygirl well said

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.

Outsourcing does not necessarily mean cheaper.

Some of the administrative mistakes we and others have experienced recently have been made by outsourced companies and have resulted in wasting the time of medical staff.

PFIs have cost the NHS dearly.

The outsourcing itself costs the NHS because commissioning staff have to employ the best (cheapest) provider and contracts have to be drawn up.

Mistakes are sometimes made because even for one condition, services are sometimes provided by different hospitals or teams. The NHS IT systems don't allow different providers to communicate efficiently. This is the result of the so-called internal market.

Reconsidering I totally agree with this letter and it's the main reason I retired as a senior nurse early fed up with being told how to run nursing services by accountants.

I do know that casdon.

But, actually, a junior doctor typed my discharge letter and it was checked and signed by the ward consultant.

Doctors dictate hospital discharge letters though kittylester, and are responsible for ensuring they contain accurate information. They should also check and sign them. The medical secretaries are allocated to consultant teams.

Not strictly true though.

While the medical and nursing care I received during my recent hospital stay was exemplary and I have no doubt they saved my life, the clerical side was dreadful with my discharge letter having loads of incorrec info on it.

However the various outsourced services I have accessed since I got home have been very efficient.

Luckygirl well said

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.

Outsourcing does not necessarily mean cheaper.

Some of the administrative mistakes we and others have experienced recently have been made by outsourced companies and have resulted in wasting the time of medical staff.

PFIs have cost the NHS dearly.

Sigh

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.

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!

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.

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.

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.

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

Shove up. I want to get on too.

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

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.

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.

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.

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.

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.

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?