NHS problems from the horses mouth

It's quite clear that NHS doctors including GPs are either retiring early or emigrating in significant numbers to obtain better pay and better working conditions in Australia, NZ and the USA. They are not being replaced at even the same rate because the Tories failed to provide enough medical school training places over the past 12 years and because the idiot Brexit decision removes the freedom of movement that enabled European doctors - including specialists - to come easily to the UK to work. Now visas and paperwork are required and most won't bother.

I once accompanied my mother to see her GP and took some unopened pills and syringes filled with anti clotting medication provided by the hospital. The district nurse was to call round daily to inject with said syringes. After a further ultrasound they deduced she didn’t have a DVT so didn’t need the visits or the medication. DN said it all had to be destroyed. I was horrified and showed the GP it was still in the sealed containers and hadn’t been touched. She said it was NHS policy and when I voiced my surprise her reaction was “don’t get me started on waste in the NHS, it sends me insane”. That was a GP aged approximately mid 40’s. They pay over the odds for almost everything and definitely have too many managers. It could be sorted out but nobody has the guts.

Yes, that was a brilliant programme. So sad that his ideas were never adopted.

Except that it is often not available because there are too many people trying to access it.

Strange thread title - that particular horse has been out to grass for at least 25 years.

I hate these threads where everyone piles on, in mostly total ignorance about how the NHS works. Over 90% of healthcare is delivered outside hospital so the idea that if you “fix” hospitals that’s job done is pure nonsense. And the “overmanaged” myth has been busted so many times. Yes it’s complex and antiquated and inefficient and under-resourced and we certainly wouldn’t have built it like this in 1948 if we knew how people would (over)use it now. But it is still free at the point of use and none of us ever has to worry whether we can afford to use it.

The issue is junior doctors thinking they know it all (particularly males) and havn’t developed the patient handling or diagnostic skills, more experienced staff have to help them do the job better.
It happens in all industries.

katie59 A doctor can only become older and more knowledgeable and experienced by first being junior doctors., learning on the job, and becoming more experienced.

If colleagues consider them a nuisance and cannot be bothered to help them get the experience and knowledge they need, the first people to suffer are their patients who end up be treated by inadequately experienced consultants.

The problem at Westminster is that politicians know the NHS problems can't be solved in the 5 year gap between general elections so Health Secretaries look busy by tinkering at the edges and engaging in re-organisations in the hope we don't notice they have achieved nothing of substance.

I worked in local government, many years ago. Drastic cutbacks were necessary, and several strata of managers were removed. We were at the coal face, and could see that it made no difference to the service we gave to the public. Saved lots of money though.

“I also trained 50 years ago and progressed to ward sister level. The demands and expectations of our nurses today is a far cry from the good old days you have alluded to and in many cases nurses are as skilled and expected to perform as junior doctors.”

In my case I trained 40 yrs ago, the job has changed for sure but it has changed so much that nobody wants to do it any more. As for junior doctors, give me an experienced nurse any day.

Katie59

“For years senior clinicians/physicians have been sent on managerial and administrative courses. “

They are doctors and nurses and yet you are expecting them to be managers and administrators as well, it’s this overloading of front line staff that is crippling the NHS.
Teachers have the same problem, overloaded with administration and meeting targets

My sister and her husband are recently retired consultants. both of them wanted to spend time looking after patients not taking on managerial roles. they worked/liased with them, there is no way they could've done the job -nor wanted to.

I don't know what world the consultant in the O/P worked in - may be the private sector? 15% on the whole wider issues of back up and management is no surprise to me, although it might be less complicated if the NHS was not operating on the levels of having to bring in agency workers constantly and chase and run round remedying impossible situations like lack of care provision/shortage beds/ambulance blockages and so on.

growstuff Its actually around 15% spent on admin.

I see some letters from retired consultants have appeared in the Torygraph disputing the thrust of the letter quoted at the top of this thread, i.e., supporting the need for managers in the NHS.

A consultant is an expert in his or her field and thus as the writer stated qualified to assess what medical care is needed and how to carry it out.

That said, it makes little sense for a fully qualified doctor or nurse to spend time dealing with administrative matters that call for a completely different set of skills and training, so employing secretaries to write letters and records, book-keepers to deal with finance, and an admiminstrator to oversee them and manage the day to day running of a hospital makes sense.

What does not make sense is an administrator trying to decide anything one needs a medical training to assess.

If this is happening, or if so many people are being employed on the managerial staff that there is not sufficient funding for medical and nursing staff, obviously the matter needs to be addressed.

As far as I can see, everyone from politicians to the general public have ideas about what is wrong with the NHS, but until the people who work in the NHS are asked for their opinion of what is wrong and how to fix it, there is little hope of improvement.

This is the real problem: politicians and perhaps civil servants believing they know how to fix the NHS, elementary or secondary schooling, transport or anything else, but neither having worked in these sectors, nor willingly really listened to those who do, few, if any, of their improvements will make things better.

maddyone

I think you’re right generally Casdon, but access to IVF is decided by individual health areas, I believe.
Still, I did say I don’t know much about the management of hospitals. And our grandchildren are priceless.

The NICE guidance does define eligibility criteria maddyone, so the vast majority of areas would use the guidance I would have thought, but it’s not really my area of knowledge so perhaps individual areas lower or higher the bar for access. I’m sure your grandchildren are lovely, that’s the most important thing of course.

ginnycomelately
Each ward sister had a junior ward sister and two staff nurses properly trained , because they had learned on the wards as well in schools of nursing, unlike the degree nurses who are generally not fit for purpose that’s by their own admission

Good grief I can’t believe you’ve actually written that. You say you’re a nurse of 50 years experience. Surely you’re aware that all nurses, who are degree trained, don’t just graduate from university after 4 years then turn up in a ward to start work. What on earth are you on about? They also learn on job in between blocks of lectures in university. Are you saying you’ve never seen a student nurse on a ward?

My daughter was awarded her Bachelor of Nursing degree 20 odd years ago. She is very skilled and experienced including 14 years in ICU. She had ward placements throughout her 4 year degree.

I also trained 50 years ago and progressed to ward sister level. The demands and expectations of our nurses today is a far cry from the good old days you have alluded to and in many cases nurses are as skilled and expected to perform as junior doctors.

I’ve been saying this for years. Too many managers and not enough medical staff. It’s wasting a fortune that could be spent on nurses.

I think you’re right generally Casdon, but access to IVF is decided by individual health areas, I believe.
Still, I did say I don’t know much about the management of hospitals. And our grandchildren are priceless.

maddyone

I don’t know anything about hospital management so it’s pointless me commenting. I know when I’ve needed hospital treatment I’ve received it, as have the rest of my family. The only thing we couldn’t access was IVF for my daughter. She needed to have three miscarriages in order to qualify for treatment, but as she wasn’t getting pregnant in the first place, she wasn’t able to access treatment. I suppose some layer of management made that decision knowing full well that the decision would save money as patients who weren’t able to get pregnant would be automatically disqualified from receiving infertility treatment.
We paid. It cost a lot of money, but the resulting twins and later single baby were worth every penny.

Managers don’t make decisions about eligibility for treatment maddyone. Access to treatment is governed by NiCE, the National Clinical Excellence body.
www.nice.org.uk/guidance/cg156

I don’t know anything about hospital management so it’s pointless me commenting. I know when I’ve needed hospital treatment I’ve received it, as have the rest of my family. The only thing we couldn’t access was IVF for my daughter. She needed to have three miscarriages in order to qualify for treatment, but as she wasn’t getting pregnant in the first place, she wasn’t able to access treatment. I suppose some layer of management made that decision knowing full well that the decision would save money as patients who weren’t able to get pregnant would be automatically disqualified from receiving infertility treatment.
We paid. It cost a lot of money, but the resulting twins and later single baby were worth every penny.

Well after 50 year’s nursing I agree completely with the consultant’s letter, We do NOT need non clinical managers at all they completely gum up everything justifying their nebulous roles , We had Matron we had a medical chief and one chief administrator they was it , each Ward sister ran her own ward with one clerk based on the ward to help with admin , Each ward sister had a junior ward sister and two staff nurses properly trained , because they had learned on the wards as well in schools of nursing, unlike the degree nurses who are generally not fit for purpose that’s by their own admission , So yes get rid of all the unbelievable autocratic not fit for purpose people who are sucking all the money from the NHS , get back to basics , Doctors Nurses and therapists, In fact anyone who doesn’t have contact with patients

Legal necessities complicate NHS management too. GDPR etc.

Optomistic1

Gosh.

As a recently retired senior director in the NHS I am pretty shocked by this retired consultants comments. I worked very very closely with all my consultant colleagues and there was plenty of mutual respect both ways. The majority of consultants don’t want to do ‘management’ as they would rather be clinical. The ones that do in my experience rely on good managers to support them and do a lot of the day to day stuff.
I get pretty sick of reading /listening to people who have never worked in the NHS going on about how there are too many highly paid managers in the NHS and that is the root of all the problems as it is just not true.
Like in any work environment there will be good and bad managers - like there are good and bad doctors and nurses but the vast majority of any person working in the NS are caring, hard working and there for one thing - treating and caring for patients. We did this by working together which sounds something the consultant who wrote that letter did not do.

I have worked for decades in the NHS and so did my OH - a doctor.

The need for managers (and their heavy workloads) is exacerbated by government micromanagement and outsourcing.

Until these are tackled there will be a lot of money wasted in the NHS.

Having a,long standing, badly managed health issue doesn't impact well on family life, either.

Katie59

“For years senior clinicians/physicians have been sent on managerial and administrative courses. “

They are doctors and nurses and yet you are expecting them to be managers and administrators as well, it’s this overloading of front line staff that is crippling the NHS.
Teachers have the same problem, overloaded with administration and meeting targets

I couldn't agree more after living with one of the professions, mentioned and leaving the other early myself I know the effect it can have on a person and on family life.
My children barely knew their father we got asked if we were a one-parent family. The year I wasn't working I asked special permission to go to two Carol concerts to please my 6-year-old who knew mummy had never been at one of theirs before.