Our bloated NHS - it’s beyond ridiculous now.

Callistemon21

^No, I'm not, but my sister was quite a senior manager (former nurse who moved into management) and I have spent many hours listening to what she had to say^.

Well, I'm presuming she didnt emigrate and take her skills with her.
☹

No, she didn't. I don't understand what you're getting at.

Not getting at anything, just so many of our skilled professionals have emigrated.

I am absolutely dumbfounded that posters presume they know more about another posters husband’s career and the management of said career than she does…

Some posters are the fount of all knowledge.

Some posters have actual experience and/or family who are living the experience.

GrannyGravy13

I am absolutely dumbfounded that posters presume they know more about another posters husband’s career and the management of said career than she does…

Which posters? I certainly don't presume anything, but I do know that anybody working in an organisation needs to be managed.

Callistemon21

Not getting at anything, just so many of our skilled professionals have emigrated.

Not all! Strange assumption.

kittylester

Being accountable covered that. Managed was unnecessary.

Just believe that he did not need managing.

You won't of course - because it doesn't fit with your thinking. Take our actual experience at face value.

But he did need managing. He worked for a large organisation and he needed to be part of that organisation - and his managers needed to know how he fitted in to the bigger picture.

I just don't understand why he should have objected to explaining his role to a new manager.

I said so many

Obviously not all - what a strange assumption.

Callistemon21

Some posters are the fount of all knowledge.

Some posters have actual experience and/or family who are living the experience.

Yep! I have family who have lived the experience! A sister and a daughter. I was a manager in a large organisation (much smaller than the NHS) too. The issues are fairly universal.

GrannyGravy13

Why don’t you tell her growstuff ?

Because I don't want to be accused of being patronising. However, I suspect that kittylester has a different understanding of management. Maybe she means micro-management, which I agree is a sign of bad management.

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kittylester

Being accountable covered that. Managed was unnecessary.

Just believe that he did not need managing.

You won't of course - because it doesn't fit with your thinking. Take our actual experience at face value.

But how was he accountable? You said no one knew what he was doing and he had to explain it to his manager. He may well have understood but obviously others didn't, doesn't accountable need someone else to understand?

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This is not a goad for Kittylester to give us more information, and I’m not being patronising. Its just something I’m interested in, and GN is for talking about things you are interested in, so…

Kittylester has told us a couple of things; that her DH took exception to his 4xboss asking about his job, when it should have been obvious. And that DH didn’t need managing. All this is relevant because we had lots of posts saying “too many managers”.

So I was trying to think about who would be the most autonomous person in a Health Board. I came up with a surgeon with a rare speciality. That person’s 4xboss might have been brought in because they were good at budgetary management, or the Trust was failing and they had to turn it round, or whatever. Maybe they didn’t have any experience at all of Mr KL’s speciality. So they asked about it. I’d be more worried about a person trying to come into a department or a Trust that thought they knew everything already and didn’t make any effort to find out.

And what about needing managed? Would a surgeon need managed? Obviously they don’t need someone to tell them how to do their job. But they need someone who is responsible for the budget to have Mr KL report back with the current status of spend. They need to agree with Mr KL what he has to spend next year. They need to agree with Mr KL how many operations he will target doing next year. They need to understand from Mr KL how many theatre staff he needs to keep his speciality going. They need to discuss with Mr KL what his salary might be over the next 12 months.

That’s management. Its not telling you what to do, it’s agreeing what you are able to contribute and helping you get what you need to be successful. If the 4x boss and all those in between were incompetent, that’s a different discussion. But anybody who works in an organisation needs to be managed. No exceptions.

Please actually read my posts.

I did not say DH took exception. We were bemused by the fact that his immediate line manager didn't know what his job entailed even though his title couldn't have been more self explanatory. No theatre staff were involved. Dh was the only person in the county doing the job.

Actually, you obviously have no experienceof the reality of the levels of management in the NHS so actually you should just listen to people who have REAL experience of a small part of it which is probably replicated all over. It's unlikely to be the only bit of mismanagement, is it?

I’m afraid I would argue that had the systems they had bought been done properly that there would have been plenty of money. Unfortunately when each trust is knitting it’s own system that is not going to happen. The coordination needed to be done at national level not local.
Anyway, I am typing from the hospital now whilst I wait for tests to be run on my mother who collapsed again today. The Southern Central Ambulance delivered us to a South East Ambulance hospital so when I arrived A&E nobody knew where my mother was because they cannot enter another area’s ambulance on the hospital system. Whilst we sat in the ambulance for 2 and a half hours the ambulance driver had to keep reminding the staff we were there because they often get forgotten. As our local hospital is one of the worst in the country for queuing ambulances, other ambulances from adjoining areas are often used so this is an ongoing problem. Fortunately, I was able to access Mum’s records on my phone to assist the ambulance crew to make decisions but…they weren’t allowed to record them! I leave you to make up your minds as to whether you think the systems integrate or not!

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Oh icanhandthemback that’s an upsetting and dispiriting post to read. I hope your mum is settled soon and finally being treated in that hospital. I think ‘care’ is so patchy lately, it’s frightening. As I said up thread, my 72y friend had a stroke 4 weeks ago. She is still on the stroke unit with loss of speech and all manner of problems. On the day it happened her poor frantic husband waited almost 80 minutes for a 999 ambulance to arrive. He was so frightened and upset on her behalf.

I can’t imagine what anxiety he went through looking out for that ambulance.

And This, from Allison Pearson in today’s Telegraph, makes for mind boggling reading about the many levels of NHS management teams:

Look away now if you suffer from hypertension ....

“Unfortunately, NHS managers appear to see their role of overseeing the delivery of healthcare as superior to that of care itself. I asked “George”, Planet Normal’s senior source within NHS England, to paint me a picture of the organisation’s structure. After reading the email, I needed a lie down in a darkened room.

Essentially, NHS England – main offices in London and Leeds, but with lots of satellite buildings in places like Leicester and Taunton – is a Hydra with all of its multiple heads turned inwards looking at all the other heads.

NHS England does no routine hospital management; it is responsible for implementing government policy. For every type of healthcare “workstream” – elective, mental health, screening, primary care – there is someone in NHS England in charge of overseeing the delivery. Each of those national leads has a team of people and each region (of which there are seven) has a set of people overseeing delivery from a regional perspective. That’s a hell of a lot of staff who are not actually providing any medical care, but are busy reporting on how others are delivering it.

Wait, there’s more. An executive board covers operations, finance, information technology, human resources and analytics. Each of those functions has a similarly extensive national and regional structure. The function of departments called things like Improvement, Strategy and Transformation is “murky”, says George, but “essentially, a lot of resource goes into looking at how can we do things better and more efficiently while never appearing to make any progress in that direction”.

I’m not sure I can bring myself to type what follows, it’s too depressing. But I think you should know – after all, you’re the ones paying for it. In between NHS England and the hospitals, there are now Integrated Care Systems, which are basically a partnership between the hospitals, GPs, some local authority services and healthcare commissioners. They too all have boards, heads of delivery, finance structures and business intelligence functions. (Of course, they do!) As George wryly observes: “This is yet another in a long line of organisational configurations that may or may not deliver any real improvements or change.”

In theory, NHS England can support, cajole, even threaten those organisations actually doing the frontline delivery. Ultimately, says George: “We are fairly powerless to bring about any real change. So you have to wonder, how much money should this organisation consume and does it provides any real value?”

kittylester

Please actually read my posts.

I did not say DH took exception. We were bemused by the fact that his immediate line manager didn't know what his job entailed even though his title couldn't have been more self explanatory. No theatre staff were involved. Dh was the only person in the county doing the job.

Actually, you obviously have no experienceof the reality of the levels of management in the NHS so actually you should just listen to people who have REAL experience of a small part of it which is probably replicated all over. It's unlikely to be the only bit of mismanagement, is it?

So it was not his 3xboss, it's was his immediate line manager? That's changed in the telling.

The "surgeon" thing was hypothetical because I was trying to show that everyone needs managing, even surgeons, for whom I obviously have a lot of respect.

You're right, I have repeatedly said I have no experience of the NHS but maybe if people in it understood more about professional management, we'd all be better off.

kittylester

You wrote, "DH didn't need managing at all in reality. In the early days, there was one manager overseeing all roles similar to his - heaven knows how many there are now. But at least she knew what his job was.

Being overmanaged was one of the reasons dh stopped working, aged 71, and now no one in the county carries out his fairly vital role."

You wrote that your DH didn't managing - in your own words. Yes, he did. Everybody in an organisation needs managing. That's not patronising.

PS. As nobody is now doing his vital role (whatever it was), it's quite surprising the whole system hasn't collapsed.

You wrote that it was partly the reason he retired - for being bemused?

Actually it gets worse. Someone pointed out:

“Sorry to say this Allison, but you've missed a layer of bureaucracy out.

Yes, between Integrated Care Systems and the front-line there's yet another layer - it's called (less than imaginatively) 'Place'. So within each ICS there are a number of 'Places', each with it's own set of Directors, managers etc etc.
So much money wasted you could actually weep.
If only we had a Government with a huge majority to sort it all out, eh?”

Words fail me.
We are definitely no longer ‘the envy of the world’ that’s for sure.

Hope your Mum is okay icanhandthemback