Our bloated NHS - it’s beyond ridiculous now.

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growstuff

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.

I think that's part of the problem growstuff

As I mentioned in an earlier post - it's just huge and cumbersome.
Can it ever be run efficiently?

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LadyWee

Urmstongran

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?”

I mean, I despise the Torygraph but in fairness NHSE do have the ability to determine these top down schemes with no consultation from
Anyone on the front line and employ what appears to be a huge cohort of people to essentially write long emails forcing you to do things, changing their minds and forcing you to do something else, and then issuing sanctions on those that don’t or can’t comply! Am very glad to be out of it but do feel for my relatives still trying their best.

The main issue between managers and clinicians is that all the policy changes and ‘shake ups’ with new managers in place don’t do anything to tackle the front line staffing crisis and the low morale that comes from it.

Let's be absolutely clear on this. This is a system brought in by a Tory government who put in place a top down re-organisation that no one wanted and which cost a fortune. There is constant revision of the requirements. One very interesting example is Procurement. Try googling NHS procurement and the amount of advice and restrictions on it is incredible.

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This thread stopped adding anything constructive several pages ago. I’m none the wiser about kitty’s husbands work life.
Without wishing to be rude to kitty or mr k, the suggestion from urmston, thst the nhs has too
Many managers remains contentious.
A huge organisation needs managers, it needs layers if managers who have different but clearly identified responsibilities. When I worked in the private or public sector, that’s what we had. Essential to service delivery

The row here is ideological and political. The idea that money can be saved by binning the diversity training, refusing to provide translators for example Is
Imo nonsense and lacking in understanding or compassion.
I would have that view. It’s based on my professional experience and my personal belief system. How could I have begun to
Understand how an Angolan asylum seeker arrived here, what led to the dreadful situation she and her children currently lived in, without the help of an independent translator
Of course, people who don’t share my beliefs will say- send her back. Don’t help her. I don’t want to live in a country with neither compassion nor evidence based practice

Urmstongran

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?”

I mean, I despise the Torygraph but in fairness NHSE do have the ability to determine these top down schemes with no consultation from
Anyone on the front line and employ what appears to be a huge cohort of people to essentially write long emails forcing you to do things, changing their minds and forcing you to do something else, and then issuing sanctions on those that don’t or can’t comply! Am very glad to be out of it but do feel for my relatives still trying their best.

The main issue between managers and clinicians is that all the policy changes and ‘shake ups’ with new managers in place don’t do anything to tackle the front line staffing crisis and the low morale that comes from it.

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No he didn't feel OK about it but he was 71 as I also said previously! Please read my posts.

Did you continue to work at that age? How much longer did you want him to keep working in a stressful job.

Honestly - hardly his fault if the NHS spends money on managers rather than practitioners! No-one else would take the role on on the same terms when he eventually gave up.

And, where did I say he didn't like his new line manager. She was very nice.

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Hope your Mum is okay icanhandthemback

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.

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

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.

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.