NHS and official government report.

"The NHS in England is a £100 billion-a-year-plus business. It sees 1 million patients every 36 hours, spending nearly £2 billion a week. Aside from the banks, the only companies with a larger turnover in the FTSE 100 are the two global oil giants Shell and BP. If the NHS were a country it would be around the thirtieth largest in the world.

If anything, our analysis seems to suggest that the NHS, particularly given the complexity of health care, is under- rather than over-managed."

From the summary of a King's Fund report

www.kingsfund.org.uk/projects/health-and-social-care-bill/mythbusters/nhs-managers

growstuff

So who would do recruitment, performance management, payroll, organisation of appointments, buy equipment, rotas, building maintenance, IT systems, operate switchboards, record keeping, accounting and all the many other roles I've forgotten?

Those are essential roles

ronib

growstuff

So who would do recruitment, performance management, payroll, organisation of appointments, buy equipment, rotas, building maintenance, IT systems, operate switchboards, record keeping, accounting and all the many other roles I've forgotten?

Those are essential roles

Errmm ... yes ...

So which unessential roles would you abolish?

Bodach

Here's a passage from a speech made in parliament on 22 November 1995 on the state of the NHS. Guess who said it..

"I expect that the House has heard of the little document, which is circulating, about the boat race between the NHS and a Japanese crew. Both sides tried hard to do well, but the Japanese won by a mile. The NHS was very discouraged and set up a consultancy. The consultancy came to the conclusion that the Japanese had eight people rowing and one steering, whereas the NHS had eight people steering and one rowing. The NHS appointed people to look at the problem and decided to reorganise the structure of the team so that there were three steering managers, three assistant steering managers and a director of steering services, and an incentive was offered to the rower to row harder. When the NHS lost a second race, it laid off the rower for poor performance and sold the boat. It gave the money it got from selling the boat to provide higher than average pay awards for the director of steering services. That is what is happening all over the place. There is masses of bureaucracy in the health service and a denial of what people need."

Answer: Tony Benn.

Why is a speech made nearly 30 years ago relevant? Is it because we were nearly at the end of the last long period of Tory rule and the NHS was in a mess then too - over regulation and disinvestment resulting in more managers being needed to try to achieve the unachievable? No, it can’t have been that.

Growstuff management consultants would charge a small fortune for a report on which roles to cut!

Definitely enhance the number of nurses and doctors therefore increase medical school places, previously vetoed by consultants!
Have greater convalescence beds available with good physio where needed. Ensure very competitive buying options. Improve use of pharmacies.
Cut
Diversity and equality posts. Interminable production of statistics.
I don’t know enough about the management structures to comment on where cuts can be made. Although the head of the Nhs seems to command an exaggerated pay packet.

I doubt very much if diversity and equality posts take up very much of the NHS budget... What else would you like to see gone?

MaizieD

I doubt very much if diversity and equality posts take up very much of the NHS budget... What else would you like to see gone?

Use of agency staff
Maybe peg salaries of all senior managers to less than prime minister’s pay?

ronib

MaizieD

I doubt very much if diversity and equality posts take up very much of the NHS budget... What else would you like to see gone?

Use of agency staff
Maybe peg salaries of all senior managers to less than prime minister’s pay?

Would you include the value of the PM's accommodation, cost of a second home, subsidised canteen, travel and the amount he/she can earn in a second job and/or after dinner speeches?

Agency staff can work out cheaper for the NHS than having permanent staff with on-costs for the whole year.

Anything else?

management consultants would charge a small fortune for a report on which roles to cut!

But surely it's short-sighted not to commission a report, if it could genuinely save serious money.

Do you have any proof to back up your costings of agency staff growstuff?
Well so what if the prime minister can stay in a country house at weekends, etc the responsibility of running the entire country is much greater than running the flagging health service.

They're using agency staff because they aren't recruiting permanent staff because the pay is too low and the conditions increasingly stressful. Cutting agency staff won't do anything to alleviate that.

I'd like to see data on senior management pay. Once again, I doubt it's such a significant amount as people think it is.

I think you're right about consultants but the cost of analysis of NHS roles and systems with a view to improving effective use of resources (note effective use, not 'efficiency savings, they might well recommend the increased management that growstuff says is needed..) would probably cause a huge outcry...

Report Bma 14 November 2022 High spending on agency staff by Nhs is a completely false economy. Total spend on temp staff across the Nhs amounted to £8.9 billion.

Head of Nhs £260k a year

ronib

Do you have any proof to back up your costings of agency staff growstuff?
Well so what if the prime minister can stay in a country house at weekends, etc the responsibility of running the entire country is much greater than running the flagging health service.

I found this from 2015. Admittedly produced by an agency...

www.care101.co.uk/Documents/101-Agency-vs-Permanent-Costs.pdf

I think their argument might fall somewhat if the agency staff are covering for staff absence for sickness, as the NHS will still be paying some costs for that staff member.

And, I understand that a cap was placed on payments to agency staff in 2019.

ronib

Report Bma 14 November 2022 High spending on agency staff by Nhs is a completely false economy. Total spend on temp staff across the Nhs amounted to £8.9 billion.

Well, it may well be a false economy, but underpaying NHS staff and cutting down training opportunities is also false economy.

With thousands of nursing and medical staff vacancies what are hospitals supposed to do?

The cap of 2019 has been broken.

Yes I agree Maizie so train more staff? Oh I forgot the hospital consultants voted not to increase medical schools.
You couldn’t make it up.

ronib

Do you have any proof to back up your costings of agency staff growstuff?
Well so what if the prime minister can stay in a country house at weekends, etc the responsibility of running the entire country is much greater than running the flagging health service.

Not in writing, but my sister was an NHS senior manager, one of whose responsibilities was to make sure that there was legal cover. She was the budget holder for a big geographical area. We had this discussion a number of times. There is sometimes no alternative. The alternative would be to employ excess staff, so that there are enough if somebody is ill.

ronib

Report Bma 14 November 2022 High spending on agency staff by Nhs is a completely false economy. Total spend on temp staff across the Nhs amounted to £8.9 billion.

Do you have the breakdown? Were they doctors or nurses? Which health trusts? Which specialisms?

ronib

Head of Nhs £260k a year

So? I assume that's NHS England, which is one of the biggest employers in the world and has a budget more than the vast majority of companies. How much does the Chair of Shell or Tesco get paid?

ronib

Yes I agree Maizie so train more staff? Oh I forgot the hospital consultants voted not to increase medical schools.
You couldn’t make it up.

Do you understand why that was the case ronib? It wasn’t because they didn’t want more doctors, but because they are already very hard pressed, and the burden of junior doctor training falls directly on their shoulders once those doctors initially qualify. I wouldn’t be a hospital consultant now for £500k a year, it’s not worth the candle.

MaizieD

ronib

Do you have any proof to back up your costings of agency staff growstuff?
Well so what if the prime minister can stay in a country house at weekends, etc the responsibility of running the entire country is much greater than running the flagging health service.

I found this from 2015. Admittedly produced by an agency...

www.care101.co.uk/Documents/101-Agency-vs-Permanent-Costs.pdf

I think their argument might fall somewhat if the agency staff are covering for staff absence for sickness, as the NHS will still be paying some costs for that staff member.

And, I understand that a cap was placed on payments to agency staff in 2019.

You're right that it's not always an either/or situation, if it's a sickness cover. However, the alternative is to employ excess staff and run the risk of staff not being fully employed.

When a unit is to be reorganised (as happens because the government directs it), staff begin to leave, there's a ban on new recruitment and nobody wants to work somewhere where they're going to be made redundant. The staff who remain have to do extra shifts, so the system is already under pressure. If somebody goes off sick or takes holiday entitlement, a gap will need filling and it's cheaper (although not necessarily better) to use an agency.

The Taxpayers’ Alliance (which does not approve of the NHS) carried out a comprehensive review of ‘non-essential’ posts in NHS England. Even if one accepts their definition of non-essential - I do not, as they included play co-ordinators, and any parent who has had a child in hospital for a length of time/repeated stays will understand how important they are - the highest figure they could up with as ‘wasted’ on these roles was £46m. The NHS England budget this year is 160.4 billion. So, how will you spend the 0.03% ;my maths, so do double check that percentage) saved?

That's interesting Siope. Thanks for funding that. I agree - £46 million is peanuts. And, yes, one of my children was in hospital for quite a long time and time with the play co-ordinators kept me sane.

Bodach

Notice your post hasn’t garnered any attention because it doesn’t fit the narrative of certain posters. Normally they’d be cheering to the rafters anything Tony Benn had said.

The NHS is a money eating black hole and needs drastic reform.