Wes Streeting about the NHS ‘failing managers’.

kittylester

There are too many layers of NHS managers.

And, I will say again, DH worked for the NHS for all his working life and, every time a new initiative was brought in, another layer of management was added. His last line manager didn't know what his job title meant and had to have it explained to her.

One of my sisters was a senior NHS manager and her experience was the opposite.

In the year or so before she was finally made redundant, her own line manager and one of the team leaders who was responsible to her left and wasn't replaced. This meant that my sister ended up trying to cover three people's jobs.

When my sister left, she was replaced by somebody on a much lower grade and without much experience. Not surprisingly, the person struggled, so after a few months new jobs were created and they ended up where they started - except the new people doing the jobs didn't have years of experience.

kittylester

There are too many layers of NHS managers.

And, I will say again, DH worked for the NHS for all his working life and, every time a new initiative was brought in, another layer of management was added. His last line manager didn't know what his job title meant and had to have it explained to her.

This isn't about removing layers. It's about making people more accountable for outcomes.

Just to be clear, the proposal from Wes Streeting relates to very senior managers who are accountable for performance of health services at a hospital/community scale. Most operational managers are clinicians, not non clinical managers, and without them services would grind to a halt very quickly.

Staff who support clinical services are the people who will be needed to gather and collate all the data which clinicians input into the various systems they use - these people are included in management costs, but they aren’t actually managers.

This looked like a reasonable report. From earlier this year.

www.instituteforgovernment.org.uk/sites/default/files/2023-06/nhs-productivity-puzzle_0.pdf

The NHS is severely undermanaged. It is also highly constrained with insufficiently clear or simple targets and incentives. This makes it difficult for the managers already working in hospitals to succeed. These problems – that existed before Covid – have made it more difficult for the system to increase activity in the last few years. They may also limit the ability for integrated care systems, introduced in 2022, to improve performance.

Understanding undermanagement in hospitals

The NHS has very high hospital staffing relative to peer countries but has very few managers. OECD figures show that in 2014 (the latest data available) the NHS was spending less than half the OECD average on administration and management combined.

Management levels also fell in the 2010s, and then further since 2019.1 Since 2009 the percentage of managers in the NHS has reduced from 2.6% of all staff to 1.9% (equating to 1,600 fewer managers overall).* This compares with 11% of staff employed in management roles in the overall economy.

With accompanying charts

Astitchintime

"The Health Secretary said it was a “guilty secret” of the NHS that poor performing leaders were able to “reincarnate” elsewhere in the service"...........absolutely true and in my several decades of NHS service I have seen this happen time and time again.
The echelons always came up smelling of roses but if a mere minion put a foot out of place we faced suspension, disciplinary, downgrading or even worse.

Very well said. Sideways moves for rotten apples, incompetents.
Still Blair should own much of the NHS money problems, started by Major, but vastly increased by Blair to signing us up to further PFI, projects usually lasting 20 to 30 years, so still paying over the odds. 160 bn still to be paid out
Institute for Government PFI. Explains all.

Freya5

Astitchintime

"The Health Secretary said it was a “guilty secret” of the NHS that poor performing leaders were able to “reincarnate” elsewhere in the service"...........absolutely true and in my several decades of NHS service I have seen this happen time and time again.
The echelons always came up smelling of roses but if a mere minion put a foot out of place we faced suspension, disciplinary, downgrading or even worse.

Very well said. Sideways moves for rotten apples, incompetents.
Still Blair should own much of the NHS money problems, started by Major, but vastly increased by Blair to signing us up to further PFI, projects usually lasting 20 to 30 years, so still paying over the odds. 160 bn still to be paid out
Institute for Government PFI. Explains all.

What does this have to do with managers who aren't doing a good job?

Thanks for that Casdon and MaizieD.

Someone close to me has just retired from an administrative job. She said there are too many highly paid managers. She said they hire managers to manage managers and invent daft focus groups which then have to have managers. They also spend a fortune on catering for meetings. Meanwhile my husband and others lay on beds in a corridor earlier this year.

Sorry an administrative job in the NHS.

Wyllow3

Yes to the O/P.

a huge no to Elon Musk, who promotes hatred and division and has been appointed to politicise and shred a non political civil service and would rip up our NHS into the private sector. Proud of our NHS, leave us alone Musk, USA style so called healthcare.

Agree to both.

Yes to weeding out bad managers.

And to take a look at the new rôle of Physician Associate. This is medical care on the cheap and patients are being failed.

No thank you to Elon Musk - his signature tune must be "If I ruled the world".

Kate1949

Someone close to me has just retired from an administrative job. She said there are too many highly paid managers. She said they hire managers to manage managers and invent daft focus groups which then have to have managers. They also spend a fortune on catering for meetings. Meanwhile my husband and others lay on beds in a corridor earlier this year.

Just to repeat ... what Streeting has announced isn't to do with reducing the number of managers; it's about removing the ones who aren't doing a good job. They will need to be replaced and it wouldn't surprise me if they are replaced with people on higher salaries, in order to get the very best people.

Allira

Wyllow3

Yes to the O/P.

a huge no to Elon Musk, who promotes hatred and division and has been appointed to politicise and shred a non political civil service and would rip up our NHS into the private sector. Proud of our NHS, leave us alone Musk, USA style so called healthcare.

Agree to both.

Yes to weeding out bad managers.

And to take a look at the new rôle of Physician Associate. This is medical care on the cheap and patients are being failed.

No thank you to Elon Musk - his signature tune must be "If I ruled the world".

I agree with all your post Allira.

Management in the NHS has changed quite drastically over the years, different Governments have brought in their own ideas and initiatives; the aim is to make everything more efficient but does it?
It did all seem much simpler in the 1960s and early 1970s but the demands on the service were probably far less then. Local Health Boards employed relatively few staff who dealt with the administrative functions and worked in direct, close contact with hospital secretaries and matrons.

However, anyone failing should be weeded out. They should not be rewarded for failure with large pay-offs either.

FriedGreenTomatoes2

No that’s because the wokerati don’t use it like they used to love. Go Elon.

It seems to me that most of the posts are by AI bots. Without them X would have lost even more of its users and value. That must be why they are plagiarising all content, (whether the provider of genuine content permits it or not) to "train AI" , and why all the real infomation that could be so useful to viewers is being turned into a mishmash of picture snippets married up with random and inaccurate captioning. Would you like him to do the same for the NHS?

Yes to improving the NHS including ensuring managers are effective
growstuff and Casdon make good points. I can’t help thinking about Ofsted and its negative impact in many ways. I hope whatever process Streeting comes up with isn’t of the simplistic name and shame variety

FriedGreenToms - get a grip - I know your excited by your hero Mr Trump becoming Potus but, no we do not want Elon anywhere near our nhs/any of our public services

But where are the managers when you need them. My aunt, who is in hospital, needs to be discharged to a care home. There is ,apparently, a procedure for this, but no one is tell us exactly what it is. Jumping through hoops and going round to jump through them again. If one of those managers could get his finger out and produce a decent explanation of the ‘pathway’, I might be able to sleep at night.

JamesandJon33

But where are the managers when you need them. My aunt, who is in hospital, needs to be discharged to a care home. There is ,apparently, a procedure for this, but no one is tell us exactly what it is. Jumping through hoops and going round to jump through them again. If one of those managers could get his finger out and produce a decent explanation of the ‘pathway’, I might be able to sleep at night.

The hold-up is likely to be outside the hospital's control. I have no idea where your aunt lives or is in hospital, but I suspect the procedure is more or less the same anywhere. The hospital has to contact the local authority, which is responsible for a care package. As we all know, local authorities are strapped for cash and there's a shortage of suitable care homes. Finances will need to be negotiated. Meanwhile, the hospital can't discharge your aunt until somewhere is found. It's not a hospital senior manager's role to sort that out. There will be an administrator whose job it is, but he/she can't magic up a place at very short notice and having a meeting with a manager wouldn't solve anything.

Apparently my aunt should have a social worker. She has been in hospital for seven weeks. We still don’t know who he or she is !,

JamesandJon33, growstuff is correct about the delays. A social worker will be aware where the vacancies are. If you use a search engine like Google you should be able to find the hospital social work team contact details. Speak to the team manager .

As a NHS past Clinical Service Manager ( Rtd but still work on the Bank) we have done all this before. They dumped Managers then the system implodes. The NHS needs good managers. totally agree about some moving sideways but getting rid of someone is almost impossible, believe me we have tried.

You need to attract good managers from outside the Heath service and pay them the equivalent amount, that's often what Private Hospitals do.
As a previous Clinical manager we run the Service. I work in Cardiology, the clinical mangers all have Masters or equivalent as a minimum. That team will also work on the "shop" floor, most services ie XRay, Path Labs to name 2, plus the senior Nurses who takes charge of the Specialist service ie Medicine, Surgery etc. Often called Modern Matron. Are classed as Managers but have duel rolls
This Government needs to look back in NHS history before committing to a change.

JamesandJon33

Apparently my aunt should have a social worker. She has been in hospital for seven weeks. We still don’t know who he or she is !,

I expect the hospital staff are as frustrated as you are. A bed is being blocked. Sad to say, the local authority is probably waiting for somebody in a care home to die, so that a place can be released.

I think you meant ‘dual roles’ Visgirl! 😊
Quite funny if not.

FriedGreenTomatoes2

I think you meant ‘dual roles’ Visgirl! 😊
Quite funny if not.

Sorry, 😅...

growstuff

Freya5

Astitchintime

"The Health Secretary said it was a “guilty secret” of the NHS that poor performing leaders were able to “reincarnate” elsewhere in the service"...........absolutely true and in my several decades of NHS service I have seen this happen time and time again.
The echelons always came up smelling of roses but if a mere minion put a foot out of place we faced suspension, disciplinary, downgrading or even worse.

Very well said. Sideways moves for rotten apples, incompetents.
Still Blair should own much of the NHS money problems, started by Major, but vastly increased by Blair to signing us up to further PFI, projects usually lasting 20 to 30 years, so still paying over the odds. 160 bn still to be paid out
Institute for Government PFI. Explains all.

What does this have to do with managers who aren't doing a good job?

Nothing, or has it. 9f course it has. Who orders the equipment etc etc from these private inputs, why yes senior managers, heads of catering,supplies, surgical equipment. Etc etc. Waste is a massive massive problem in the NHS. So I think it has.

Freya5

growstuff

Freya5

Astitchintime

"The Health Secretary said it was a “guilty secret” of the NHS that poor performing leaders were able to “reincarnate” elsewhere in the service"...........absolutely true and in my several decades of NHS service I have seen this happen time and time again.
The echelons always came up smelling of roses but if a mere minion put a foot out of place we faced suspension, disciplinary, downgrading or even worse.

Very well said. Sideways moves for rotten apples, incompetents.
Still Blair should own much of the NHS money problems, started by Major, but vastly increased by Blair to signing us up to further PFI, projects usually lasting 20 to 30 years, so still paying over the odds. 160 bn still to be paid out
Institute for Government PFI. Explains all.

What does this have to do with managers who aren't doing a good job?

Nothing, or has it. 9f course it has. Who orders the equipment etc etc from these private inputs, why yes senior managers, heads of catering,supplies, surgical equipment. Etc etc. Waste is a massive massive problem in the NHS. So I think it has.

It really depends what you mean by 'senior' managers. I think we probably have a different understanding. Senior managers don't waste their time ordering equipment; they leave it to relatively junior administrators.