Wes Streeting about the NHS ‘failing managers’.

That's right, the ordering is done at a much lower level, day to day in the departments. midlevel managers, or ward sisters, will be ordering, arranging rotas & cover, recruiting, arranging agency cover if needed, submitting overtime for payment, dealing with disciplinary & sickness issues, acting as budget holders for the department in addition to nursing or IT projects or payroll or whatever their department does. One Trust I was at outsourced the finance department so department managers had to assign accounting codes & submit all expenses for payment on the software system, which wasn't straightforward.
I worry about league tables - not that there will be a lot of additional posts needed to do this as their is plentiful data in useable form available, just that it is another "target" to worry about & generate meetings over & sometimes the alogrithms analysing the data are too crude to accurately represent performance. My main worry is that we want an interconnected health service working together seamlessly & the league tables may get in the way of this in some instances.

Thank you valdavi for confirming what I wrote earlier on this thread. My sister was a senior manager and I know something of what her work involved. I wonder how many people really know what senior NHS managers do - it certainly doesn't involve ordering supplies.

I'm also concerned about what Streeting has in mind. He should look at the way Ofsted distorted what happened in schools. It's not that difficult to play the system and improve A & E waiting times, etc, while ignoring the quality of patient care.

This is an anecdotal example ...

Two years ago, I was diagnosed with breast cancer. Two lesions were discovered and the first consultant I saw said I would have to have a mastectomy. Obviously, I was upset but was consoled by the plan to have an implant at the same time as the op.

So I had an appointment with a plastic surgeon. She spent most of the appointment telling me that she had one of the lowest infection rates in the country. Unfortunately, I'm diabetic and diabetics have a high risk for infection and breast implant rejection, so she wasn't prepared to operate on me.

I was really upset because 'going flat' was a shock to me. I burst into tears and one of the breast care nurses suggested I see a different consultant. The second consultant was a specialist oncoplastic surgeon, who agreed to operate on me by giving me an extended lumpectomy, which has preserved my nipple and about two thirds of my breast. He then agreed to a second op which has reduced the size of my good breast, so both breast are more or less the same size and shape and I can wear a normal bra without an insert. I can also go swimming and my breast look the same.

If the breast care nurse hadn't understood that I was upset and hadn't suggested a change in surgeon, I would now be flat on one side and I'm pretty sure I'd be unhappy. That plastic surgeon wasn't prepared to take the risk because she wanted to preserve her good record. The second consultant was prepared to take a risk and I will forever be grateful to the nurse and to him.

My concern is that medics will opt for safe options, just so that their position in league tables looks good.

glad you got what you needed. Yes, something to bear in mind.

I would like to see one of the criteria for success as creating a culture of listening to patients and putting their satisfaction ahead of ticking all the boxes, but I doubt if that's what Streeting has in mind.

I started my working life back in the 70’s as an administrative trainee in the NHS and believe it or not there was actually a professional qualification for Health Service Administrators, equivalent to a university degree
There was a 3 year national training scheme for graduates entrants and most of the Regional Health Authorities and Hospital Management Committees ran their own training schemes too. Most if not all senior managers came through one of these schemes, so they understood how the NHS worked, what a complex organisation it is and how to coordinate the many and varied professions working within it.
As someone who spent the whole of my working life in the NHS the management rot set in with the first of its many reorganisations and has got worse with each subsequent one and created ‘jobs for the boys’. Some of the senior management appointments I’ve seen in my local area almost beggar belief. It’s all very well people being able to talk the talk at interview but if they have no real management experience they are almost being set up to fail
I’ve got no time at all for the new Health Secretary but he is right about the money wasted on managers being made redundant (not sacked) with huge pay offs and then getting another job elsewhere but the way the NHS is structured at the moment is at the root of its poor management.

This sounds rather like a rehash of another wizard wheeze to improve the NHS.

I seem to remember that a star rating system was introduced during the 1990s to rate hospitals on their performance. To penalise the poor performers and reward the high flyers.

I remember my local hospital, at the time, had a zero star rating.

It's not a guilty secret, it's well known to have been going on for years!! If a manager fails, they either get moved into another job or given a big pay off to leave!!! There's league tables for all sorts of targets in the NHS, and if they hit the targets the trusts get financial gain. No government has sorted it out, can't imagine a minister with no NHS background being able to!!!

Things would be less complicated and require fewer senior managers if they brought all the trusts back together under one structure again. And then you wouldn't have a postcode lottery any more, everything would be seamless. That would also stop the "reincarnation" Streeting mentions.

I think the NHS is undermanaged for two reasons - too many underperforming managers (they need sacking) and not enough managers overall (it's the largest civilian employer in Western Europe and it's managerial cadre is inadequate in size). Cutting down the number of managers will lead to worse performance, not better. Managers are not beancounters - they run all kinds of services essential in a modern hospital.

We'll see! He's saying the right words but.....all politicians lie to get into office and never follow through. As for Starmer and Reeves..🤡🤡

Indigo8
"This sounds rather like a rehash of another wizard wheeze to improve the NHS."
I agree!

Far too early to judge. There are so many issues/problems to overcome and these moves are not intended to sort them all out!

valdavi

That's right, the ordering is done at a much lower level, day to day in the departments. midlevel managers, or ward sisters, will be ordering, arranging rotas & cover, recruiting, arranging agency cover if needed, submitting overtime for payment, dealing with disciplinary & sickness issues, acting as budget holders for the department in addition to nursing or IT projects or payroll or whatever their department does. One Trust I was at outsourced the finance department so department managers had to assign accounting codes & submit all expenses for payment on the software system, which wasn't straightforward.
I worry about league tables - not that there will be a lot of additional posts needed to do this as their is plentiful data in useable form available, just that it is another "target" to worry about & generate meetings over & sometimes the alogrithms analysing the data are too crude to accurately represent performance. My main worry is that we want an interconnected health service working together seamlessly & the league tables may get in the way of this in some instances.

Well, is Wes Streeting really intending to repeat the mistakes that led to the suicide of Ruth Perry because intolerable pressure was put on people in terms of their school's place on a league table/inspection regime. Beggars belief. All that happens in these circumstances in my observation is the data is manipulated; people aren't treated on basis of need but how it will affect the league table; and the "good" people who don't surrender to the system but just do a very good job are the ones who suffer (like Mrs Perry). I would like the NHS to focus on the patients, not "managing" their place on the league tables. As for Mr Musk, I can only think PP's are maybe just trying to be controversial for a reaction from others

I don't think the NHS has ever been 'under one structure' ReadyMeals. I worked in the NHS in the early 1970s and recall the ending of the diverse 'Hospital Boards' in the city when the NHS was restructured into Regional and Area Health Authorities, which were still supposed to respond to local needs, rather than central government directives.

I agree that further 'ideology based reorganisations' seem to have atomised rather than unified the NHS.

There is no point in keep putting money into the NHS without some sort of productivity plan in place - having a husband in hospital at the moment with a suspected heart attack I can honestly say the Nursing staff are worth their weight in gold & theCardiologist he saw was spot on but the whole system is creaking - when (after 24 hours) he was still in A&E I counted 11 ambulances waiting outside, standing room only in the waiting area (honestly about 5 deep at 10:30 on Friday morning) - either the whole popuation are suffering accidents & emergencies or many should be sent elsewhere for minor attention.

As for needing Musk to sort it - X Twitter is TOTALLY Toxic thanks to Musk - it's the sewer that all the bottom feeders use - That's Musk's real legacy!

Wish we could sack MPs who are rotten apples.

MaizieD

I don't think the NHS has ever been 'under one structure' ReadyMeals. I worked in the NHS in the early 1970s and recall the ending of the diverse 'Hospital Boards' in the city when the NHS was restructured into Regional and Area Health Authorities, which were still supposed to respond to local needs, rather than central government directives.

I agree that further 'ideology based reorganisations' seem to have atomised rather than unified the NHS.

Me too, a bit later though. It was a lot more streamlined than it is now MaizieD. In England there were Districts, Areas and Regions. There were 7 regions covering the whole country, an area would be a county, and a district was a city, or a patch including a group of town and rural areas. There were no internal markets or competition for funding, which cut out all bidding processes, the borders were coterminous with the Local Authorities. With hindsight, after working in the NHS for 40+ years and seeing numerous reorganisations I’d say it worked a lot better than it does now.

Oooh, I'd forgotten about the District Health Authorities...

I agree with Wes Streeting about getting rid of the bad managers. I also agree with a poster upthread about Physicians Associates.

As for Mr Musk, I can only think PP's are maybe just trying to be controversial for a reaction from others

Like poking a bear I suppose?

Why do we need these ghastly men to run the show?

Here here friedgreentomatoes

Casdon

MaizieD

I don't think the NHS has ever been 'under one structure' ReadyMeals. I worked in the NHS in the early 1970s and recall the ending of the diverse 'Hospital Boards' in the city when the NHS was restructured into Regional and Area Health Authorities, which were still supposed to respond to local needs, rather than central government directives.

I agree that further 'ideology based reorganisations' seem to have atomised rather than unified the NHS.

Me too, a bit later though. It was a lot more streamlined than it is now MaizieD. In England there were Districts, Areas and Regions. There were 7 regions covering the whole country, an area would be a county, and a district was a city, or a patch including a group of town and rural areas. There were no internal markets or competition for funding, which cut out all bidding processes, the borders were coterminous with the Local Authorities. With hindsight, after working in the NHS for 40+ years and seeing numerous reorganisations I’d say it worked a lot better than it does now.

I worked for a District Hospital Management Committee in the late 1960s/early 1970s.
All management to do with several hospitals was carried out by far fewer management and administrative staff than there seem to be now and that did include procurement by one manager with a couple of staff. There were probably no more than 30 staff in total, we were not located in the hospital. Each hospital had a Hospital Secretary based in the hospital plus secretarial staff for consultants etc and appointments administrators.
Matrons were in charge (and could be formidable).

I then worked in a clinic which was run by the LA.
Everything changed in 1974, I believe, just after I left.

It seemed to work well. Presumably everything is far more complicated now but perhaps the administration has been over-complicated at the expense of medical staff.

Ann29

Wish we could sack MPs who are rotten apples.

I’ve often wished that there was a version of OFSTED for politicians.

Some time ago, when I worked as a lab technician at a local hospital, a colleague idly pointed out to me one day "y'know, there's only two people in this department who haven't got the word 'Manager' on our name badges - me and you"

True enough. We were surrounded by onion-layers of clipboard wielding management types who spent an awful lot of time whizzing up and down the corridors attending (supposedly) "urgent meetings", while the non-manager minions were doing the donkey-work.