Wes Streeting about the NHS ‘failing managers’.

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.

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.

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.

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.

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.

FriedGreenTomatoes2

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

Sorry, 😅...

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

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.

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, 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 .

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

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.

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.

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

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?

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.

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.

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.

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".

Sorry an administrative job in the NHS.

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.

Thanks for that Casdon and MaizieD.

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?

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.

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