To think the NHS is bloated with unnecessary management while frontline staff - doctors and nurses - are overworked and overpaid?

Agreed. I work in the nhs in a clinical role and have five layers of management above me who do either very little or no direct clinical work.

You should definitely put your ideas into practice. Get rid of all the managers except your ward clerks.

Just don’t complain when the lack of payroll managers means you don’t get paid next month.

To be fair you wouldn’t be able to complain cos you’d have got rid of the complaints team.

And actually there’d be no way to complain because you’d have got rid of IT (so no emails) and Procurement (so no pens or paper).

I think there is a lot of waste in the NHS when it comes to equipment.
I used to do a lot of buying and selling through auctions. There was one we used to go to called Canute International medical. Basically they had the contract to take everything away when a hospital ward was refurbished. The stuff they had was unbelievable. When a ward was refurbished everything went. Didn't matter if the laptop/dialysis machine/whatever was a week old off it went to the auction. Most of it was being bought and sent in shipping containers to Africa. Canute no longer exist so I don't know if it's the same now but I bet it is .

Sorry, you work in a hospital and think waiting list managers aren't necessary? Without them, who will make sure patients get given an admission date? That they seen in order of urgency? That patients expedited by their GP do indeed get seen sooner? That there are beds and theatre operating lists available on the days the patients who are being admitted? Will the consultants do all that?

And if you think the only admin needed are ward clerks and secretaries, who is going to staff the outpatient reception desks? Manage new referrals? Book appointments? Manage the hospital finances? Handle recruitment of new staff? Order equipment? Arrange outpatient clinics? Answer the phones? And everything else that needs to happen for a hospital to run successfully?

I work in the nhs and I totally agree. The only admin we need are our amazing ward clerks and the consultant secretaries. What we don’t need is a glut of waiting list managers and higher who are only interested in figures and spreadsheets and not patient care

My DD spends a lot of clinical time doing management/admin stuff that has to be but there is no one to do it.

The NHS receives less money per head of population than other european countries... relatively easily but

Blaming a lack of investment in the NHS on "too many managers" is a typical British response to a problem that can be solved, but would require more money to be spent.. ie No one wants to pay any more tax.

I note no one is suggesting we hand back the 4% NI cut, which is costing the Govt £10 billion PER YEAR!!

Its all squeeze even more out of NHS staff and then blame them when it all goes wrong.

Come off it, no-one is talking about no admin or management roles at all. There is a middle ground.

I'm not saying it isn't a lot of money. But compare that to the average FTSE 100 CEO. How many millions do they make ?
All I'm saying is comparatively speaking a CEO of trust manages the same sort of size operation and is paid a fraction.
Whether or not anyone should be paid that much is an entirely separate debate and I'm not justifying it. And I'm not saying they're good people either.
But I found it laughable that someone who works for a consultancy firm whose partners earn 500k slagging off a trust CEO for earning the same as a senior manager in a consultancy when they've got 10k staff reporting into them and a 1bn budget.

I don’t know about you but the systems were so illogical. So in the Trust I was in, if you were off sick 3 times within the space of a year you got hauled into a room with a po faced HR person asking if you’re a skiver. One year I was off with a chest infection, went back on the Monday, shouldn’t have so was off again on the Tuesday. That counted as 2 sickness periods. Then I had a few days off after surgery. But the people taking 6 months off wouldn’t have this as it was counted as 1 sickness period! Everyone moaned about it but getting something done involves 4,917 different people and forms, and for some reason public sector gets away with running in a way a money making business wouldn’t dream of.

I mean the policy must have changed now but still it was ludicrous (and we had oodles of HR people in our not v large Trust)

I'd argue some of that is lack of hr support.

You have nurses for example in charge of managing if someone is following sickness policy which is unlikely to be their natural skill set, then when you want to proceed you obviously need hr support. But in my many trusts this is surprisingly limited.

In my areas for example we have 1 part time hr advisor and a shared one with the other half on the trust. We have a staff group bigger than many national businesses, for example wh smith (all employees from truck drivers, to senior staff to shop workers). In no world would WH smith be expected to function with approximately 1 full time equivalent hr person.

I got to where i am (id like to think) because I was strong clinically. I got promoted up in steps from entry level jobs. At no point have I had any hr training, I've been left to read policies and implement them. For example I'm now expected to write building risk assessments, then bollocked when someone complains about disabled access. The trust doesn't own the building, the only disabled loo has been blocked for an age, and I'm spending lots of clinical time chasing it because recently they slashed corporate pushing more facilities, hr style stuff onto clinical managers

Ironically my role is actually a clinical one but by virtue of them axing the managerial one those tasks fall to the senior clinicians

Prevention is better than cure - good people are out there but they I did meet a lot of shitty unqualified NHS managers who were interviewed by a mate and that’s why they are where they are. Don’t get me started on the piss takers who were always off sick. I had a admin colleague who’d been off sick for 4 years in total out of 10 and was furious when they wanted to sack her because of it.

The management system needs a huge overhaul in general really.

A lot of it isn't law though, and the laws that are there are highly subjective. Most people's managers in the NHS will be completely untrained people with a clinical background only.
The policies etc that I follow are made by consulting people like dei representatives to understand equality impacts

It’s far too reductive to say ‘desk job = not worth X salary’. The ‘desk’ is not indicative of value or usefulness.

The finance and operational directors, for example, have a huge amount of responsibility on their shoulders. The the uppers in finance will all be qualified accountants.

We shouldn’t need whole departments to not be harassed or having workplaces abiding the law

My inclusion department has just successfully campaigned for one of my staff to get reasonable adjustments they would have left without

They are also doing specialist training for international nurses and helping reduce the disparity of health care progression (which is bloody horrendous in representation)

They've also been providing training on managing communities needs. He'll they've even supported me in managing some politics around someone going off after a miscarriage that isn't properly represented in policy

The get rid of DEI is a right wing talking point, that ignores how instrumental they are in making sure people get equal access to health care. As an employee Should you get sick and want to not be fired, be sexually harassed, want to take maternity leave or come back from it... you're likely benefiting from some DEI support, campaigning. Let alone for the patients accessing health care who might need clinicians up to date on specific issues facing their populations.

Is that what they tell you?

A typical NHS chief executive is paid between £150 - 250k. They manage the equivalent of a very decent sized company in the private sector. Go find a private sector CEO who earns that little.

Competence matters though

I work in the nhs as a specialist clinician but spend most of my time doing admin work.
For example today I've spent time emailing out resources and creating a flyer (because I have no admin to do it)

Managing complex hr process, which probably takes me twice as long because my training is clinical. We are woefully understaffed hr wise, so often stuck with people for long drawn out processes because we have so few hr advisors available

The trouble is when you have clinicians like me doing this stuff, we are acting outside our skill set. I'm a senior therapist, i have ooodles and oodles of clinical experience, masters etc all in things that aren't this.

We don't have hr support because they can't recruit because they aren't paying equivalent wages to other sectors.

I once was on a project that had project managers. While I rolled my eyes initially at some external cost the difference of these things being run by people with experience in managing budgets etc was massive.

I would assume people think my job is useless because they don't see the processes that I'm supporting, staff I'm managing, and clinical quality I maintain.

DH is an NHS manager and feels similarly.

A typical NHS chief executive is paid between £150 - 250k. They manage the equivalent of a very decent sized company in the private sector. Go find a private sector CEO who earns that little.

Unless it's a family member taking over the family firm a private sector CEO will have the intellect and skills to do the job and be held accountable for doing so. That's why they are paid more.

The only ones who get anywhere in NHS senior management are the ones who have hit targets, usually by bullying, lying and stepping on people. They are, by and large, fairly one-dimensional production managers who have only ever known targets and terror. Most of them have never had any management training whatsoever, many have not stepped inside a classroom since they did a BA in Geography in the early 90s.

One chief exec I had, an ex-nurse, was barely literate. She used to say things like "turn this into English."

Same with education. My sister has had several paper pushing roles in local government.

She used to organise summer camps for middle class kids in North London (it was meant for everyone but most of the kids had never even been on a bus before as they were driven everyone.).

Laughing at the suggestion that £150k isn’t a huge salary 😂

When I was at the NHS we were always told the directors on £120k got paid so much because the buck stopped with them if something bad happened. But it never did. If there was a never event or a serious incident, they’d be in a new role in a Trust in Scotland quicker than you can say “escaping blame”. The director turnover was off the scale. Always a bunch of nasty fuckers as well.

Oh bless ya cotton socks. its ok.

@Whyherewego procurement is the first problem I'd want to tackle.

Huge salaries ? Says the person who works for a consultancy.

A typical NHS chief executive is paid between £150 - 250k. They manage the equivalent of a very decent sized company in the private sector. Go find a private sector CEO who earns that little.

The average consulting partner in a consulting firm will earn 500k to 900k.

Is there inefficiency in the NHS, of course there is. You should see the hoops we have to jump through to buy anything from a procurement perspective. And it just got worse. Why? Because of legislation telling us that for anything we want to buy we have announce it, publish in x y z places, run a procurement, make sure it's reviewed by lots of people, mark it, document everything meticulously, publish all the results, wait 10days, then award the contract. To buy a few hundred Adobe licenses.

We didn't invent or ask for all this. The government did because they wanted to make Competition. And then we get blamed for inefficiency.

FWIW the number of DEI roles is a LOT less than people think