To think that one of the NHS’s biggest problems is that it’s almost impossible to sack anyone?

Indeed @JohnofWessex. I haven’t seen anything in the public sector that I didn’t also see in private.

NHS worker here. I agree with you to a large extent actually - it is very difficult to address poor performance systematically (and yes, it does exist). But I honestly don't see a way forwards. I used to find it easy to criticise the system but the higher I rise, the more despondent I get about how to improve it. It seems to me that there are two big barriers. The first is the obvious issue of not being able to recruit enough suitable people for a lot of posts so you end up having to work with basically anyone who will do the job. The second is that I do think performance can be genuinely very difficult to measure effectively in a lot of NHS roles. Any sort of payment or promotion by results type of system flounders on the fact that health is complicated; people can get better or worse for a range of reasons out of any individual clinican's control; and it would disincentivise doing jobs where survival or recovery rates are inherently low / disincentivise working with complex and difficult situations. Measuring the quality of care is very hard actually, and whilst patient feedback can be incredibly valuable, it isn't fair to rely on that alone (people who are unhappy are way more likely to give feedback through formal channels than people who are satisfied; complaints often say more about systemic issues with waiting times etc or about unrealistic patient expectations than about the weaknesses of individual staff members - although of course criticisms of the latter are sometimes valid too!).

In my own field of psychological therapy, I have seen situations where people have deliberately avoided taking on certain clients because they know their difficulties are likely to be chronic and therefore the therapy outcome measure won't look good! I have seen people try to force distressed clients to complete measures of their mental wellbeing at inappropriate times because they need these numbers to justify spending time with them. I've seen people encourage patients to over-report their initial distress so that it looks like they've improved later. I've seen people ditch patients because something goes terribly wrong in their lives so inevitably they're not going to be better off overall by the end of therapy, and therefore will count as a black mark against their performance. This stuff is all so ludicrous and is driven by fear of losing jobs (psychology is so oversubscribed in terms of would-be entrants to the profession, and its evidence base so precarious, that this seems to be one of the few areas where performance management can be a bit more brutal).

There are major issues with the competence of management in the UK across the board

Agree with the bullying culture.
I worked with a woman who had trained at the same hospital and never worked anywhere else.
She had basically been over promoted , couldn’t cope and would literally scream and shout at staff and patients. Many complaints were made, nothing ever changed except she was removed away from some clinics.
I heard she retired, presumably on a huge pension.
such a shame as the rest of the staff there were great and the days she was not working were good.

The automatic pay band movement is much reduced. Unfortunately there are too many people who apply for higher banded jobs who are just incompetent but have the ability to ace interviews fortunately they tend to be moving to non- clinical senior posts.
The other problem is the recruitment - someone resigns as they are overworked their job does not get advertised until they walk out of the door. Their replacement (chosen by highly competitive interview 🤣) cannot start until all their pre-employment checks are done (internal candidates as well) and external candidates will only give in their notice once offer confirmed. HR or more likely HR partners are incompetent at best. So without a team member for about six months during which time someone else resigns.
We had someone applied for a higher band job in a critical area and was offered it despite being known for making repeated minor errors rather than readvertise

You do know that 6 months sick pay depends on length of service and not everyone gets it? It’s also in a rolling 12 months too? Similar to many public sector roles

They don’t move through the bands on time served. You move within your band only if your manager approve the pay gateway. You can’t move to a higher band unless you apply for a vacancy at a higher band and are succesful.

there’s also not a pay increment every year either

it also only takes 5 years to get to the top if a band and then you’re stuck

GP surgeries are private companies - they’re not run by the NHS, they’re under contract to provide a service on behalf of the NHS. They’re businesses which are there to make a profit

Absolutely true - work in NHS.
I fed back on concerns regarding a couple staff members on various issues - such as poor note keeping, discriminatory behaviour towards patients, rudeness etc. Other staff had also raised concerns on this staff member. But who got in trouble - myself and another staff member who raised concerns were accused of bullying, poor commuinication.

Surprised they managed to get another job after being off sick for 3 months. You’d think that would effectively make them unemployable.

NHS worker here and I agree with you OP.

I haven't either. The posts from posters who nap or have baths all day earn 6 figures or close to that, and I doubt that they work for the NHS.

It's the 'Peter Principle' people get promoted in the NHS above their level of competency. They have no managerial experience and they cannot performance manager poor performing staff.

I was so shocked when I first started working in the NHS with regards to the behaviours and work ethic which was seen as acceptable.

Poor behaviours don't get challenged, poor performance isn't addressed and highly paid managers have no idea how to manage other than by bullying staff.

The whole culture is so hierarchical and so archiac with so little accountability. There is no reward for good performance and there is no detrimental impact for poor performance.

The NHS needs to introduce performance related pay and stop rewarding everybody the same with moving through the pay bands on a 'time served' basis.

It's always been the same

This 100%
Been 30+ years in the NHS and never seen it so bad. Managers are unable to manage, as those who play the system are enabled.

Seen competent team leaders be dragged through the mud by poorly performing / abusing sickness staff who are being managed playing the victim card.

Anxiety/ bullying is the new weapon of defence these days. Not helped by HR policies being overly ‘inclusive’ at the cost of work boundaries and expectations.

Only comment for this thread.

They usually get promoted!!

Links? Because I haven’t.
plus evidence they aren’t bullshitters.

From my experience, it's not frontline staff e.g. receptionists, doctors, nurses, etc. It's the background staff working in IT, admin staff who work outside of hospitals, and patient info staff. Obviously they do vital roles, but from what I've seen, this is where people slack, get away with working from home, having all the 'sick' days, and getting paid overtime for on call hours where they're not needed for much and get paid to sit around at home. This is where they can find a bit of money, not in cutting vital services to the public. Plus the top end staff being paid 6 figures for doing the same jobs lower band staff are doing. It's an absolute mess, but they're in the job for life if they can keep getting away with it.

But from what I’ve seen and heard, one major issue is that it’s extremely difficult to dismiss underperforming employees.

It's a problem. DD is doing clinical placements in hospitals and some of the staff have been less than helpful. She spoke to the tutor who arranges the placements and when she said who it was that was being unhelpful the tutor said that those staff members had been spoken to before about their treatment of students, and one in particular was rude to everyone, even her (she is also rude to patients).

I have read multiple threads on this site of women who don’t have enough work to fill a day let alone a week, and almost invariably they work for the NHS or the MOD.

Why should the have to do a 5 day week? Opting for a work life balance by going part time doesn’t = incompetent

Many GPs do work 5 days a week, but face the patients for less than that

They are often training (CPD), in supervision, performing duty doctor shifts (not seeing patients, but giving clinical opinions on requests and incoming test results), in budget, MARAC, MASH, Prevent, MDT and practice meetings, discussing palliative patients and sometimes on house calls

Just because a doctor isn't seeing patients, doesn't mean he or she is not at work

Our chefs and catering assistants over mental health and the community hospitals are all employed directly by NHS

Absolutely not true. It’s very easy to get rid of a teacher. It’s being done daily to excellent, experienced teachers because they are expensive.

My boss at the hospital is lazy, incompetent and all the other negatives. Turns up when she damn well pleases and sods off home early most days. The only part of the hospital she knows her way to are the exit and the cafe.

Protected by the higher-ups, she is nothing but an Oxygen and salary thief.

Thing is, when she is off on annual leave, everything runs much more smoothly and no-one notices she's not there.