I’m an NHS manager

[secretnhsmanager]

I know you all hate me and think I’m a flabby, bloated bureaucrat or whatever our Secretary of State is calling us this week. I work for the dreaded NHS England, you know, the one about to be abolished. I’m in one of the regional teams and I’m a fairly senior manager working in an area of medicine that is something that involves lots of different hospital departments - it’s a condition that requires an emergency ambulance so think cardiac.

I work alongside clinicians in the services to identify where they can improve their services for patients and then help them to do that. It’s a lovely, rewarding job and I find that the clinicians I work with are appreciative of what we do.

We don’t get an opportunity to tell the public what we do and in the media we are always criticised and assumptions made about us that just aren’t true. What’s really depressing is that a lot of clinical staff hold the same opinions of us. So here I am. Ask me anything.

oh and btw our collective opinion of Wes is that he’s a total wanker.

The obvious question would be, as someone who is within the system, what do you think the major issues are with the NHS? Are they things that can be fixed from within or do they need political change to implement them?

What do you think you could have done differently to avoid the situation NHS finds itself in?

I used to be one too. Mine sounded more operational though, I used to have to be senior manager on call, argue with surgeons etc and it nearly killed me. Thankfully I’m no longer a hospital manager.

What training/degree/skills did you do to get there? Management background or a health professional background?

i would like to know your training.
also your interest in spread sheets.

I worked in the NHS for over a decade, and think the narrative that the NHS has too many managers is just tabloid-promoted nonsense.

I love the NHS and what it represents - it needs Drs, nurses, admin staff, healthcare scientists, and who knows how many other roles to function properly. It categorically doesn’t need to be restructured by every new government.

no hate here op (rgn turned sen mum) you do a tough job.

If you were hands on clinical before- do you miss it?

if they offered you an out (package/promotion etc) would you take it?

Tell me in simple words what you think went wrong between NHS Management and the Darlington nurses, bearing in mind the tribunal judgement was handed down in the nurses’ favour. Thank you.

I’m guessing you’re female but I’m imagining NHS England is mostly white middle aged middle class white men.

I hope I’m wrong though. I would love to imagine that there is a good diverse spread!

Main problems….in no particular order…

1. the NHS is always subject to political whim which means that we end up with SoS who knkw nothing about it, yet make decisions that affect the health of our population because they want to be elected or to progress their career once elected. Whatever you may hear, NHSE is not independent. Our job was/is to make sure govt health policy is implemented and that our health systems don’t spend too much money and spend what money they have how it should be spent (putting it simply).
2. Because the NHS is the ultimate political football we have to operate on the same election cycle as govt, or shorter because we are expected to make the govt look good before the next election. That means that even when there are good policy ideas to implement we can’t do it because we don’t get enough time between elections. It’s even worse when we get an ambitious but ignorant sos because then the timescales for delivery of the impossible are even tighter. And it’s NHSE and nhs managers elsewhere in the system that get the blame for the failure.
3. too much recycling of ideas without time to try the ideas out properly see above
4. Money goes to the acutes whilst more work goes to primary care
5. no money for social care means bed blocking - I hate that phrase
6. endless restructuring which actually costs more money than it saves and is generally only done for headlines

What we need is a govt and sos that will be honest about what change can be made in the length of their term and for a public to accept that. We all pay for the NHS and we have the ultimate power to decide how it serves us and so we can use our power as people to say stop this endless restructuring and political posturing and just let the NHS recover, improve and give us time to do what we know needs to be done to give you the service you deserve. Stop pitting clinical against non clinical staff and stop using the media for inflammatory headlines. But most of all we just need time to do our jobs.

i think I covered this in my first reply, but basically let the NHS - clinical and non clinical - staff get on with our jobs; while the clinical staff see the patients, let us do the work behind the scenes to improve services. We all know what needs to change, we just don’t get the chance to do it before some new sos comes along to change everything.

God, on call is brutal. Respect for you for what you did. It’s rough out there and even worse now.

@secretnhsmanager thank you, that’s a very detailed response. It’s pretty much the same things that I think are the issue with Education as well. Points 1, 2, 3 and 6 are almost word for word what I would say.

I have a similar job OP. How’s your mental health holding up? Mine is in the bin. I’ve never known work to be as hard going and miserable as it is now, I’m really regretting not going for VR. Have you gone for it? And if not, why not?

I have a masters, and many additional certificates etc, and am getting on for 20 years experience in healthcare management. It’s soul destroying to be made out to be a pen pusher and a useless bureaucrat isn’t it!

My route isn’t the usual! I did a biochemistry degree and then a biochemistry PhD followed by a few years in research. I then had a career change in my 30’s and needed something more stable in my life so joined the NHS. I’ve had little management training to be honest, which is typical of the NHS and have been left to figure it out for myself. I find that my background is useful for having the conversations with clinicians as I understand the detail and the physiology. However, the management bit has been a challenge for me and I have had a steep learning curve. I work with quite a few healthcare professionals and they are all fab and obviously have a different perspective to me, but I think NHS management needs to be diverse and include people of all professional backgrounds because we are here to manage a service that needs to meet the needs of our population…which isn’t just managers or clinicians.

Another clinician here keen to hear about your background. I'm not patient facing anymore, I'm mid senior management and policy and governance is my passion.

Very little training. Some courses in the leadership academy and service improvement. There is an NHS grad scheme but I went in after a research career and so went in at a fairly low band and worked my way up over 20 years. I didn’t know that the grad scheme even existed when I started out!

Thank you 🙏

Sorry..I have a love hate relationship with spreadsheets. Mostly love at the moment as I’ve discovered copilot so am playing!

You’re a senior manager at NHS England with very little training?

I wasn’t clinical sorry. I decided to take the research route as I have no people skills 😂.
we were all offered VR in this current mess but I’m not taking it as I have a large mortgage to pay and no partner to share the load so it was all a bit too scary. I also don’t mind moving to the DHSC and/or know that I can find something elsewheee if needed. Mostly I’m very committed to the disease area I work in (which will be outing) and want to make sure that it goes into the new model region and to do thst I have to be here.

I have no idea about that case sorry. I work in a different part of the country so have not heard anything

It is actually very female heavy! It is a good career for women in my experience and EDI is a big thing and actually in practice rather than just tick box. My regional director is female, many directors are female and most of us senior managers in the rung below arw female. These days a good % of the consultants I work with are also female. I have never felt that being female has been a disadvantage to me here whilst in research it was pretty obvious that I was viewed with suspicion when I got married and then having my first child really fucked my career for good.
We still have a way to go re promoting other ethnicities, but I live in a not very ethnically diverse area of the country and so think that’s a big factor here.

My sister is a teacher. She is counting down the days til retirement! Thank you for what you do for our children

What are your thoughts on the banding system? And what is it particularly that would draw highly experienced and skilled clinicians away from delivering valuable clinical service into management? Are they as readily replaceable as a manager might be?