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.

Do you believe staff have the opportunity to speak up about things that they see going wrong in departments, hospitals or the NHS as a whole?

Do you see how a lot of staff are not listened to?

Do you believe it is not worth speaking up or trying to make change, as the rules and funding are all set up and will not be changed regardless of who complains?

Do you agree with the above or do you often see positive change and staff being listened to?

What have you noticed with regards to staff on lower bands who raise concerns being ignored? My experience shows me that lower paid staff are not listened to at all. Higher paid staff are respected more and are more likely to be listened to, but ultimately my experience shows me that major changes come from the top and are so influenced by the people higher up, no staff really stand a chance at making change for the better.

@FreshInks, I think an undergrad degree, PhD, leadership training, and service improvement training, alongside all of the OP’s experience, probably makes them more than qualified for their role.

Love to you. I’m ok at the moment but as a single parent with one child off to uni in the next couple of years and the other following soon after, there have been sleepless nights about how I can support them. It’s hard to concentrate on the day job. I couldn’t risk VR because although after 20 years and an 8D I’d have a good pay off, I’m also in my 50’s and have kids to support, a mortgage to pay and so on so decided to stay for now. It’s the 3am terror that gets me ans then having to get up and put on a face for the team. I feel for you.

In any large organisation there can be better efficiency so this isn’t a critical question re the NHS. But seeing as you offered AMA, do you observe areas for better efficiency and reduced waste, and if so, are you able to offer suggestions? And if so, do you hear back on what happened with that suggestion?

Keep going and stay in an acute they need people with a passion for governance. And who reads the policy documents as Sam Jones apparently didn’t bother when she was a chief exec.

I wasn’t a senior manager when I joined. Then I was a band 4 admin. I learned on the job. I also had nearly 10 years research management so wasn’t completely useless. But yeah, we get little training and practically no investment in non clinical management and leadership training. Most of us have had to do it on the side.

I think the most frustrating thing for me when I was at the top of Band 7 in the NHS was that I was having to spend a lot of time on tasks that lower bands could have covered (and at the same time, there was too much Band 7 work for us to do). My colleagues and I were vocal about this, but somehow nothing was ever done to tackle the issue.

it went national, that one, it was to do with the nurses not being heard by the higher ups in terms of their right to a female only area to change into scrubs, there was a biological male. I didn't follow it super closely so I am not 100% sure of the finer details as being a sen mum is my whole world rn

In short it isn’t fit for purpose. There is little incentive for talented clinical staff to remain clinical and starting nurses at band 5 is an insult. I think that there needs to be two AFC one for clinical and one for non clinical. Many clinicians - by which I mean nurses ans AHPs - that go into management tend to go into management not because of a burning desire to be a manager but because they are ambitious and want to make a difference to policy etc and can’t do it on the shop floor. I think that needs to change because too much pressure is put on lower bands on the wards as the higher bands have gone elsewhere.

I would argue that a good manager is as irreplaceable as a good clinician. And a bad manager as replaceable as a bad clinician.

Short answer. No. We pay lip service, naive freedom to speak up etc but the senior management in hospitals often don’t want to hear. I currently have a trust in my region where my service is failing to the point of being dangerous. The cmo isn’t listening to the staff who are trying to tell them what is happening. I was told to b ack off when I raised it and fobbed off with empty promises and the end result is that the service may well close because of the risk to patient safety.

Yes staff aren’t listened to. I say yes to speaking up but choose who that is. Yes staff at lower bands not listened to, but staff at higher bands aren’t respected more, it’s more a case of no one respected and the cmo protecting their arse. Sorry the quote function hid half your post. I agree with what you are saying and the culture in acutes needs to actually change rather than paying lip service. Annoyingly this is something that we I. NHSE did and were very good at doing and then our role got diluted and we lost our influence and in future.,,,well who knows.

I think so, but some proper management training would still be welcome! Thank you for your support.

I know that my acute colleagues would have lots of examples, but I, not qualified to comment except from my experience, which is that where I work there is surprisingly little of any waste and we are very efficient because we have to be, because we are a very scarce resource now.

My eldest DC is waiting to hear if he has got a place on the NHS GMTS (graduate training scheme). What advice would you give him if he is successful?

Yup. Still happening. In another team we have 8As arranging meetings 🤯

I am a manager in an acute service but with many years operational clinical behind me. I work with people who have no clinical experience on my services. I find we make a great team having a business /different background.

we have been told our non clinical services are going through a review to get our services more frontline. However i am frontline in a way as i do lots of the backroom, invisible things to make sure clinical staff can do the frontline patient care and take the pressure off.

it’s hard and makes you feel unvalued when you can see the positive impact to patient care but constantly being told not needed as you lead an invisible but important service.

@secretnhsmanager thank you for your reply. It’s not often we can speak to senior managers and ask them honestly so it is nice to be able to. I am sure it is very difficult for you guys too as well as the staff on the floor. A lot of us want to improve things and then you get the poor staff who have tried and failed and are burnt out and just give up in a sense. I hope the NHS can see some more good changes over the next few years but it does seem someone high high up is pulling strings. I am sure there is an agenda behind everything and therefore change can never be simple, or approved at all in some places. Are there aspects of your role that you enjoy? Are you able to have a good work life balance?

How much do you earn and how much is the NHS obsessed with the trans issue?

I didn’t hear, sorry. It’s a tricky situation as we have such a strong EDI policy but that doesn’t protect women in these situations. It’s wrong, of course. I am all for understanding and equality for trans women but where does that leave us as biological women in vulnerable situations? I’m sorry, I don’t know the case and feel for the nurses, but have no suggestions and can’t provide an explanation of their decision. Speaking as a mother of two daughters though it angers me that they could be in that situation.

Good luck to him! It’s a lovely career despite what we say. I’d advise listen to everyone working in the service, don’t think that the band 4 admin doesn’t have anything to offer - they have possibly been in their job a long time and seen more managers than you would believe! Eyes open and ears open. See everything as a learning opportunity because a patient experience of the NHS doesn’t mean you know how it works. Finally, have humility because every day is a school day.

It’s people like you who make this job bearable. Thank you.

I love my job. I love that I work in an area of medicine where there have been so many innovations and new treatments we can offer patients now. It os transformative. I work with so many dedicated clinicians who want to offer the best care and I love being able to make that happen. It’s what gets me up in the morning. Cos I’m the mother of teens. They don’t 😂

Well said op ! My husband is the same and works hard for the nhs in a vital role. I have said before that the problem is no one realises what you do and no one cares sadly.

What’s your medical training, to have a real idea of how best to treat patients? Do you earn more than the amazing consultants you work with?