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.

I disagree. The NHS we have today is a much better and well managed service than the one you experienced.

No questions but sending solidarity. I’m a commissioning manager for an ICB. We’re in a consultation period and expect about 500 job losses in Q1.

Sympathies. It is so shot. Wishing you luck.

I've been a clinical and non-clinical manager over decades and it's simply not true to say that consultants and matrons aren't good managers. That's such a ridiculous sweeping statement.

Government are ultimately responsible for the cultural dislike of managers. It suits their agenda when making endless cuts to allow it to be understood that they don’t have proper jobs and waste resources. All colours of government do this. Managers are used as cover. It’s true that some don’t help o themselves, by not explaining their value effectively.

How do you know if you didn’t experience it? Operations were rarely cancelled, there were more beds, we had our own cleaning teams on the wards, you could get a GP appointment very quickly, we had community hospitals for the elderly, we had efficient district nursing teams, there were loads of jobs for midwives and nurses, junior doctors all got training posts, nurses were not bogged down with paper work, career progression was easy and rapid, there were no patients in corridors, you could choose where you wanted to die and you got support, we had crash call teams in hospitals, there was dignity and respect, we didn’t need bed state managers, we didn’t expect patients to go private for loads of operations, everyone had an NHS dentist, nurses didn’t walk around with iPads, doctors and nurses didn’t have huge student loan debt …. I could go on and on. It was a million times better.

Thank you. He worked as an HCA on a challenging ward (neurosurgery) during COVID so he has been at the sharp end, which I think will serve him well.
Everyone has an opinion on the NHS like schools and the media have a great time reinforcing myths and out of date ideas.
I spent a long time working in Universities as professional services staff and I see real parallels between that and the NHS. Academics and doctors are seen as a superior class of person to others. The public, and often academics/doctors, do not appreciate the complexity of what is needed to deliver the visible services of teaching/research or healthcare.
They overlook the fact that managers need the same skills as those that are valued in private sector industry to keep a large complex organisation running. No one (well most people) would challenge the fact that Rolls Royce, Shell or GSK need managers!
Also, as diagnosis, monitoring and treatments have become more sophisticated and technical, we keep people alive who frankly would have just died in the “good old days”. The job of nursing has changed hugely and public perception has not kept up. What most people think of as nursing ie basic cares is what HCAs actually do on the ward nowadays. Just my 2 cents as the Americans say.

What do you think of NHS procurement? E.g, I can buy an in ear thermometer for around £30 on Amazon. But going through NHS supplies it’s £120. I get that there has to be certain supplies for quality control but it seems like someone is making a lot of money from over charging the NHS.

Is there any hope for psychoanalytic psychotherapy? It feels like it is on the out and manualised short term therapies will be the only treatment.

Ok whatever. This is ama not a debate.

Different times different pressures and a very different health service. That model won’t work today. Anyway. This is ama not a debate.

I agree with everything you say. Thankfully the new generation of consultants have more humility and a better idea of what goes on outside of their own little silos so the arrogant stance of consultants know best is mostly dying out. It’s still there in a few of the hospitals in my patch. Interested those are the ones where there is regional intervention because patients are getting the best treatment, financially they are in deep trouble, governance is non existent and they are well known for being difficult places to work.

I know little about it I’m afraid. I do think that a lot of companies take the piss and overcharge us because they can, but have no specific examples as I’ve never worked in thst area.

I haven’t ever worked in mental health, sorry so can’t answer. It is a mess out there, that’s all I know from talking to colleagues who oversee mental health services.

Great thread, OP. Also an NHS manager. Same level as you and joined via NHS grad scheme.

I was working for the national NHSE team but have just left and taken a local NHS job. I refuse to be a civil servant. I have worked very closely with DHSC when at NHSE. They are one of the most ministerially led civil service departments out of them all. We will no longer be listened to if we advise that ministerial plans are rubbish (and the national team absolutely were listened to before). We will have to crack on with it. I think I can do more good back in the system, so here I am.

If people think things have been bad under NHSE, just wait until it’s absorbed into DH. I sincerely hope Reform do not get into power, else we will be handing the NHS to them on a silver platter.

Yep, exactly. Along with the it was better in the old day’s narrative (examples of which are on here) and the change being all our fault. Hey ho 💁🏻

What band are you

I’m in NHS admin.

Does it also fuck you off watching us be disparaged at every turn? Without us the system would grind to a halt within a day or two. No patients to be processed, no appointments booked, nothing. The consultants etc., all see what we do, but for some reason the government have decided we’re target number one.

The NHS is the biggest employer in the UK. It IS the real world.

Thank you. Yes, I get that worry and it’s one of my concerns too. I think it might be a bit different in the region as we have always been more independent of the central NHSE teams and more aligned to our local health systems. I’m staying out for now as I’m worried about the service I work in and can see it going to ICBs who are too overwhelmed with everything else and have never engaged much with this service anyway. So will see what happens. I had such high hopes for this govt but they are worse than the Tories and Wes is such a…..wanker. I’m hoping he goes soon and secretly hoping the media find something nasty on him and his dealings with mandelson (revenge 😂).

8D

New national director for Mental Health has just been announced, he is likely to have some influence. Nick Broughton. Was a consultant psychiatrist for over 20 years prior to CEO roles.

As OP has said, the NHS is so politically led right now that one week something can be on the table, and the next week it might be off again. No guarantees for anything. Mental health is widely neglected compared to primary and secondary care (and many would argue primary care is neglected in favour of secondary).

We need to focus on preventative medicine, not curative. And I worry we are abandoning curative with the likes of GLP-1s, the intention behind, by the way, is all about pushing more people back into the workforce for longer. The whole programme was pushed via DHSC to reduce the economically inactive. Reducing the burden on the NHS over time is a convenient perk, or so they hope. The government don’t care about people’s health, they care about their value to the economy.

Oh god yes. I started as a band 4 admin in a PCT!

I say this, but the consultants are now apparently targets to, or they were on GB news this morning!

Nobody actually wants to pay attention to what is needed to make the system better

Totally agree with @EnglishRain. Also a NHS manager. The continued ignorance of DHSC around the health of the citizens they are meant to be serving is unbelievable. The scariest thing is that, when presented with evidenced facts, if it paints a picture that they don't like, they either ignore the answer or misrepresent it when reporting upwards.

Wes is indeed a wanker 😬