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.

Is it the exact same thermometer ?

The nhs is constrained by a lot of government regulations about what suppliers they can deal with . And cheapest is not always best, we switched to cheaper gloves in our trust and every second one split when putting them on so a complete waste of money . And it looked like we were using more so even more pressure to save money by buying cheaper ones

Oh no! I dint watch GB news or any news in the mornings. They need to be listened to, alongside other staff groups. The old view of consultants being god and everyone has to pander to them is over though - mostly!

What do you think of Provider Collaboratives?

They’re now complaining that consultants are overpaid and that they don’t do enough to justify their salaries!

What does your 'typical' day look like?

Thanks for starting such an interesting thread. Why the comprehensive thumbs down on Streeting?

Oh definitely this. The whole three shifts thing isn’t new, we’ve been having these discussions for years. If the DHSC and successive govts would just fuck off and stop meddling and restructuring every other year (that is not an exaggeration btw it really is that often) then we could have delivered them by now.
i grew up in London but now live rurally and a long way from there. The population needs here are completely different to London yet that’s where the DHSC are and that’s where the politicians are so that’s where the policies are written. So short sighted. Anyone who wants to read more about different populations and their needs - just look up Chris Whittys reports on coastal communities and ageing.

Why is the admin so bad? The appointment letters that have three pages on how to access to car park but nothing on the reason for your appointment.

It’s so basic.
Also admin related- why so much actual paper work plus computer records to be completed by the nurses?
Why does it take so long for discharge admin to be completed?

The letters are out of our control. If you’re at the point of hospital treatment, you’re likely going to know what your appointment is for? The letters are a standard template, they can’t go into your medical history for each one.

Discharge is a medical process, not an admin one. They need to co-ordinate it. The largest issue is medication, which needs to be sent home with the patient. The time it would take for nurses to hand off to admin to do the discharge process is going to be just as long as the process is now.

They are the future, but I’m not sure what I think of them yet. I’m involved with a couple, but peripherally and both of those seem to be morphing into structures that seem more like bigger trusts trying to take over smaller ones, so more of a merger. We’re going to have to watch and wait there.

Ha well they had an opportunity to go to medical school for 5 years, spend further years training on the job whilst taking and paying for professional exams and then working long hours in difficult conditions……all to earn just over £100k. But they didn’t and still the earn the same 💁🏻

Whenever I read or hear a conversation amongst NHS staff, I constantly hear reference to what band someone is on, that’s kind of why I asked earlier what you thought. One time even I was in hospital for I can’t remember why, and an nhs employee was chatting to me and she introduced herself with her band - as a non nhs person I couldn’t work out what she was referring to, but since then I hear it a lot. I couldn’t have cared less about what band she was on at that particular point, as a menber of the public I have no idea what they mean!

Is the structure so strict that you stick to “your band” and is it really par of the daily discourse as to referring to people as their bands? Or maybe this is just what public sector is like wherever bandings are published. I’ve only been in the private sector. Just an observation from an outsider - and yes I admit to knowing nothing about the working of the NHS - but the band references seemed odd to me being so frequently mentioned.

As an experience nurse at 8a managing a service I was so sick and tired of feeding endless ‘data’, never to have any response or outcomes. Being told what training my staff needed. Not being left to do the job I had spent 35 years learning.
Yes the nhs is MASSIVELY over managed and micromanaged.

It varies. I often start at 7.30 to catch up on e,ails that come in overnight. Then meetings - this week is mostly team and internal meetings around VR and the new structure. This afternoon I’ve got two whole hours with no meetings so I’m going to do a bit of my own data analysis (I have a team to do it but I prefer to do it myself especially as I’m trying out copilot at the moment). Then I’ve got a meeting with some consultants to talk through how they are going to improve their service. I’ll finish early tonight at 5.30 as it’s mine and the girls’ evening for eating together and watching a movie. Will check emails before bed.

mistly the way he’s treated us but also his ideas are shit and out of date. Will try and write more comprehensively later, sorry.

I’m sick of experienced band 8a nurses not understanding the political landscape that we operate in and that I use your data to make decisions about the entire populations health needs. But hey, you crack on and maybe think about more then just your staff.

It’s a hospital thing in my experience and particularly a clinical thing. I use my job title and so do all my colleagues. I only know what bands people are if I’ve recruited them.

Yep. That’s the attitude. Ask yourself why nurses are leaving in their droves and the nhs is failing.

We actually think about the patients we see day in day out. My staff are frustrated by endless. ‘Service redesigns’ that those of us that have been there a while see on repeat.. ‘oh we’re going back to that way now are we’ I’ve heard so many times.
You mention political landscape and that speaks volumes. It’s the health landscape you should be worrying about.

What improvements do you find and can they be implemented?
Are these things that are on an. Individual basis or are they patient cohort wide?

Why is your job needed?

From my perspective Wes made a purely politically based decision about shutting NHSE down for votes. The old rhetoric around "pen pushers, red tape" blah di blah. The press and public loved it. He had no real idea or care about what NHSE does.

Now, nearly 12 months later, all that has really changed so far is people have left NHSE taking their expertise with them, other people are hanging on waiting for redundancy, others are on long term sickness leave. Work is almost frozen as DHSC has added yet another layer of bureaucracy. It's almost impossible to get work done. The challenges and barriers are ten fold what they used to be.

And who is worse off? Patients and staff.

Wes should be ashamed.

But it shows why so many clinical staff have such a dislike of some NHS managers. I've worked with some incredible consultants to completely redesign how services are delivered. Their management skills have been pivotal to the success of these projects.

But the NHS is massively political and as long as the government is in charge of it, and it is publicly funded, then it will always be political. It's fine that you deal with your patients, that's your job. It is the OP's job to think about the bigger picture and I'm not sure why you think so disparagingly of her and other NHS managers? Do you not think that the NHS needs to be flexible and change with the changing needs of the population? What about advances in medicine and treatments that improve patients' lives? Honestly you sound like one of those old school nurses like the ones that my mother trained with years ago (btw my mother retired as a CEO of an acute trust when she realised that she was turning into one herself) who just resist all change and all improvements just because. My advice - get with it or get out. People like you are holding the NHS back, not the managers.

I retired when my experience and expertise we no longer listened to.

It’s very easy to dismiss the older workforce as dinosaurs. It’s very naive to think you know better than learned experience.

The state of the nhs speaks for me. It’s hardly thriving under this regime

Thank god for that. I don't dismiss older people as dinosaurs - unless they act that way. Btw I'm well into my 50's myself but work in a very fast moving world where my business has to keep up or will go under.