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.

You’ve assumed I resisted all change. Absolutely not. In fact in the last 5 years of my career I instigated and managed the biggest change in service delivery in my area for about 30 years. It was hugely out of date and no longer met the needs of those who used it.
I could see that, I could work out how to change it and did it. (Nearly finished me off too).
What I really lost patience with was the endless change for change sake.. I used to ask why? How will it benefit patients? How will it decrease my waiting lists. No one could ever answer.
But hey. This dinosaur did her absolute best for her patients and her team for 40 years. I have no regrets.

Im sorry but isn't it your job to not 'back off' when you think a service is bordering dangerous? You are paid over £100,000 a year. Whats the point if you don't act in such a situation?!

You have a team to do your data analysis, and yet you will waste time doing your own on copilot? Why not ask a one of your team to do that? Do you not trust them? You have a meeting with consultants asking how they are going to improve their service? Sounds unbelievably patronising or micromanaging or incompetent, I can’t decide which. And you wonder why people think we have too many managers? You were rude to the nurses on this board and dismissive on anyone who challenges you.
I’ve worked with some brilliant managers, I’ve worked with diabolical ones. Good managers absolutely are worth their salary, diabolical ones need to be removed. The tax payer funds all of this, there should be proper accountability and transparency.
As for not being listened too and dangerous practices…what are you gettting paid close to 100K if it’s not to stick your neck out and blow the whistle?
you have beautifully explained and highlighted everything that is wrong in the NHS…in fact you have put in black and white for all the world to see just why we have too many on the payroll within the NHS, and what can easily be done to resolve the issues…well done OP I salute you!

Some of these responses are really not very nice. All they will do is stop the Op from carrying on in this thread.

Well quite. OP said in an earlier post clinicians not being listened to has led to poor quality/dangerous care, yet she dismisses the opinions of those with relevant professional qualifications and management degrees and experience.

Begs belief.

@secretnhsmanager Much solidarity to you. I'm an 8a and so one of the 'middle managers' that people seem to hate even more than senior management. I'm 100% overworked and underpaid, I regularly do 60+ hour weeks yet cannot claim overtime. I didn't go for VR and claim 8 month's salary (16 years NHS service) because I can't guarantee I'd get any job in that 8 months and you can't work in the NHS for that period - not sure people realise that.

Oh and I don't mind saying with my chest that Wes IS a wanker. He has recently (and won't be outing as there are plenty of 8a in my Trust) agreed to a public inquiry within the Trust I work for which is not only going to take years of staff time pulled from seeing patients but is expected to also cost approx. £13m of money that could also be spent on seeing patients but is also probably not going to come up with any answers that aren't already in the public domain

The improvements vary depending on where the problems are. For example my team are currently working with a hospital to introduce a pathway where patients are taken directly to the scanner as soon as they arrive in ED. We work with teams to process map their pathways and then use best practice or evidence to suggest where the pathway can be made better eg a clinician from the ward meets the patient in ED and goes with them to the scanner to see what the scans pick up so decisions about treatment can be made quicker. Other improvements involve using AI technology as clinical decision support tools and helping sites implement that.
quite often we are asked to audit/visit a site that has eg had a lot of complaints to do a peer review or deep dive, so we arrange that and of course take part.
My team and I are definitely needed. The clinical teams don’t have the expertise we have, nor do they have access to what is happening elsewhere like we do. We give them the advice, the expertise for improvement work, plus the headspace and skills for doing their bit which is implementing and making it sustainable.

Yes, this. Then today we hear that this round of VR hasn’t led to as many wanting to leave as they needed for this 50% magical reduction. So another round next year…but at least not CR. I guess. We have no idea what the regional structure will be and no idea what we will be doing next year. It’s diabolical.

Yes, this. Then today we hear that this round of VR hasn’t led to as many wanting to leave as they needed for this 50% magical reduction. So another round next year…but at least not CR. I guess. We have no idea what the regional structure will be and no idea what we will be doing next year. It’s diabolical.

I didn’t say I did back off. I said I was told to. I’m not going to say on here what I did, but it wasn’t walking away. That’s why the service is shutting - because when we did go in we discovered it was even worse than we thought.

I like to occasionally do my own data analysis because it is what I was trained to do originally and I want to see how good copilot is and whether it picks up what I do. It’s nothing to do with trusting the team or not, just a couple of hours in a busy week where I could do something for fun. Oh and copilot mostly gets it, but some things are a bit odd but it can’t understand nuance even in data.

Why are my very old parents beating offers of healthcare off with a stick, and teams seem to find it hard to take ‘no, thank you’, for an answer, when my niece can’t get a referral to check if her back pain is scoliosis and my SIL is paying for uterine scans because the NHS won’t provide any, despite her gynae history and elevated risk of uterine cancers? Why does the triaging always seem to work in one direction? And why do you think Streeting is a bad SoS?

Thank you. I’m used to it, but I see some of the people don’t like it when I answer back. That’s another problem in my opinion. We have to just stand there and take a load of downright personal abuse from clinical staff (mostly nurses, sorry) and can’t answer back or tell them they are wrong. It sucks and to be honest says more about their small mindedness than anything else.

Whatevs

And back to you. 8a is such a crap band to be at - senior enough to deal with the shit but not senior enough to make the big decisions. I remember it well. Thank you for everything you do and you’re right, it’s bad out there. One of my team had a look in trac today for 8A posts and there’s nothing that anyone would actually want to go for! Sit tight and hoping that you get a job you deserve in the new world.

But you’re using data that is about people - if you don’t deal with actual people how can you make all these decisions? Experienced band 8 (and 7, 6 and 5 nurses) opinions need to be appreciated and valued. The NHS is not a factory so you can’t treat patients as products on a production line.

Clinicians find your attitude to them/their experience/their opinion insulting and it’s not surprising that they will express this

Ahh but think of the headlines and, even better the photo ops of the wanker stood frowning in the middle of a hospital corridor (why are they always in the middle of a fucking corridor?) with his sleeves rolled up to his elbows and his tie tucked in like some poor cosplay of a consultant.

It’s probably because primary care are constantly told to do everything they can to prevent elderly people from going to hospital because they can’t cope because there are too many patients in ED every day and no beds left.

do u think the pay difference between “managers” and clinical staff is fair? What do you think of doctors and nurses who have to fight every single year after year for their pay raises?
And, in my trust we never! See any “managers” unless it is to get into trouble about something we don’t have any say about, but, when Charles and Camilla came for a visit post Covid the entire hospital was FULL OF managers I MEAN TENS OF TENS OF THEM all
out in their Sunday best to meet and greet and grovel to them. Would you understand that when this happens but we can’t find a manager to come see us when we are highlighting issues and are past pillar to post? Can you understand why the clinical staff have zero respect for management when this is the only thing we see?

It’s called population health management. It’s used to make decisions about what health services are needed in a particular area of the region. Although the data set I looked at today was from a massive national audit and I was comparing how our sites did with the national picture ans where they are outliers so I can plan the strategy for how we tackle that. Hope that helps.

I think that there needs to be two different pay scales as what non clinical staff do and the responsibility we have ie for a population and services etc are totally different to what responsibilities clinical staff do. Nurses get the headlines. Doesn’t mean we don’t fight for fairness across the staff groups. It just doesn’t get reported because it doesn’t fit the narrative.

I’ll continue answering questions, but can’t be arsed with dealing with snarky comments. I get enough of that during the day so 💁🏻

Can you give some concrete examples of back office improvements that managers like yourself do? I don’t doubt you I just struggle to comprehend new information without specific and concrete examples.

where i work in staff meetings they are constantly referring to the bands of staff.
mind boggling,
well the 3s and the 4s, and also the 6s, the 8s and 7s get left alone.
the doctors, are simply doctors, whatever their grade!