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.

My son-in-law is a senior NHS manager just as his mum was and like her he expects his career will be a sequence "Golden Handshakes" followed by immediate "Golden Hello's" before retiring early on a massive pension. Good luck to him!

Thank you - there are literally five jobs that meet my NHS Jobs criteria currently. Two are operational so would require me being on site at least 2-3 days a week in a city 50 miles away) and the others are specialist IT/HR that I'm not qualified to

This is an interesting thread. I’m almost top of B6 (a nurse) but used to be a BMS. OP, you mentioned that a new initiative that you may put in is having patients triaged and scanned on arrival to ED. This sounds great. However you also mentioned having a clinician from the wards attend to them for this scan. This all sounds lovely. However, would additional staff be allocated to the wards or departments to allow for this, or will it all fall on staff already on the floor?

My Trust has done a lot of different rounds of redundancy. Lots have gone…including porters. Which means more is put on the nursing staff. My ward has Level 2 patients - we need more staff on the floor, but we are not getting them. We escalate this constantly. Say, with your team’s new initiative, an ED patient needs a scan. Are you expecting to pull a nurse from the ward (no doubt already understaffed), or one from ED (ditto)….or would there suddenly be a team of nurses made available that would do just that this?

oh and FWIW, SCNT and safe care aren’t worth the “paper” they’re written on.

Yes of course. I do have to be a bit vague about specifics but will give as much information as I can.

1. Paediatric long covid services - this was a few years ago as these are mostly closed now. Our regions service had a low number of referrals. We spoke to the clinicians in the service - which was based at a large children’s hospital in the middle of the region - and they reported that they were rejecting a lot of referrals from GPs as the children didn’t meet their criteria. We looked at their criteria and spoke to a neighbouring service that delivered in a different way, we also talked to physios ans OTs in our adult services and a local paediatrician as well as parent groups. It turns out that the referral criteria for the children’s hospital was too tight and so the children just weren’t sick enough for them to take. They also didn’t have the expertise needed to provide the care that the children actually needed ie there wasn’t organ damage, really complex mental health issues that they normally deal with. We then worked with the neighbouring service to design something that met the needs of the actual population using it.
2. Cancer services - this is about a decade ago now. The NICE guidance recommended that for patients where there was a high suspicion of pancreatic cancer GPs should be able to refer them straight for a CT. Secondary care resisted on the basis that there would be a flood of referrals. We brought together GPs and radiology teams to discuss it and presented data from an audit we did in general practice to see what was happening with the patients currently. We presented that to the radiologists and they were able to see that allowing GPs to refer wouldn’t flood the service as the numbers were low and also that without this step patients were waiting much longer for a referral and often ended up as an ED admission and outcomes were very poor. By allowing GPs to refer at an earlier point the patients outcomes could be improved (it’s still a bad one) and also as the first thing that secondary care/ED would do is send the patient to the scanner the work was happening anyway. I left the cancer network shortly after so don’t knkw what happened long term, but we had a trial in about half of our sites.

He’s delusional 😂

He’s delusional 😂

He’s delusional 😂

It already happens in stroke units at least in hours, so is possible. We’re using that as a model for another acute service. In short, Their process is that there is a pre alert to ED or straight to the stroke unit that a potential stoke patient is on the way and they are FAST positive. A nurse or doctor from the stroke unit meets the patient and does a quick eyeball then to the scanner. The stroke nurse or consultant can then work with the radiologist to interoret the scan, decide if the patient meets the criteria for treatment and then arrange the referral to the specialist neuro centre or given them thrombolysis whilst in the scanner. It does mean that the clinician is off the ward for about 20 mins but, like our pathway, it’s really time critical if the patient is going to have the best chance of survival and recovery. So saves money 😂

These are good examples. This work is desperately needed in the NHS. The irony is the media / politicians saying (and the public believing them) that jobs like yours are “inefficient” when it’s the opposite - the nhs needs more admin staff and greater management to run effectively and efficiently. It’s depressing quite honestly.

See it’s all about the bands 😆

Aren’t you embarrassed to prop up such a disgusting system ?

Or Do you feel you make a minor difference so that makes up for it ?

Isnt this because the NHS isnt a unified employer so you could be sacked or made redundant in one trust and then apply and start somewhere else shortly after. Doesn’t the NHS have any kind of cross employment so if, say, a post is at risk in one trust, alternative employment might be found in a neighbouring one? Rather than being paid redundancy only effectively to start elsewhere maybe in the same job for a different trust which is legally a separate employer but really it’s still the nhs.

I don’t understand what you are talking about. So can’t answer your question.

Not really, but people going for VR aren’t permitted to work in the NHS for 6 months (I think) that is any trust, any icb etc. if they do then they have to pay their settlement back. I don’t know what the rules are for compulsory redundancy, I think they can get an nhs job straight away and keep their settlement?

Not really, but people going for VR aren’t permitted to work in the NHS for 6 months (I think) that is any trust, any icb etc. if they do then they have to pay their settlement back. I don’t know what the rules are for compulsory redundancy, I think they can get an nhs job straight away and keep their settlement?

Very many NHS managers are senior nurses eg: matrons. My specialist training was in the time of the Langsley report and reforms. We had plenty of managment and leadership training. Why do you think Drs and nurses don't make good managers ?

Experience!

I remember this happening - re: stroke - we have it at our Trust (now on a different site). However they'd put a specialist nurse on to do this addition to the ward staff. Would you consider doing similar for your team's new initiative? I'm asking this because there are a lot of great looking ideas/plans that happen, but they often then do not provide us with the correct amount of staff etc to ensure those things can be carried out safely and effectively.

Like prompt assessment etc is needed/vital for stroke etc, so too is sufficient staffing on a ward - e.g. like mine that has acutely sick patients with tracheostomies and ventilators. If one of my staff was to be off the ward "for 20 minutes", and that happened several times over the course of the day (not to mention that the staff member would need to wait with patient until porters available to transfer patient back to relevant dept etc....except numbers of porters have been cut...therefore less people about to do more work - you get the picture) - then patient safety is compromised. I'm just asking how that would work when Trusts are already cutting staff numbers, and people like me/my ward colleagues are already seeing the outcome of that.

Money is saved by staff numbers being cut. New initiatives are put in to help patient outcomes (and save money). All great for the books. But then people like my colleagues are off the ward for a lot longer waiting for porters (we're not allowed to transfer an acutely ill patient on our own). Do you guys get much say in how wards/depts can be staffed to cover these new plans?

Well you and I differ then I am lucky enough to split my week over clinical and strategic work. There are good and bad throughout both sectors. Personally I think a clinical background is important in making strategic decisions/ demands as you need to " walk the walk" as well as " talk the talk".

I don’t work in stroke, but yes that’s what happens there. We hope to use the model of a specialist nurse and part of our work will be highlighting to the trust that this role, plus others, is needed. We can support the clinical lead to write a business case for the appropriate committee in the trust and both myself and my medical director will be holding meetings with senior leaders to put the case to them.

At the moment the trusts are all just going for the short term fixes of cutting staff without and not thinking of the consequences of that on the staff, patients and their ability to run the services. We can influence and use our experience with other trusts and our improvement services to help as much as possible, but the bottom line is that there are a lot of CEOs and CMOs and senior leaders (both clinical and non clinical) in hospitals who really should be sacked because they are making knee jerk decisions and often choosing their own reputations and ambition above that of patient and staff safety.

Whilst I don’t. I’m not responding to snarky nhs manager/non clinical comments, sorry. I’ve just about had enough of the bashing in my real life where I can’t escape it. On here I can safely ignore.

@secretnhsmanager Just to add to my recent experience with VR, it differs on how long you can't be employed by the NHS for. So in my case I have 16 years experience so would received 8 months pay if I took VR - I couldn't work in the NHS for 8 months or would have to pay the remaining back (e.g. if I got a job after 6 months I'd owe them 2 months salary). My role is fairly niche and never comes up hardly ever so no way would I give it up - and the same type of thing either doesn't exist in the private sector or is paid much less!

I didn’t know that, which is shocking because I should! I’ve got staff in a similar position re niche skills and they too are staying put and hoping for the best. I think it also reflects the uniqueness of our NHS in that we have whole teams working on areas of the service, in my case to bring in improvements, that are so specific to the NHS that we have probably made ourselves unemployable outside. But also shows that the NHS is an incredibly diverse and specialist service and much much more than nurses and doctors at a hospital which is how some members of the public view it to be.

@secretnhsmanager You've completely hit the nail on the head... my role doesn't even exist in many NHS Trusts - it's often picked up by Finance, Service Managers, etc. never mind outside!

You may not like my opinion but it isn't remotely snarky (mocking in an indirect or sarcastic way). I am not being sarcastic at all just expressing a different ( informed) view. I would think being able to hold differing views and perspectives was an important skill in strategic roles.