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 have recently had a look at my local Trusts Board papers. 400 odd pages of repetitive and fairly meaningless data. If they didn't exist, I wonder what the impact on patients would be? I wonder how much time would be saved without them and the extent to which that would extrapolote to more resources for patient care. So much of it appears to be box ticking and the NHS appears to have too many former nurses dedicated to box ticking rather than providing care. One wonders how many lives woukd be saved, bed pans emptied without the hollow box ticking and corporate back patting.

How do you personally cope with knowing the system is broken? Does it stress you that you are constrained by budget and policy? What is your view of frontline staff? I’ve been admitted during one of the worst NHS winter crises and saw nurses running around A&E shouting for drip stands and pillows, whilst police came in to deal with a patient who’d assaulted a member of staff. My BIL was also a beds manager for one of the major London hospitals during the first Covid outbreak. I have no idea how frontline staff manage to continue to do such an amazing job in the face of such difficulties.

Meaningless to you maybe. But I’m not going to write a lengthy reply because you’re not interested 💁🏻

I know people in the nhs who think he’s good.

I just plod on and influence what I can influence in my corner of the country to be honest. I reserve my anger for politicians who are just there to serve themselves, like the wanker that is Wes. I don’t think the general public have any idea of how we are constrained by political whim in NHSE and it suits the govt to let them go on thinking that we are making the decisions, whilst in reality we are just the messenger. I’m so tired and exhausted of listening to frontline staff telling me that I and my team are useless, whilst they are in a session that we are running, or a meeting that we are chairing, giving them direct help and resources to make improvements. I actually have good relationships with 99% of the frontline staff that I work with and I know their jobs are difficult, but that vocal 1% take up a lot of airtime and do nothing but block others - their own colleagues in these cases - from changing things for the better for patients and the staff.

However, the public need to also take some responsibility for how bad things have got and I don’t mean the fat bashing and so on that goes on on here weekly, but by doing things like not going to ED because you’ve got a sore throat and can’t get a GP appt.

I am deeply interested. Do you think being an NHSE Manager gives you an insight into my mind and the right to decide whether and what I'm interested in.

I'm on A/L at presnt btw. I hope you are too.

I’m sure there are. We’re a diverse workforce working in diverse environments. Everyone’s experience is different. Mine and the vase majority of my colleagues think he’s a wanker

No, but your posting history on this thread and on MN in general does give me an insight into your mind. It is my non working day today. However I’ve spent an hour dealing with a few emails, just in case you are worried that I may have some time off (after working 14 days without a day off).

You are an NHS Manager so this is relevant in whatever part of the country you work in. As far as I can see, there is nothing about this on the NHS Employer's website or NHS Resolution but I assume you subscribe to the Health Service Journal?

Misleading headline as this case was to do with women's sex-based rights but we see the usual reframing:

Streeting sent NHSE director to investigate trust mired in landmark trans-rights case
By Ella Devereux1 6 January 2026

Wes Streeting instructed NHS England to intervene at a trust facing a landmark trans-rights case, which today saw it found guilty of indirectly discriminating against female staff by requiring them to share a changing room with a transgender woman.

https://www.hsj.co.uk/leadership/streeting-sent-nhse-director-to-investigate-trust-mired-in-landmark-trans-rights-case/7040921.article

This headline is more accurate and there is no paywall:

NHS Trust spent over £600,000 of taxpayer money fighting Darlington nurses over male access to female changing rooms

https://christianconcern.com/ccpressreleases/nhs-trust-spent-over-600000-of-taxpayer-money-fighting-darlington-nurses-over-male-access-to-female-changing-rooms/

If you are requiring female staff to share toilets or changing rooms with men, however they happen to "identify", even if they have Gender Recognition Certificate, then you could find yourself being cross examined in the Witness Box too.

Might be worth finding out if your Trust is breaking the law?

Yes I subscribe to the HSJ. But like most people I don’t read all the articles and this was one I didn’t read. To be brutally honest this is of no relevance at all to me and the team in which I work and trans issues are really not a “thing” in any trust with whose I work. We don’t have time to indulge in culture wars.

OMG! 😵‍💫

We don’t have time to indulge in culture wars.

You mean that as an NHS Manager you do not have time to check whether the Trusts you work for are in compliance with the Workplace (Health, Safety and Welfare) Regulations 1992 and the Equality Act 2010 and you dismiss the legal responsibilities of duty bearers under these pieces of legislation as "culture wars"??

The Public Sector Equality Duty, is that "culture wars" that you do not have time for either?

You said early on in this thread that you had not had much training as a Manager. It shows.

Have you had any training in Risk Assessment?

No hate from me

I read that the NHS workforce is around 2% managers compared to 9% in the private sector. If it were better organised with effective management in place, it would probably run better?

Expecting clinicians to be good at operational or change management is a tall order… some will be, but it’s a different skill set surely?

It really annoys me when politicians deride “back office staff”. All businesses need those people behind the scenes to function. Perhaps there are poorly performing people surviving in the nhs because there’s not enough resources to manage them effectively?!

Nurses manage!

Anything band 6 and above will have a master level qualification which will involve leadership modules which from what you’ve said is more leadership training/qualifications that you have

Im not sure you understand the role of the nurse, particularly a senior nurse

The masters thing is completely inaccurate. It’s absolutely not a prerequisite to have a masters to be a band 7 or above.

Keep doing what you are doing OP. I too was one of the clinical staff who thought there were too many managers until I got more senior and took a unique band 7 role which gave me huge insight into the volume of work that senior management (8c’s, 8d’s etc) do. I’m now one of them but not in the public health system. The NHS needs to be vastly more efficient, in my opinion, but it needs more staff to do that, not less.

Thank you and I agree. I too have met ex clinicians who suddenly realise that what we do is different but no,less worthy. The clinicians I have an issue with are the ones who block change and bitch about us. I don’t see why anyone should have to put up with their job being derided by their own colleagues…..yet we do as managers.

I think some of them are on this thread 😂. Those and the one wanting to provoke yet another trans debate are just tedious and I’m ignoring them.

The percentage sounds about right. It isn’t that the nhs is globally inefficient (like all areas there will be pockets of waste as it’s a lot of large organisations under one umbrella) but there’s always room to make things better, quicker and pathways work better. That’s what my team does, but we are one small team working with 14 acute settings and so, yes, more people doing this work regionally like us, plus locally in the sites would make a massive difference.

NHS Manager here married to another NHS Manager , bands 9and 8c. Both with years of experience including a couple of NHSE regional jobs. I have to admit we both think the NHSE jobs were the most bizarre in our careers- gravely overpaid for what we did with entire teams of people around us paid at least 2 bands higher than what they would be on if employed by a Trust. Junior admin posts artificially upgraded to band 5s, managers with 8a skills doing 8d jobs (sorry). Claiming expenses left right and centre, hotels in London, expensive train tickets (where cheaper fares were available but „it wasn’t a problem”, lunches). Conditions that frontline staff could only dream of. And most of what we witnessed was endless pointless talk, inflated egos. Constant sending emails full of questions to other NHS staff groups who were actually trying to deliver some outputs. I know you say the data you collect from providers is crucial for planning future services but let’s be honest, once automated, this data can be harvested and analysed using AI. Some managers will still be required but not to the scale NHSE and IcBs have currently.

We both left NHSE as felt bored, under-utilised, disempowered and frankly pointless. I can see though that if I stayed longer I would have eventually started believing that my role was making a difference- I mean what other choice do you have if you want to stay sane in jobs like that?
So I know it’s „not a debate” but sadly as two senior NHS Managers we both can’t wait for NHSE to finally be gone. Although I know that in reality it will still be there just under another name.

I followed the series of (many!) threads on MN about the Darlington nurses, and other relevant cases, @Bosky. This thread has perhaps revealed a great deal about the managerial mindset that we witnessed on the losing NHS Trusts’ sides (and also embedded in the Civil Service).

The gross waste of public money, the barely-veiled contempt shown toward the nurses, the ‘nothing to see here’ gambits, the strategic resignations, the lack of legal knowledge, the paucity of safeguarding training, were all pretty shocking.

https://www.bbc.co.uk/news/articles/c2lr71q0v99o

It’s your view. I think you may have had the wrong jobs, or something because it’s not a reality that I recognise. No trips anywhere these days. Can’t even get lunch provided for a workshop. But no I’m not engaging in bitching about NHSE for all the reasons I’ve mentioned 😂

Non nhs person here! Is it true that what one trust deems a particular band or band need for a role can vary trust to trust?

Your post was very interesting too I’m learning a lot from all directions on this thread!

Yep. Totally agree with this!

I'm a bit confused about why you think it's the OP's responsibility to check that Trusts she works with are compliant with various equality legislation? The CEO, COO, HR managers, DEI managers of those Trusts would be the people needing to ensure compliance, along with anyone who is making decisions about toilet or changing room provision. It's not something which is the responsibility of every single NHS maanger, just because they are an NHS manager.

Most NHS managers will have accountability and responsibility within a specific area. The OP works on improving services for NHS England, she doesn't work for those Trusts and isn't responsible for their compliance or not with legislation. I'm a band 7 in an NHS IT department, so probably count as an NHS manager. Things like single sex changing room provision do not in any way shape or form fall under my remit, I have no responsibility for anything related to that and zero influence on it, and it definitely wouldn't be me being taken to court if my Trust were found to be non compliant.

I do recruit people, so of course do need to comply with equality legislation in relation to that, but I'm not responsible for the entirety of the Trust's compliance, just because I'm a manager.

I think you should work in the Trusts- and within divisions close to services. It’s not effective to have you sitting in a regional team. You are not close enough and you are seen too much as the critical part of “critical” friend.

I think it’s the right thing your organisation is being abolished. I’m a bit of a policy nerd and a lot of money has been spent on NHSE since it was set up in 2013 and it grew massively - yet the value for money is just not there to justify the investment. To be brutally honest, you’re outsiders and your impact is going to be much more limited because of that. I understand some coordination is still needed at regional and national level.

Can you get a job as a transformation lead within a trust? That’s where you will make a bigger impact and people probably wouldn’t hate you so much! I’m assuming these roles exist?

There is meant to consistency across banding in the NHS and there are controls in place now, where special HR recruitment panels review new posts to check if the banding is accurate.
in reality admin is easy to manipulate by a couple of bands and it is all about buzzwords. As the band goes up, the level of responsibility and range of duties is meant to reflect that. But if you are a hiring manager who knows the system you can manipulate your job description to achieve the desired banding. For example replace the need to „manage” something with „to lead”. Include words like strategy or system level working.
I worked in a large city Trust years ago and we were losing staff constantly to another trust only a few miles away because they paid at least one band higher to their admin and managerial staff than we did. The jobs didn’t differ.