Does anyone work in senior management in the NHS?

[ludocris]

Just wondering whether anyone has any insight into what, if anything, is being done about the wait times in A&E? There are so many threads about people in agony waiting for hours to be seen. It's quite scary. I recently had a long wait overnight myself, but fortunately I wasn't in pain. It was like being in a hub airport when a load of flights have been delayed - people just trying to sleep everywhere, in the most uncomfortable positions.

Where do we think this is going?

Not suggesting it's within the power of NHS senior management to fix it, I realise the issue is chronic underfunding. Just thought they might have some insight into what the government is planning to do (again, if anything...)

Not senior nhs but A&E nurse….need more money to pay for more staff, we need more staff who want to work in ED. Better designed departments. Better public education on how to look after minor ailments and injuries. Improved 24hr access to crisis mental health services.
Altogether means more money

And do you think that's coming? What are your senior managers saying to you about the huge pressure on the NHS (and thus you and your colleagues) right now?

The night I spent in hospital there were at least 2/3 people with mental health difficulties who needed staff watching them and following them around to ensure they didn't hurt themselves or others. Whether they actually needed to be in A&E for medical treatment or whether it was just that there was nowhere else for them to go I don't know.

Um probably not. We don’t see senior management. we have our department managers trying to manage the risks we see on the shop floor, improving processes streamlining flow etc. but there’s just not the staffing or space to manage the number of patients we are seeing, not to mention space in the hospital to admit to wards if needed so patients end up waiting for a bed in a&e for hours in a bed that can’t be used for the next patient.

we are a relatively small hospital and frequently are coming on to a shift with 60-70 people waiting to be seen, plus patients in 26beds and 4 resus. So 90-100 patients in total with people continuously booking in it’s impossible to catch up.

Not unusual at all….those staff would have been allocated to an area at the beginning of the shift so there’s probably an area that now is short so everything is delayed again. It may be that they needed medical attention but possibly not we often see pts who come in who need to see mental health but they aren’t always available

It's not just A&E. Ambulance service is shocking at the moment too.

Generally speaking people don't want those jobs. They're hard. The terms and conditions have become worse down the years. This is why being a GP was so popular, compared to being a hospital doctor it was a lot more predictable and routine. But even GPs are leaving in droves due to the terms and conditions becoming worse.

More is expected for less. But it's at a point where money alone can't fix it. There needs to be serious recruitment drives and investment in the NHS but it's not coming I'm afraid.

Senior management haven't got a clue what's happening on the shop floor in A&E and other areas of the hospital. They sit in their offices looking at charts and figures and working out which junior managers they can blame for the lack of productivity (insert here patient care).
The junior managers then go and make life hell for the overworked clinical staff, who then leave.
Lo and behold, an understaffed NHS, long waits in A&E, and all the other departments, and so it goes on.

If the NHS stopped paying for all these "senior" "manager" salaries, they'd likely have more money for deserving staff on the ground, including ambulance drivers who do actual, vital work.

There really does need to be senior managers in a hospital they are important to the overall running of the hospital.

Also people who drive ambulances are either paramedics or Emergency care assistants they don’t just drive the ambulance!

We are trying to recruit. Have a permanent advert out for HCAs and nurses but we can months between applicants.

None of whom grow on trees.

You could give the NHS a blank cheque - it wouldn’t fix it.

The problems with the NHS stem from the community and many many years of underinvestment there.

The hospitals have had years and years of reduction in bed capacity, but particular in terms of cottage hospital / rehab beds for patients not requiring acute care but not well enough to cope on their own.

The assumption has always been it's cheaper to get people home with carers ( true), However the treatment of carers in the community and carer homes ( generally) is poor with shit wages and little respect, and the pool of people prepared to do the job is diminishing ( and with the increase in fuel costs probably getting smaller). Care homes in my locality have closed as many are redeveloped into housing ( profit without the hassle of trying to recruit staff, we now have only 1 'nursing' home left in my local area, with several other residential homes shut.

So we have fewer hospital beds, fewer care home beds, patients staying in hospital longer because they can not be safely discharged without a package of care ( or they are discharged and bounce back), so no hospital bed to admit to from A&E and a consequent impact on the ambulance service,

Add to this chronic understaffing which means that even if we can recruit to roles, the pressure on individuals means that we are losing people as fast as we can train them ( if not faster).

We have 2 posts we interviewed for last week and managed to fill 1, so go back to advert again...

All I can say is very little of this is in the hands of the A&E nurse or ambulance paramedic....

I did have paragraphs !

Our local doctor's surgery is is directing almost everyone to A&E. I think this is at the root of the problem.

When I was a mental health nurse, the crisis team was based in A&E as was the duty psychiatrist.

Having more HV’s, and based in surgeries/clinics again would help as they used to be more contactable . People don’t seem to know how to look after a sick child anymore, they go off to A&E when some tips and support would be better.

That's about the jist of it IME .

GP’s being open Saturday mornings for emergencies would help.

The problem is not money, but a recruitment challenge at all levels. There just aren’t the people available for the roles we need filling. We have record vacancies at all levels and can’t spend the money. If you want a secure career- head on over!

NHS England are requiring all trusts to expand services (to achieve the long term plan goals) which is taking staff away from existing services. Trusts are now offering golden handshakes to tempt staff away from neighbouring trusts. We have money we can’t spend.

So in effect, we’re all fishing from an increasingly empty pond.

We URGENTLY need a national recruitment drive.

Please don’t deride senior managers. I’m not one myself, but I can see we would fall apart pretty quickly without the coordination and risk management work they undertake. I think those who do slag them off, are a bit thick tbh.

Thanks for the replies. It's quite eye-opening to learn that the issue is more about understaffing than underfunding. Though perhaps if nurses in particular were better paid, it would be easier to recruit?

I'm certainly not deriding senior management - I just thought they might have some insight into any governmental strategy to improve the situation. Though on reflection, it's sounds like I'm suggesting that front-line workers might not also know this, and I do apologise if it came across that way.

The trouble is that many of the issues are not within a hospital trust’s gift to resolve.

90% of A&E traffic is elderly people who need better primary care and social care, and people in mental health crisis who need access to MH services.

We are chronically understaffed but even when senior management do rustle up the money for additional clinical staff, posts go unfilled as fewer people are training to be nurses and midwives.

Until the government brings in more sensible bursaries for nursing and midwifery students and abolishes tuition fees on these courses, and pours money into more GP clinics, addiction services and mental health outreach, hospitals are always going to be on the back foot.

That would be amazing. I guess it depends where you are

At our a&e we have a single rotating paramedic who mans the hospital porch. This allows ambulances to unload some patients when there are no beds. These poor patients are are parked in the porch with the paramedic (formerly DH, but he has now left as it was so bloody terrible). The paramedic can provide glasses of water, painkillers and blankets basically for these poor people who can be there for hours. They and their families are usually extremely cross about this and can't understand why it's happening. But at least some of the ambulances get back out on the road. Sometimes they hire a tent as the porch gets too hot in the summer

Nurses need degrees now. £30k worth of debt to earn £25-35k.