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?

There are out of hours GP services at weekend, but as these are not always based at their own practice patients prefer to sit on a problem from Friday night to Monday morning and then roll up far far worse after the weekend than they might have been.
Practice staff can work all the Saturday mornings you want, but that then means less appointments Monday to Friday which is when the vast majority of patients want to be seen.
Our practice have recently lost three HCP with over 100 years experience between them. Repeat advertising for advanced nurse practitioners...no takers.

Every word of this ^^ 👏🏻 (I’m a Band 8 non-clinical manager).

The ‘government strategy’ is to chronically underfund, fragment, run down and denigrate the NHS. Senior managers are no more enamoured of this than the general public - except that people who work for the NHS are more likely to vote Labour than Tory. But we are not in charge of the resources or the overall strategy, so we are obliged to implement badly thought through, rushed initiatives and then spend endless hours in meetings explaining why nothing works.

I'm not a senior manager (I'm a band 5 who manages a small team) but I do work closely with some fairly senior managers (band 8) and I can assure those who think they're sitting twiddling their thumbs in an ivory tower that that couldn't be further from the truth

The people I work with go above and beyond on a daily basis, they work themselves into the ground to provide the best service they can to the patients but there's just never enough...never enough theatre lists, never enough clinics, never enough staff. We only have so many doctors and there's only so much they can do...they do as many extra lists/clinics etc that they are physically able to do but they still have lives/families/need to sleep!

We all do the best we can but we just don't have the capacity or resources to provide the level of service expected at the volume required. It was bad pre-COVID but the backlog is so big now, I don't know how we'll ever catch up

I know of 3-4 recent/current local initiatives to try to reduce wait times at A&E: trying to stream some people to other health care, trying to provide better preventive care, trying to stretch social care packages further. These projects all sort of work & they are all expensive, none of them seem to be assessed against costs & they may all not be cost-effective.

imho, Nationally there needs to be more taxes to create more places to train domestic HCPs & recruit more HCPs from overseas. Then there needs to be commitment to provide jobs to lots more HCPs. The local managers can only plan using the resources they are allocated. Give them more resources.

I don't know how we prevent UK govt from becoming a Health service govt that does a few other things like defence and trade treaties, though.

fwiw, A&E waits in many other high income countries (public service A&Es) are appalling and long have been. The 4 hour target was very ambitious & unusual.

Do you think the largest employer in the world doesn't need some sort of management? Do you think just a few would be sufficient for the entire country and all of the different settings? Do you actually have a clue of how many managers there are and their roles, or have you just been reading the daily mail?

The issue OP is multilayered, and it isn't all down to funding. There is a global shortage of nursing staff (possibly other HCPs too I'm not sure though), and it's no different here, many many unfilled roles. Even agency staff who get paid £££s are hard to find sometimes- so there are no quick fixes in terms of upping staffing levels which would make the biggest difference. Its a viscious circle at the moment- people leave because the workload is unmanageable due to being short staffed and then more people leave and it continues. What might help?

Better access to training. Even with student loans etc not many people can go back to being a student for 3 years (possibly 4 as many need an access course). Fees should be paid for and perhaps if you leave the NHS within x years you have to pay something otherwise you don't. Bring back diplomas and better bursaries.

Offer more flexibility in shifts- a lot leave as their situations change and they can't commit to nights/12 hour days etc. As they change this can be an issue as well, offer set shifts.

Improve the environment- free parking for staff and bus pass subs for those who don't drive, improve the staff facilities etc. Makes a more pleasant and appealing place to work.

Better community support so that less people misuse A&E as they don't have any other choice as they can't access any sort of care. More power to request time wasters are directed to the correct place for them.

Mental health ambulances and units (with at least x number of staff in a setting trained in physical health in depth too). The system for this is especially crap.

Plenty could be done but no government will have the appetite for it. I do think the effects of short staffing (let's be honest you can have all the facilities and kit but without staff it's pointless) will soon be catastrophic.

& recruit more HCPs from overseas

We already breach the agreed limits on overseas recruitment. There's an ethical consideration to effectively poaching staff from poorer countries as we can pay more etc which then leaves them in a deficit after training people. Although some nurses etc come from America etc we can't really compete in terms of benefits and the like, so unless someone has a burning desire to live here in which case they'd probably be looking into it already; not sure how successful that would be.

@ludocris I didn’t say you were bashing senior managers, just that many people do.

The problem is a lack of coherent strategy nationally. The long term plan is excellent. But in the current ‘State of the nation’ it’s not deliverable without some serious investment in 1) students and training programmes 2) overseas recruitment.

Prevention, integration of care, perinatal mental health etc, are all incredibly important long term… but they have unintended consequences of destabilising the existing, extremely precarious services. We’re trying to do too much before we have got the basics sorted.

Health Education England needs to do much, much more. We should be seeing National recruitment posters on every bus stop and pitches on TV. Healthcare careers are incredibly rewarding, but the staff are run into the ground and need more staff desperately.

@Spagaps agree with all of this. It is incredibly complex but those of us who work in the system have the answers. The government is just not listening!

Yep, infuriating isn't it. It's reached the point where they must be purposefully trying to decimate the workforce and have it collapse, because there's no way they can be this clueless.

DH worked 18 years, with mostly a team of locums due to recruitment difficulties. The amount of times he came home saying that it was dangerous there was horrifying, and he wrote to the chief exec to tell them as much.
I think seeing this story was one of the nails in the coffin as he realised how easy it was too be the scapegoat for a failing system: www.bbc.co.uk/news/resources/idt-sh/the_struck_off_doctor
(Warning: article about Dr Hadiza Bawa-Garba and death of a 4 year old, an upsetting read)
He became unwell and did not return to working in that dept. He does still work for the NHS, though it's hard to explain how much life this has taken from him

Didn't the government used to fund nursing degrees? As they previously have with teachers? I should know this, working in HE to be honest.

But of course as PP have said, recruiting staff is just one part of the huge puzzle.

I'd be interested to know what people think about the continued covid restrictions in hospitals. When I was there a couple of weeks ago there was an elderly lady on her own - probably in her 80s, who was trying to sort herself out and kept dropping stuff on the floor and other people in the waiting room were trying to help her. Pre-covid she would likely have had someone with her (she was on the phone to a son who lived locally). The only people who seemed to be accompanied were those who I assume had official carers.

Not that there would have been any seats available for anyone accompanying patients...

This. And I'm in Scotland so same shit, different nation.

And it's whole system flow. Can't discharge people from wards as there's no social/community care so can't transfer from A&E to wards as there are no beds so front door stacks up. Workforce challenges across health & care system.

Yes senior manager. At the moment we have 1 consultant triaging at the front door alongside a GP and two senior nurses. Attempting to turn people around and sign post elsewhere. Same story every time; either can’t get a GP appt or GP told them to come.

We have 2 x GPs we employ inside A&E and they are heaving from 8-7 every day.

Minors full of “stomach ache/headache/chest pain” with normal obs.

Majors full of the same but with abnormal obs

No delay in resus (basically if you are seriously unwell or hurt there isn’t a wait)

I’ve said it before and I’ll say it again “better safe than sorry” is never a reason to go to A&E (unless you’re talking about kids. A&E is for sick/hurt people - not just checking if something might be going on. Your safe but sorry delays the treatment for people who are sick.

people have forgotten how to look after themselves and the general threshold for when they need to ask for help.

The fact that it’s the largest employer in the world should ring so so many alarm bells.

Nope, you have to pay fees (over £9k a year), there is a bursary now which is good (although not as good as it was), but you'll be on less money than others in your band who didn't have to get a loan. Alongside full time placements and also not being eligible for the 30 hours childcare it really closes people off. Teachers fees aren't paid for although some subjects do attract bursaries.

I agree that sadly sometimes a relative or friend is needed not just for support but to carry out care. They've loosened restrictions a fair amount here thankfully, but when DS was in during lockdown only one of us could stay with him and we couldn't swap over. Fair enough...but also you couldn't leave the ward, couldn't have stuff dropped off and weren't provided with any food with no opportunity to buy any. It was stuff like that which you think wtf. Unless you know you're going to be in for x time and have time to pack y number of meals in case (I didnt) just don't eat. I asked to go to the restaurant or a vending machine and they said no as who will keep an eye on him...

Why? What model would you have instead? Different companies for different areas?

We are a tiny country

Too many managers and pen pushers and not enough frontline staff

@Spagaps, I agree with you about dodgy ethics of recruiting HCPs from LMICs. Regardless, all the rich countries are going to continue to do it. It's a high-demand pathway to prosperity out of Nigeria, Philipines, Viet Nam, India, etc. UK can still compete for some HCPs from such places.

Personally I think it's preferable to try and improve conditions here and make it a more appealing career to people here. We are talking about reaching out to Nepal which is on the recruitment red list which is outrageous. To be clear this isn't as I think they aren't capable etc, but because it is unethical.

I'm a senior manager in the NHS and it's so much more complicated than either under funding or under staffing. Premises are generally poor, pay/hours are better in the private sector, training has become more challenging eg removal of bursaries, funding being tied to very specific, and usually unhelpful, targets, brexit has hampered recruitment and then you have system wide issues such as a disgracefully under funded social care system which results in people waiting on wards for placements and huge pressure on primary care taunting in more people going to a&e. Then we have an aging population, a tsunami of people experiencing mental health issues, the impact of covid etc etc. It's a shit storm with no easy solution.

It’s not. It’s the biggest in Europe. I worked as a senior manager in the NHS for 20 years. I agree with everything @Spagaps says. The tragedy is that in the decade up to 2010 the NHS was running effectively. All the improvements achieved in that time have been destroyed. It’s heartbreaking.

I tried to get into nursing/midwifery in 2005 and I wasn't able to get a loan or bursary. Then they scrapped bursaries when I was thinking about retraining later so I couldn't even entertain it.

I imagine it deterred many other people too. Imagining we could rely on immigration......