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?

The senior management are the problem.

Too many of them swanning around waving their clipboards and not enough frontline staff (because too much spent on theses “managers”)

I have been saying for ages there is something wrong when Nhs trust regional directors are paid mor than the PM . It’s not right and they have huge pensions as well .

everything needs a big shake up .

The 2017-2020 cohort is unique in that they were the first cohort to start paying fees and they received absolutely no bursary whatsoever.

I thought this letter from a surgeon explained a lot. The NHS needs managers, but what are they managing?

Many of them seem unaware that looking after people is the point.

There is a tragic lack of joining up with adult social care too, as people have been pointing out for years. MIL was discharged from hospital far too early, with no care plan, she ended up having 2 falls within 2 days, requiring 2 ambulances, the second one she was in for 12 hours + (complete with paramedic crew)

X rightly identifies the Griffiths report of 1983 as the start of a new order within the running of the NHS.

Non-medical management now measured success in terms of numbers and percentages, rather than common sense. One index of efficiency was considered to be bed occupancy of as close to 100 per cent as possible. The way to achieve this was to get rid of what were seen as redundant beds. Well, Covid demonstrated what a good idea that was.

Some years ago, I was clinical director of an ear, nose and throat department, and was asked to explain how it was that the ratio of operations performed to outpatient consultations was lower than in other surgical specialities. I said it was in the nature of ENT practice that many patients could be treated conservatively. This explanation did not satisfy management, and I was asked if there was any way the number of operations could be increased.

When I then asked if they would like me to start performing unnecessary operations, the subject was dropped.

Oh do bore off with your analysis of senior managers. They have to work closely with clinicians- never worked anywhere that doesn’t have clinical directors in the senior leadership teams! Absolute nonsense that clinical perspectives are not represented at the highest levels.

Even in the most strategic teams at NHS England eg. they have a practicing GP as clinical director in a primary care team I’ve liaised with over a project.

By clinicians I mean both medics and nurses, in very senior posts in the trusts I’ve worked in

One the training is ridiculous, I'm just about to go into third year and it's only my last placement I have been treated as a student nurse the first 5 placements I was used as a HCA which I already have many years experience of. The training needs to be condensed for people who have care experience 2300 hours are required to join the register over half you will be used as a HCA to plug staff shortages. I hardly learnt anything just meds rounds, OBS on top of HCA duties.

I work in acute medicine, which runs along side A&E and the amount of patients who are at our unit who should be managed by their GP is approx 95%. There is no need for them to attend at all.

OF course they are treated, but not seen/discharged within the 4hr window. Although they are all triaged within that time.

Add the fact that another few % are overdose/mental health, and the rest are 'genuine' candidates for hospital as in very not well and that is your standard mix of patients on a day to day level.

Combine the fact that GPs dont seem to be doing an awful lot in primary care, add in staff shortages, lack of funding, extremely poor pay for the majority, crappy conditions and you have our NHS.

We 100% do need senior management, we also need every single person working to run a hospital.
And I still love my job, love the ethos of NHS, but things MUST change.

That doesn't sound much better than the nurse training I did in the 90 ,s I did project 2000 which was the very early days of the Diploma,we had a common foundation course in which we did 18 months in all different areas of nursing ,general, children's, mental health etc ,after 18 months we branched off into our chosen area I did mental health, tbh the placement, s didn't know what to with us and often treated us as an inconvenience, the last eight months of our training was rostered practice ,and we part of the numbers not super nummery any more ,I would have hoped things has improved since the 90,s .

I do wonder if part of the problem is that the consultants are the unofficial managers and therefore make decisions on how things are run. I know it's just a tv programme and a book, but the recent drama seemed to suggest that many consultants don't work the hours they are paid for and too much pressure is put on junior doctors as a result.

GPs don’t seem to be doing a lot in primary care?

Are you serious?

The stuff that you’re seeing in secondary care is the tip of the iceberg. You’re not seeing the 90% that gets dealt with in primary care and doesn’t make it to hospital.

Primary care are managing all those chronically ill patients that are awaiting delayed hospital investigations or treatment or surgery. The ones that have been parked whilst secondary care plays catch up. They’re still in pain, or unwell, or frightened and needing input, care and management.

They’re dealing with palliative care and terminally ill patients. They’re managing chronic disease, care homes, nursing homes, poorly babies and children, idiots who want an appointment because they’ve had a sore throat for 37 minutes. The Covid vaccine programme for everyone aged 5 and over. Relentless requests for prescriptions, fit notes, appointments. And they’re doing this with fewer staff.

Agree @Sidge primary care is under massive pressure right now, with a retiring workforce

Honestly feel that each part of the system needs to think about things from other’s perspectives. Walk in someone else’s shoes. Now more than ever we need to act as a whole system. From working out what local authorities, charities and families can do to support the NHS, as well as investing in services which will help other services downstream. It’s one big system and we need a bigger picture, strategic view.

Managers are needed, to get skills and experience beneficial to the role yes it means some are on high salaries. But why on earth would someone on say £100k in industry come to work for £30k or whatever; they wouldn't. The front facing bit of the NHS is only a small part, lots of cogs ticking in the background to make sure everything else runs smoothly. I'd rather a project manager overseeing refurbishment of a hospital for example than someone with a medical background (albeit they'd have input to make sure the spec was fit for purpose). The issues with the NHS are numerous with no easy fix, but they lie with the government and not people who work for it.

Pretty much this. I am an ED dr. The problem is not straightforward and the solution not simple but this sums part of it up. Add to this an aging population and imagine A&E in the middle of 2 piles of dominoes that are collapsing. One side from primary and secondary care the other from the hospital and lack of beds. We sit nicely in the middle where everything piles up.

A shit place to be as a patient and a shit place to work right now too.

yes sidge I am serious.

But I wont getting into a who works harder/more match. And I have worked in Primary care too.
The NHS as a whole needs a good shake up and working together should be key. Its a bloody awful situation for us all who work there.

@Jaxinthebox oh absolutely it’s utterly damaged and needs a total fix. Agree with you there!

But really can’t agree with the “GPs don’t seem to be doing a lot”. They’re on their knees. Let’s not bicker and top trump each other on workload, it’s not fair. Everyone is struggling.

I work in medical admissions and a huge number of patients are sent in by the GP when they don’t need to be probably because they are overstretched.
Example: 36 year old man admitted for ? Covid because he felt tired and had a temperature 🙄
Even the patient thought it was a bit weird.
He tested positive for covid and as he had no complications, was promptly discharged home.
As he had no transport, he had to get a bus home

This was at height of the pandemic of course but everyone just shrugged their shoulders as if it was just one of those things.
Then there are the patients who can’t get to talk to a GP and they just turn up inA&E.
This is tip of the iceberg.

I know this may off tangent a bit but it’s just a symptom of the general mismanagement within the entire health service.
And of course, staffing is a huge problem.

Many nurses are turning to agency or private sector, not only for better pay but to be able to have a life.
It’s not unusual to be rostered to do 3 -4 night shifts then one sleep day as day off followed by 3 day shifts. All 12 hour shifts. Having annual leave cancelled , being pressurised to work extra et etc.

It does filter down from senior management who pressurise the more junior management in order to be able to achieve their “ targets”. The result is staff burnout/ going off sick and leaving remaining staff having to work harder because so many vacancies cannot be filled by agency staff.
Of course, patient care goes out the window when one staff nurse is expected to look after 12 patients.Or not enough staff to care for patients full stop and so the ambulances build up outside.
So it’s a vicious circle.
Its all a mess really.

I think a big issue is managers not being encouraged to see the bigger picture. All they care about is achieving targets in their own departments / managing their own budgets so you get this fragmented system which doesn’t seem to gel together.