to think that the NHS has a poor management problem, rather than a funding problem?

[Otherpeoplesteens]

How can this possibly be justified when they constantly moan about lack of front line resources? Surely the need for one of these indicates the rest of the management isn't up to the job?

www.jobs.nhs.uk/xi/vacancy/9d1a745b46d4961077d1a7dbfbfcb280/?vac_ref=914468963

Yes I work for the NHS.

I would say in my dept on a normal working day there are 11 staff actually working on the ward and then 12 qualified but office based specialist role staff and managers who haven't laid hands on a patient in years. That isn't even thinking about admin staff, PA to the big boss, receptionists, ward clerks, etc.

I'd say that equality team is a huge waste of money. A much more cost effective way of doing it would be an E&D lead reporting to the HR Director. Yeah, that does appear to be a department set up with the sole aim of keeping suits employed.

BillSykes - thank goodness people like you who get it exist.

I was, briefly, a suit in a shiny office during the days of PCTs and World Class Commissioning (in my defence I had been hands-on, doing real work for years before in the private sector, but got an offer I couldn't refuse because nobody else in the entire NHS in the North West was capable of understanding the requirements of the job). The empire building, vanity, and hubris had to be seen to be believed. And these are the people calling the shots.

I quit in disgust and went off to get some real management qualifications off my own back. An MBA and some brilliant consulting experience in industry later I can hardly get an interview in the NHS, because I'm "not one of them."

And in industry my health background is toxic too!

Other our paths may well have crossed...commissioning and the bullshit surrounding it is one of the hugest money draining cons in the NHS. You need to commission a cost effective yet well run service. You probably need some frontline management, some money people and a couple of suits to do that properly. Not armies of consultants spouting jargon and charging £3k per day to run a training course. It's just lunacy. And watching some amazing services go to the wall while that still goes on is incredibly frustrating.

Bill World Class Commissioning actually made a lot of sense and had some good evidence behind most of it, but the PCTs bent over backwards to make sure it didn't work whenever it looked like it might, in spite of their incompetence. PCTs were scrapped because the people were useless, not the thinking.

The ones with brains all left commissioning. The utterly useless ones now call themselves CSUs and CCGs, and are still there with fingernails dug deep in the doorframe...

Billsykes's dog. My OH works for one of the commissioning bodies planning STPs and most of the people he works with come from global accountancy firms so your wish is coming true!

That's not really the sort of thing I meant. That comes more under the 'selling consultancy back for even more money' than what I was hoping for. I'd like to see people from the private sector come in and scrutinise the value of management and what they are doing. At the moment scrutiny is mainly concentrated on frontline services, but nobody is scrutinising the scrutinisers and therein lies the problem.

I imagine these accountancy firm employees will be making a lot of noise about how many latex gloves are used and that one supplier claims they can make a 0.125% saving by providing shit patient care but won't be making an awful lot of comment about what a waste their consultancy fees are or how overpaid the doof next to them is.

BillSykesDog Exactly. It'd be the first thing any private programme manager would do - scrutinize internal 'waste' before impacting the frontline. Back office managers in government are usually so overpaid for their experience they have to take pay cuts if they return to the private sector.

The sad truth is that an outsider coming into the viper's nest that is NHS politics is always going to run out of sanity and be hounded out long before they make an appreciable impact.

NHS Fast Track Executive Programme anyone? This was a scheme designed to bring in execs from outside the NHS at director level, as well as catapult clinicians into exec positions. Resisted everywhere they went, programme ran once and never repeated.

Circle anyone? Private company contracted to run the bankrupt Hinchingbrooke hospital trust who were actually making some inroads and getting some good results, and had started to pay back the debt. When they were hounded out three years into a ten year deal, everyone stood up and said "this is not politically motivated." Which of course means that it was.

Hitchingbrooke had a terrible inspection report when it was run by Circle. And Circle made a total mess of the dermatology unit in Nottingham. I have no faith in Circle at all.

Hitchingbrooke had a terrible inspection report when it was run by Circle. And Circle made a total mess of the dermatology unit in Nottingham. I have no faith in Circle at all.

Careful! You'll shatter the illusion. All these fantastic private sector managers just iching to cut through the terrible waste! I've worked for Capita, it's muppets all the way up.

Also I was involved in some of the private managers brought into Local Government. A lot floundered because they had no understanding that about how it is managed politically. And I don't mean office politics. Local Government is ultimately managed by elected Councillors, and the power of individual Councillors bears no relation to their capability to do the job. Good Local Authority senior managers find a way to work with this. The Private Sector people had no idea.

I've often been in the top clinical role in my team; all my managers from my line manager upwards have been non clinical, and plucked from the private sector. The vast majority of these kick ass managers have been truly awful.
I remember one from my Blood Service days that had come from Sainsbury's; I think his former job had involved collecting trollies for all his managerial skills and insight.

YANBU.

Cockicidal, I don't want to see private sector managers running frontline services. As I said earlier, the best run services I ever worked for were those that were run by people with clinical backgrounds right up to director level. The difference that made was amazing, just from the practical knowledge of what's happening at ground level.

What would like to see is private sector mangers with no vested interest (e.g. not Capita, PWC and the normal consulting firms with a vested interest in the NHS as a money making cash cow) going in and reviewing management and seeing what they are doing and what value it actually adds. Because some arms like commissioning cost a hell of a lot of money not to do much. Hell, I'd like to get rid of commissioning altogether and just go back to having the NHS run by local trusts with no competition!

But I do agree with you, in my experience (and the nature of my work meant that I saw how a lot of services were run) the NHS is always best run when it's run by clinicians with input from bean counters. Services run by bean counters with input from clinicians which they ignore are always the ones which are chaotic and fail.

I'd love to see pointless layers of management ripped out to give clinicians more power and say.

I don't think I disagree with any of that, Bill
Sounds sensible to me.

Just, when you sit down in a meeting and you have a toxicology service run by scientists who've worked in labs, or community services which are run by someone who has actually been a nurse the difference is amazing.

It's just simple things, like scheduling a regular team meeting in the afternoon so that community nurses can make all their calls that morning and send off any bloods before lunch instead of scheduling it in the morning so all the calls are done in the afternoon which delays the bloods by a day and can really impact patients and affect their outcomes.

It's a small thing, but when these small things are repeatedly picked up and headed off it makes a huge difference to a service. If people without clinical experience are running a service it gets actions and you have to have six months, a year of running a silly idea which causes problems before it's changed. And there are normally five or six of these silly ideas running at once causing problems for staff and patients and snarling up the service. Put clinicians in charge and miracles happen.

Sorry for the two long posts, I am very passionate about this!