To ask how NHS managers get away with it...

[cakehoover123]

Have friend who works for an NHS service and is constantly asked to work beyond her hours, take on unmanageable caseloads so she ends up doing admin in the evenings, etc. This is because there aren't enough staff and they can't recruit.

She says she can't say no, because if she does the service will fall apart. She's permanently terrified that she'll make a mistake through exhaustion and get struck off.

But surely the managers should be held accountable for this. If a manager can't run and staff a team safely, within normal working hours, that's a massive management failure.

In my (private sector) job, if a manager asked me to work like that, I might do it for a week but any longer and I'd say no, and if they pushed, I'd be raising concerns about them with leadership. And if leadership didn't fix it, I'd leave.

How do NHS team managers get away with pushing their recruitment and retention failures onto exhausted frontline staff? Why aren't senior managers holding them accountable?

Is it because frontline staff don't want to fail patients, so they just keep working? But even then - having exhausted staff isn't actually good for patients - and surely managers should have the courage to point that out.

YABU - you don't understand the NHS / your friend is an exception
YANBU - it's nuts.

I have long thought that the NHS has too many managers and inefficient systems. It seems that, in the recent case, the managers are downright dangerous too.

You're blaming the wrong person. The team leader only has the staff they are given, they can't just recruit as they see fit. Band 7 in the NHS is well known as being one of the hardest positions - you pick up the slack and fill the gaps and get all the blame from both below and above whilst the senior managers hide in their office.

They are responsible for retention mind you, but so is the whole team to a degree. Everyone needs to make it a good place to work.

I've worked in various roles and I can definitely say team lead is the hardest, I worked upwards of 60 hours a week.

Having been one, part of the problem is the great terms of conditions of the NHS. It means that key team members can be off sick for months and strong unions and threats of tribunals make it almost impossible to fire people for poor performance. So the competent staff are left doing everything.

As a manager in Social care, there is only so much you can do - the work has to be done, you get pressure from above, pressure from below. It's not the managers fault there are no staff and they don't create the work. It's a very difficult position to be in I am doing operational work, work loads of extra hours just to keep my team afloat and I cry most days. It has been brought to the attention of senior leadership team several times, we have a report that says we need 25 more staff (I have 23 currently) to match staffing levels in other teams in my council the teams that already say they are struggling with their staffing levels! But we have just been told we have overspent on staffing and can't give us any more posts. It is absolutely disgusting to be told you need double your staff load to be a safe team but they want us to cut staffing. Health and Social Care are a sinking ship.

This is replicated across the public sector and not exclusive to the NHS.

I’ve worked in both, private sector, more work generally means more turnover, or if it is an industry governance requirement, more work is mandatory and essential for business continuity/success. Shareholders have to take a hit, make less profit and staff up as required.

Public sector - budgetary limits filter down from central government. Very little room for manoeuvre. More work doesn’t necessarily translate to an increased budget for more staff. Professionals are leaving the PS in droves for more pay and a better work life.

The NHS CEOs are the stuff of nightmares.
The one in the hospital I worked in, implemented a new computer system from an American company, which of course meant numerous 'work' trips over there.

The system has never been fit for purpose, had to be Anglicised and guess who was head of training?
Non other than the wife of the CEO, and she hadn't got a clue.

Thankfully the CEO left under a cloud, but with a hefty pay out.

My trust has no problems recruiting management staff in non clinical roles. In the last 2 years , I have seen 5 new posts. Meanwhile, we are constantly told there is not enough money for clinical staff

@TippledPink I'm sorry to hear the work is stressful.

When you say it's been brought to leadership's attention, has it been put in writing?

Surely if you wrote a formal letter stating you don't have enough staff to run the service safely for users (or staff), that you consider this creates serious risks, and asking for a written justification for why they consider the situation safe, they'd have to act?

Or is that too risky for your own job? But even then, couldn't managers team up across the service to do this?

I don't want to be critical, just to understand.

Oh god here we go...

The biggest problem, not just with the NHS but with businesses in general, is that it tends to be the most ruthless, entitled, greediest, and self-absorbed individuals who pursue and make it to the top jobs.

The only way to change this that I can think of would be to bring in legislation that makes certain c-suite behaviours a criminal offence, punishable by long custodial sentences and asset seizures and enforce them fully. Maybe then you wouldn't get examples like the above or like those we see in banks, energy producers, supermarkers, etc.

Unfortunately, you'd need the government and the public to stop worshiping money as their god for this to even be given a thought.

I'm too angry to respond appropriately right now due to the LL case. Where is the accountability for these barely trained managers ???

I put it in writing every other week I am just told there is no money for more staff.And it is pushed back on me on how am I going to improve the situation with the resources we have. We have to save £6million this year. They have staff engagement sessions with the leadership team. Everyone says how unsafe it is. We have CQC coming soon, I was group interviewed recently and we all said it is unsafe, something is going to happen. If there is no money I don't know what can be done, it's a shit situation for everyone. I feel I can't do a good job and I hate that.

As long as people keeping working very long hours to prop up a service, it will continue happening. Sometimes you have to let something fail in order to get people to pay attention.

Because its rotten from the top down.

And the toxicity either poisons or suffocates anyone coming up that dares to question it or not toe the line.

I had as much effort put into breaking me for speaking out as this trust put into protecting a killer. All because I spoke up and challenged the shite.

I can see that the new trend on mumsnet is going to be vilifying all NHS managers.

Surely if you wrote a formal letter stating you don't have enough staff to run the service safely for users (or staff), that you consider this creates serious risks, and asking for a written justification for why they consider the situation safe, they'd have to act?

Sorry, but this is so naive. It’s so easy to demonise managers when you’ve never had to deal with the realities of this kind of role.

Absolutely. I suppose it will give the teachers a brief break from it being directed at them.

I have recently resigned from an NHS Trust in the North because the pressures because became much.

Senior Managers (Bands 8/9 and above) know how dire things are but they are too focused on solving staffing problems to show any actual concern for the nurses who are killing themselves on the ground floor.

The unit I came from has a staff deficit of 47% so the wards are only staffed with half the number of nurses they should be and it is incredibly dangerous.

Sometimes a nurse turns up for a shift who has only been qualified for about 3-4 years to find she’s the most senior member of staff there and that she only has a newly qualified nurse and a nurse from an Agency working with her. It’s just not safe.

Staff are crying before they even start work and a large portion of them cry when they get home. They hate the fact they are giving sub-standard of care because they simply don’t have time to give the level of care they want to. They would love to sit and talk to their patients and offer them comfort and reassurance etc (some
are end of life), but instead they have no option but to do the minimum before moving on to the next patient.

Visiting times had to changed to include covering the the lunch time period because the nursing staff (including the HCAs) simply don’t have the time to help some of the elderly patients with their meals anymore.

They’re running around for 14 hours, with a lunch break if they’re lucky, with twice the amount of patients they should have and the weight of their patient’s safety weighing heavy on their shoulders. Most of the nurses leave their shifts at least 30 minutes late most days they work.

A good number of staff are on long-term sick because of stress and other staff are leaving to go and work in community jobs, not necessarily because that’s the kind of work they want, but purely to escape the NHS hospitals.

The wards are trying to encourage staff to do extra shifts but it doesn’t work because nobody wants to be there no matter how much BankPay money they would receive. Even agency nurses have stopped booking shifts.

The student nurses don’t want to work in the unit because they can see how dangerous it is, how stressed and broken the nurses are and how little support there is.

Some nurses feel that it will take something very dangerous to happen, as a direct result of the nurse being overworked, exhausted and stressed, before any real changes happen. The nurses are absolutely terrified that they will be the one who makes that catastrophic mistake and they will hold that guilt forever when actually it is the fault of those who are forcing the nurses to work under such pressures who should be held accountable.

Senior management are trying to put Damage Limitation controls in place to try and hire more staff and retain the ones who are still here but I think it’s too late for that. It’s a total shit show.

Thankfully I could get out of it all but I know many unhappy nurses who are trapped in their job and they are so miserable.

I would never encourage anyone to be a nurse in these times.

As long as people keeping working very long hours to prop up a service, it will continue happening. Sometimes you have to let something fail in order to get people to pay attention.

And what do you suggest health care worker (or indeed social workers given the prevalence of Health & Social Care Partnerships) let fail? When their work involves the care and protection of sick and vulnerable people? Letting something fail in those professions can easily result in death, would the general public be happy to accept that because “sometimes you need to let something fail”.

@NewLifter yes it will! All very predictable isn’t it. Maybe it should just go on some kind of calendar so we all know who we should be vilifying this month.

Yes absolutely, we are working 60+ hours and facing burnout, just with the motivation of covering up for serial killers. You definitely nailed it.

When we've seen yet another case of senior management persecuting whistleblowers rather than acting upon unusually high death rates then these senior managers need to be held accountable. It's not an unusual case, the very top of the NHS is utterly corrupt.

I don’t disagree that those particular managers should be investigated. I’m disagreeing with this type of thread where it seems that all nhs managers are being ripped to shreds. Just my opinion.

Having been a "manager" (clinical lead of staff) there was bothing that made my life more difficult than staff who insisted on working over their hours to get things done "or else everything will fall apart".

If i put a business case in for more staff/other resources I didn't have a leg to stand on because those looking at it would only see that good service was being maintained. I put my foot down (which was awful because my juniors who were martyring themselves just.did.not.get.it....lots of tears and difficult words) and made everyone take their breaks, finish on time, and not do any work from home. If that did happen, they'd have to take that time back and I'd send them home early. Incidents went up, we were much less efficient, less patients were seen etc. But guess what? Sickness and turnover dropped and most importantly we got the case for extra staff approved so there has been a long term benefit to everyone.

The problem with the NHS is that there are too many people who think it all rests on their shoulders and refuse to see the bigger picture. You need to have those in management roles making the business decisions understand the clinical side and experiences of those feet on the ground, but also understand the bigger side of how to implement changes for the better.

By the end of September this year our already massively stretched staffing in our profession with in our trust will be completely unmanageable. I honestly don’t know what we’re going to do. Our juniors are very junior for the most part and we just don’t have the seniors to support.

we already feel over stretched to a point where the service we are providing is not at an acceptable level. We try our best, we really do, but it’s hard when there’s not enough staff. It’s only going to get worse if we can’t recruit quickly. It’s not our mangers fault. They’ve tried to be supportive and come up with new ways of working to try and improve things (it’s not really working as we just don’t have enough staff). But it’s not like they don’t care and they’re not pushing us to work beyond our hours or anything, we do, because we want to do the best for our patients.