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.

For an organisation the size and scope of the NHS it's UNDER managed.

And oh yes, our NHS is much more under managed than other health systems. A lot of that is due to the innate shortage of staff, but also we are all aware that we are accountable for public money and so whilst a lot of systems still need improving (IT in particular js dire) there js so much service improvement happening to streamline processes.

For those who want an insurance based model....just imagine how many admin staff will need to be recruited and for which you will be paying out of your premiums, to ensure that the claims are dealt with quickly.

This is probably a stupid question but I have very little knowledge on how the NHS works. But why don't we have a huge training/recruitment drive encouraging young people into careers in nursing or medicine? It seems from what a lot of people saying big problems come from having a lack of staff and people applying for roles.

The short-staffing NHS staff talk about isn't necessarily about vacancies - it's about poor workforce planning.

The staffing in many wards and units is based on calculations made several years ago despite people being sicker (pardon my bluntness but 40 years ago they would have been dead patients, not inpatients) and there being more patients in general. The so-called increasing acuity/increasing technology conundrum. Also takes longer to populate electronic systems. Target culture aided by electronic systems, etc etc.

That's why healthcare workers strike for more pay. Recruitment and retention will improve if people are paid properly. Instead pay and posts are frozen, money is spent on agency staff and Trusts end up overspent and thus unable to increase permanent staffing numbers... and the false economy cycle continues year on year.

We do. Most people in the UK aren't interested.

That's why the NHS is spending money on actively recruiting nurses from India, Saudi Arabia and the Philippines.

We were recruiting from Spain and Portugal before Brexit but it's more difficult now.

My friend is a band 8 in overseas recruitment. They make 50k plus a year being paid to go to Dubai for instance to host recruitment fairs for the NHS.

They're living the dream lol but at the end of the day, their salary is worth it for the NHS as they're bringing in staff that we need. An Indian/Phillipino/Saudi nurse housed by the NHS and working full time on a substantive contract at band 5/6 is hugely cheaper than a UK nurse working for an agency who charge extortionate rates.

@labamba007 with kindness - why didn't you train as an NHS healthcare professional? It's not like anyone doesn't know those jobs exist, we all know from being children the options to be a doctor or nurse when we grow up. It's not a secret that the job is there. But people don't choose it, they aren't choosing it. I don't really know how we convince people who don't want to do the job to do it? And yet those of us who do choose it get criticised for it continuously.

This perfectly describes my trust. I don't know what to do anymore. I report/datix/email/verbalise concerns, it still comes back to us to sort out. My trust advertises continuously for band 8 plus managers but frontline recruitment is never a priority. We are gaslighted and ignored. When I was listening to the managers involved in the LL case I felt a sense of familiarity. It's exhausting trying to care for patients and meet management demands/reports/requests/reviews. The blame only ever goes one way.

Not everyone is running around busy though are they?

Sadly had to visit paed A&E last weekend. 9 nurses on - all waiting on 1 doctor, who was also the only doctor running the paed ward. Those 9 nurses had nothing to do except wait. All patients in there had been dealt with and all paperwork done. They were literally sat there having coffee. 9 nurses. Whilst I'm sure in other places in the hospital , there is one poor nurse running around ragged.

There's your problem right there. I actually had to point out that they simply should be assessing my child there and then rather than waiting for the doctor (they said it was over an hour for triage because they didn't want to up patient's hopes they'd be seen any quicker!!) - as it was, I also pointed out they could fix my child there and then without seeing the doctor (they could but it needed me pointing it out)

I worked in retail. The way the NHS is run is shambolic. All staff seem to take their dinner breaks at the same time for eg. I remember once having an appointment, huge wait, waiting room was packed out and from out of nowhere came 8 manager type people discussing how they were going to relay the chairs in the waiting room. Talk about being bloody clueless. I was about to wipe the floor with them but an elderly gentleman beat me to it! They disappeared fairly pronto. But they'd have been better off helping the staff clear the queues.

Don't start me on how the agency nurses are being paid big bucks to do exactly the same job. The NHS simply shouldn't employ agency staff, or if they do, same rate of pay. It should be that if the NHS trained you, you can only work for the NHS. They're their own worse enemy.

@cakehoover123 - truthfully I'm surprised by the naivety of your post. When I first read it I was really upset but I've had time to calm down before posting.

Where do you think our money comes from as NHS managers? You think we're sat on a never ending pot of money that we're not choosing to spend because we would rather our staff were miserable and our patients failed? I'm a middle manager, both higher and lower level managers work endlessly in my Trust. They work at 5am, 11pm, weekends, holidays. The senior managers are on call in the middle of the night. It's not even well paid.

Everyone knows we're understaffed. And I thought everyone knew the reasons why, I'm saddened that people don't. That's my naivety, I guess. The problems are:

1. We can't recruit. Certainly in the services around me. People don't want the job and I can't blame them. It's very high stress, literally life or death for little pay.
2. And when we can recruit, there is no money for it. That money comes from the government. My manager wants me to have more money for staff, as does her manager, as does the local commissioner. I've been at all the meetings, wrote all the letters and emails, listed it on the risk register. Everyone agrees, everyone is frustrated but if the government don't give us the money then we do not have it. I can't magic it up from a pot somewhere.

I've been offered an NHS job but because they can't seem to come up with specific general hours (you know so I can actually get to work and sort out childcare) so here we are 2 months after an offer and nothing is happening. Chaos

I'm disabled, so bit difficult. My comment was not a criticism of anyone.

And then there is the bullying of the public re. caring, There is a post on the elderly parents board where an Mner was threatened with the police by the nurses because she didnt/couldnt answer the phone

But don’t you see @whereisthecheese, all you have to do is have the courage to point it out. That will solve everything! Simples!

Despite what the DM tells you, the NHS is quite clearly under managed rather than overmanaged - around 2% of its budget is spent on managers, compared to a national average of 9.5%.

https://www.nhsconfed.org/long-reads/nhs-overmanaged#:~:text=NHS%20managers%20make%20up%20circa,under%2C%20not%20over%2C%20managed.

Band 8 starts at 48k doesn't it? Find me a private sector equivalent post to an NHS band 8 and I would guess they are being paid significantly more with less responsibility. At band 8+ heads rolling doesn't just mean jobs being lost its you're legally responsible for those decisions, if your staff fuck up you're the one whose face is in the papers and potentially facing prison.

I'm nhs. I just say no. My contracted hours are my hours no more. They're not going to sack me.

I worked in NHS for many years in clinical, team lead and 8c managerial roles. Ended up throwing the towel in after my 2nd child, it was totally and utterly hideous. The oodles of policies there to protect staff mean naff all to many senior managers. I've also been a union rep and been seconded to an HR project briefly, which was a total eye opener!!! I had to interview various managers - some were awesome, others - I have no clue how they got there!!

The NHS is only still clinging on by a fingernail because all staff work more hours, take no breaks and work at home in their spare time. On the whole, those who work in healthcare put themselves before others by nature which is taken full advantage of. I've seen it spit many dedicated staff out, me included. It's flexible working policies are a joke (although look good on paper!).

I think if there were more genuinely flexible roles, especially part time, they might entice some of us back. Not everyone wants to work full time hours with commute, with a family etc

There are many really old school senior managers who didn't believe in flexibility, hybrid, working from home models at all (hopefully that's changing) and are quite honestly dinosaurs who don't like change.

The whistleblower policies are an even bigger joke, I once knew someone who did that, then was "hounded out of a job" by her manager with trumped up disciplinary hearings for things like record keeping etc, I was a union rep at the time and couldn't believe what I was witnessing.

Until the outdated culture changes along with the funding, things won't improve

The NHS having "too many managers" is such a boring, reductive and uneducated narrative.

Very well explained. I worked in the public sector, my best friend in the private sector. He would have to work silly hours occasionally when contracts and deadlines were getting scary. But he reckoned that his that was much better (and better rewarded) than this constant need for long hours and staying late just to keep the ship afloat. And of course the big difference is that in something like the NHS it's all about the welfare of the people who need the service, and the accountability and public criticism when things go wrong because of it.

If he stuffed up, his company made less money, his boss wouldn't be happy. But it would be a private bollocking, no-one would be in danger, no-one would die.

Any organisation that has 1.2 million staff and thousands of departments will
have and need an army of managers

But like many companies people do jobs and by default because of there grade are classed as management even though there not

Welcome to the public sector! Yet the media drivel on about how lazy we all are

There are certainly a lot of inefficient systems, especially driven by IT systems that do not integrate properly.

As in any organisation, there are definitely some managers who are incompetent. Given the context they are operating in, that means their incompetence can be dangerous in a way it is not for an incompetent manager in another industry.

Those incompetent managers can be both clinical and non clinical but there seems be particular vitriol aimed at non clinical managers and indeed I’m not sure many really understand the concept of clinical managers. Probably the two most senior managers in the Letby case, alongside the CEO, are the Medical Director and the Director of Nursing but I think your average man / woman in the street is presuming it is all non clinical. Laying into clinical managers wouldn’t sit as well, so its not made clear.

There are definitely not too many managers - see link above.

Yep. I'm not a manager nor do I work in the NHS. But you only have to walk into a large hospital to discover that it's almost a little city with so many medical, clinical, administrative, housekeeping, supplies and HR requirements....I could go on and on with all that must be involved in simply keeping the building functioning and furnished, the power on, and the place staffed, never mind all the complexities of the medical and surgical side.

None of us is in a position to say that there are too many managers. We simply don't understand what it takes to run a hospital. Most of the medical staff won't either. It's background stuff, while they're focused on their patients. But it's the managers that make sure they have everything they rely on in order to treat or nurse those patients.

@HoldingPatterns agree. This is a public sector wide issue. I think if people knew what goes on in some agencies, they'd be shocked at how overworked we are

What I don’t get is how in education a head teacher would have to be a fraction as crap as those managers re safe guarding and whistle blowing in an incident far less than the death of 1 child to lose their job, have the school taken over etc. Look at the head who took her own life. Hauled over the coals because of a playground scuffle and a background check and no child was even hurt let alone lost a life.

Hospitals care for the most vulnerable in the most vulnerable situations .It’s the same re CPA and MDT meetings I’ve sat through re my dc in the NHS. The minute taking, meeting quality,adhering to correct procedures , paperwork etc is appalling. I’ve had to do a PALS complaint re lost referrals, documentation, following an upheld complaint, etc,etc. Nobody bats an eyelid. They quote go to PALS for everything. Yet nobody takes that seriously. Yet in education you have to document everything and follow procedures to the letter for far less. Half of what I’ve experienced in the NHS would have had a school put in special measures for safe guarding and management issues immediately and I know compared to what others have experienced in the NHS it’s a drop in the ocean in comparison.

Why is the NHS just allowed to be so lax when who it serves are often the most vulnerable at their most vulnerable and there is far more risk than in schools?

How do people suppose managers recruit staff when no one suitable applies? Our department has put a post out 5 times and not had a single suitable applicant, not much the manager can do about that. I would say our department is under managed not over managed, we have only one manager, no deputy so we end up frequently escalating management problems and queries to our manager’s managers who have been roped into being part time discharge coordinators, so aren’t always available to help. It’s a mess.