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.

But it sounds as if there just isn’t the structure to keep managers to account.

It's disgraceful that NHS staff are under so much pressure, having to work extra hours without pay, and in a stressful environment. The burnout rate must be dire. Employers have a duty of care to staff but without more money to attract and retain more people, nothing will change.

It's no better in local government, either. Thirteen years of austerity have pushed our public services right to the edge.

Elsiebear90

Staffing is the same in education particularly for heads however I know as a member of staff if I went to any head in the country to whistle blow with safe guarding concerns there is a robust system that would not facilitate the continued harm to pupils.

It’s not a picnic in education either. Particularly for management. Makes no odds, safeguarding is robust with repeated training every year to make sure policies and procedures are adhered to.

@Lacew1ng55 To an extent, because it is not always clear whether ‘harm’ was caused:

1. by the natural progression of that patient’s condition or the known side effects of their treatment (i.e. its not really ‘harm at all’)
2. by an unintended error or omission in care, or
3. because there is a criminal amongst your ranks deliberately causing harm.

In a NICU, that judgement certainly can’t be made on the basis of 1 death, as it could in a school environment, because sadly babies are ‘expected’ to die in NICU. Mortality rates will vary month to month, year to year and it is not until the point where they start to go ‘out of control’ (from a statistical point of view) that a consideration of any special cause variation could come in (Has your population changed and that has changed the expected outcomes? Have you got an incompetent surgeon on your hands? Or - and of course this is so vanishingly rare and awful - have you got a killer?)

That is not to say that the whistleblowing concerns were handled correctly in the Letby case. There seems to have been evidence that there was something very strange going on much earlier in the process.

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.

So if somebody calls in sick, we should just say “oh well, we don’t have a doctor tonight” and run an unsafe department?

Agency staff are used to fill specific shifts which can’t be filled by recruitment. So there might be a gap when somebody leaves before the new person starts in post, or somebody off sick, or somebody working part time.

The gaps still need to be filled. If I approached you on Monday morning and said “can you go home now, and come back to work at 8pm and do a nightshift?”, or if I rang you at 9pm and said “I know you did a ten hour shift today, but our night doctor has called in sick, can you come back to work and do another 12 hour shift?” would you do that for no extra pay? Or would you need a significant financial inducement to agree to do that? Because that is the kind of situation that we offer locum rates for.

I guess my query is when the first doctor raised concerns the first time. It’s a safeguarding concern from a very qualified professional working in the system. Surely at that point a water tight whistle blowing/ safeguarding procedure should kick in place. Aldo why wasn’t an external body scrutinising mortality data swopping in?Schools have Ofsted devouring all data.

Swooping

Most people in the nhs can’t just leave as they are in a vocational career in a monopoly employer. There’s not always somewhere they can get a job unless abroad etc

as I say: call it the NHS and say no more. Work hard for the good private professional when you need them

Sorry, not buying the endless litany of excuses from people attempting to justify their own position. Nor LGOs or CSs piping up that they are equally "overworked". The NHS is a failing organisation and requires radical reform.
Anyone in any doubt should familiarise themselves with the thread on the abysmal mistreatment of women in labour and the immediate aftermath. It is absolutely appalling especially with the poorer outcomes for women of colour and their babies

Maybe the NHS and CS should make it easier for lower grade positions to be filled, their recruitment procedures are a laborious joke. The NHS in particular requires people to account for every breath they've taken in the last five years, then they never even get back to people. I always wonder why they are happy to not apply the same rigour to overseas employees?

As for the person having the cheek to suggest that British people don't want to train to be doctors, have a look at the BMA refusing for years to increase the number of training places so as to maintain exclusivity. After all we can't have too many plebs slipping in, let alone on pure merit as opposed to Daddy already being a doctor. Nurses should not have to have degrees either, a return to the SRN and SEN system would be far preferable and funnily enough attracts far more of the right kind of people to the job

I have to admit that I find this thread rather,refreshing in its support of NHS managers rather than the usual bitchfest.

Yeah and that's the kind of nonsense that the public like you want to complain about.

You don't think it's nursing unless everyone's running around or 'looking busy'.

And as a patient or parent of one, you want some kind of evidence that the staff are doing 'something' because you pay your tiny taxes and think that means you can judge people that you think aren't working hard enough for you.

You have no real idea of what those nurses are doing or do during that shift or any other shift but you think you can sit there and bitch about their jobs and make up in your mind what you think they should be doing.

Get a grip.

And yes, you'll be weeping if an insurance based health system comes into play. Because your retail job won't cover what you want.

As for the person having the cheek to suggest that British people don't want to train to be doctors, have a look at the BMA refusing for years to increase the number of training places so as to maintain exclusivity

The BMA has no say whatsoever on how many training places the government funds. That is down to the government, universities, and the GMC who approve the training courses (for academic content).

The government was able to increase the number of training places at the drop of a hat last year, they could have done that at any point they wanted to fund it.

NHS worker here. It goes unnoticed because the staff work above and beyond their contract. I will stay late because the person I'm caring for needs someone to care for them and sometimes there isn't anyone I can hand it over too. The NHS also fills vacancies with nq staff and international staff, all of whom require supervision etc. So on paper there are no vacancies but in reality there are massive gaps in staffing especially in experienced staffing.

My manager is amazing in her support and tells us not to work over etc but the issue goes way above and beyond her remit.

You can’t really compare a school to a hospital, they are totally different environments, one treats patients who already unwell and often have complex medical backgrounds with a multitude of health problems which are being treated simultaneously, the other one is where kids who are young and presumably in good or reasonable health come to be educated.

As someone else explained it’s not always easy to tell if someone has come to harm because of an error or poor care or whether it’s just a natural progression of their disease, side effect of treatment/interventions or a new unexpected health event. In some cases it is clear cut, in others not so much.

Families can also have unrealistic expectations of what we can be achieve and underestimate how ill their relatives are, that’s not to say poor care and mistakes don’t happen, of course they do, but it’s not always clear cut, it may appear that way to the patient or family, but in many cases it’s not. I’ve been involved in many cases over the course of my career where patients or relatives felt they experienced poor care, harm or neglect, in some cases that did happen, but in most cases it did not and patients/relatives have misunderstood what happened, why it happened and what was possible.

NHS doctors raised concerns. They had expertise within the system. There was abnormal mortality data. The safeguarding and whistleblowing system in the NHS absolutely should be as robust as any other public service otherwise there is no point having either at all and we all deserve to be safe.Clearly both are broken as they just facilitated the death of several babies whilst several highly qualified professionals jumped up and down trying to raise the alarm. It’s not just tragic but ludicrous.

There is a fair amount of arrogance within the NHS and just dismissing the above isn’t good enough.

I can say from experience that this is down to the individual trust or department and not something that is NHS wide. Yes we are incredibly busy and under resourced but I NEVER feel pressured to work like this, nor do I pressure my direct reports to do so, quite the opposite. I've always found the NHS to be very caring and flexible.
Your friend needs to escalate her concerns to hr or speak to a 'freedom to speak up' champion. Either she's taking this on willingly or her manager needs to be dealt with.

The NHS suffers from the same issues as the rest of the public sector in terms of management:

1. Little actual authority until you are at very senior levels in the organisation.
2. Not enough training and support to ensure management decisions are consistent and in line with policy.
3. Relatively poor pay for the level is responsibility taken on as a middle manager resulting in poor interest and engagement in the role and high turnover.

I am a public sector manager and when I talk about the above to people I know who manage in the NHS I get a lot of nods. For example, recruitment approvals are general taken are far too high a level in the organisation, wasting time and creating a huge bunfight for resources as everyone tries to convince the same senior management committee that they are the ones who need the resources, regardless of available budget or agreed headcounts.

In such a situation it is pretty much impossible for middle managers to manage workloads of staff effectively. They are set up to fail.

Well I'm a doctor and don't really see why we need to be ' managed'. Yes for annual leave cover and rota and medical staffing, but beyond that not really! Especially middle management, senior management for the Trust and services fair enough. But not micro managed and told what to do all the time.
For eg : management we are leaving work an hour or more late at night can we have some help? Management: no, you need to finish in time.
Us: management we need help on day x of the week we are overwhelmed with work until 7 pm. Management, a manager can come to observe practice in day x. Oh yes great, a non clinician who has never done a days ward work in their entire life doesn't believe us, instead feels they can advise us on what to do. No because you don't know our job , and if we followed what you said it would probably endanger lives. Total Bollocks!

This

Take care of yourself

@Lacew1ng55 I’m not in anyway trying to defend the senior managers - they clearly should have acted earlier than they did. I’m just trying to articulate how difficult it is when you are trying to extract unexpected death (and the causes for it) from expected deaths. Healthcare is unique in that regard.

It seems that an association with Letby was first noticed after 3 deaths but I don’t think anyone at that point actually suspected it to be anything other than coincidental. With the benefit of hindsight I’m sure that all those involved wished they had taken action at that point. I suppose one argument is to use something like that as a benchmark if there is an involvement in something that looks it is an unexpected death or harm - bearing in mind that will bring into suspicion potentially a large number of clinicians who are not killers. So that has to be balanced - and this is the key bit that also differs from an educational or other context - with the risk of that action on patient safety. This thread is largely about short staffing, so what are consequences of taking staff off the wards in this scenario - what are the potential harms that will come to patients as a result of a vary cautious approach like that? I would hazard a guess that more patients would die as a result of that approach because the link between poor staffing and poor outcomes is clear.

In terms of data it did show up as outlier for deaths after a year and the unit was closed to some admissions, whilst the reasons for that were investigated. I think that was the point Letby was also removed. A year seems a long time but as I say, when you are in an environment when a certain amount of death is expected, it can take that amount of time to be able to pick up an outlier.

I appreciate this is a very dispassionate and objective way of looking it when we are dealing with parents who have lost their children - my heart goes out to them.

Yep, this sort of sh*t, I believe, happens in most places.

Managers everywhere 'getting away with it'!

I don't think this is solely happening in the NHS!

I think there are public servants up & down the Country giving it their absolute all to try & keep stuff going!

Yes they would like a pay rise, yes they would appreciate the recognition for what they do but they just keep plugging away trying to keep the lights on because they believe in what they do!

Of course there is poor management in the NHS. However for those roaring about "non clinicals shouldn't be in control of hospitals" in the Letby case the senior managers with the main roles were ALL qualified clinicians. Indeed the medical director who is responsible for medical and clinical issues in the hospital seems to been the worst of them, threatening fellow consultants with the BMA etc. So they clearly are aware of how it on the wards but choose to not give a shit.

One of the nursing directors was often seen having a coffee with Letby when she was moved there patient safety unit and allegedly under the most serious investigation by the hospital. The same nurse who told a consultant that she in no way prepared to stop Letby working a shift.