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.

@stayclosetoyourself with all due respect, it sound like you are quite a junior doctor and perhaps don’t understand what the non-clinical managers are there to do?

Your complaints (rota management etc) seem to be about your clinical leads. I would not expect a service manager to have any input whatsoever into how I manage my time as a consultant - if I think I’m working over my job plan, I’d speak to my CD, who is another consultant. Otherwise, it’s up to me to manage my time as I see fit.

If junior doctors are working over their contracted hours, they would go to the department training lead (me, in my Dept) who would look at the rota and workload. Or they can report to the guardian of safe working hours. Our managers don’t get dinged if we get a poor trainee survey, the consultants do.

The non-clinical managers will organise things like: ordering replacement equipment; ensuring our departmental budget balances, writing business cases for new services; managing clinic scheduling and waiting lists; dealing with recruitment and medical staffing issues (getting approval for the post, putting adverts out, getting contracts issued etc); signing off expenses claims; liaising with CCGs. Not something I as a consultant have any skill or interest in.

We have two non-clinical managers in a department of two wards, six dialysis units, 20 consultants and SAS doctors, 16 junior doctors, and many many nurses. That really isn’t a huge number.

Lacew1ng55
I'm sorry but you are excusing the managers behaviour in the LL case.

It's really a very big deal to accuse your colleague of foul play. The Drs knew there was something seriously wrong. Not just one consultant. The way management behaved is actually how they often behave. How they could dismiss such concerns and get the consultants to apologise and support their escalation to the GMC is typical management behaviour.

Tell me, where is the professional body for NHS management, so that they too can be tried for manslaughter when they make an incorrect decision? Oh yes, there isn't one. Why do they get paid so much more than clinicians then, they just say sorry and move.

Tankfly
Completely agree.

Yes, try doing that when you have patients to care about.

Saschka
I'm SAS
That actually happened - the medical staffing / rota managers/ service managers for acute care do actually intervene like this. They ask the CD too and so do I , but in these particular examples I complained about junior Dr staffing levels ( I was managing the ward after the consultant left with oversight from CD) and that was one of the responses. At other times they've been helpful but I did feel that was very unhelpful and typical management behaviour tbh

Yes you would think.

Whistle-blowers are very frowned on by senior managers. If you whistle blow they will manage you out. Been there, got the t-shirt.

Mortality data takes a while to filter down.

Apparently they didn't report the deaths appropriately so it wasn't picked up at a wider level,

Exactly - I have a professional responsibility which at time extends to a legal requirement to work over my hours. I previously worked in a unit where only 1 RN was on shift at a time, with HCAs supporting. If the night RN didn't turn up, I couldn't just leave....

NHS is in a bit of a mess!

I manage staff in nhs. I work way over my hours. But it's my choice. I do feel a pressure, but partly thats self inflicted pressure I put on myself.

In terms of those I manage, I am actually quite strict about them not working over their hours, and definitely not into the night (you might say it's unfair I get to work over hours, but I don't let my team! If someone is absolutely desperate to work over their hours I'd let them, but give them the time back in extra leave. Plus I'm quite senior. I see the responsibility and extra hours as part of what im.paid for. My junior staff have many years left and don't get paid enough. They need good balance so they don't burn out.)

If I find out one of my team is working over hours, and it does happen from time to time because lots of us like to give it our all, then I speak to the staff member and we adjust their workload to it can all fit into the working day. What's left is my responsibility. If work can't be done, it can't be done.

There are not enough staff in pretty much every NHS team. Everyone is working flat out. We need managers to ensure their staff are keeping a balance, and not taking stuff home unless they absolutely are desperate too and it is completely their choice ...

Midfourties who do you manage? More junior managers or clinicians?

Saschka
As a senior Dr, I'm sure you are aware that different hospitals have different management processes. Our managers have had a huge amount to do with the junior dr rotas. They have managed to upset such a large cohort of them with their insistence for internal cover at ridiculously short notice that we can no longer recruit consultants. The juniors know that the Drs are treated with little respect and have very little flexibility or redress for their job plans.

The only Drs that have light clinical work loads are the ones who are in management. The managers are very careful who they chose to be CD. We've had the same ones for many many years.

It’s not the team leads that are the issue, it’s the ridiculous expectations from management much higher that have no recent clinical experience!

I’m a Band 7 ward manager, I do at least 3 jobs, Ward Manager, Nurse, HCA…also do a bit of admin as well.

I don’t ask anyone else to do anything near what I do myself but I know we don’t have enough staff and the team work incredibly hard. Safer staffing levels were agreed way above my pay grade so many years ago and the level of acuity does not in any way resemble what it would have done at the time. Changing it is far beyond my ability although I do try to argue my corner! The best I can do right now is be as hands on as possible and fill in the gaps myself! I’m heading for burnout and have a 2 year exit plan.

And they can refuse the junior Drs leave based on staffing levels.
They can also move juniors around to fill gaps.
They have guidelines about what grades are needed in what areas but when we are understaffed they won't agree that that is happening , they will sort of ' doublethink' it and say it's nit happening.
A few years back we had a meeting between all the clinicians and HR over compliance reporting and EWTD - rather defunct now I guess. We said our on calls are crazy there are multiple sick patients waiting to be seen in admissions, AE, waiting rooms etc and multiple pre alerts and MET calls, the bleep going off once per two minutes etc. they said we had to report we had a 30 minute break per 8 hours. We said we couldn't as we couldn't take a break it wasn't physically possible. They said well you have to. Living on another planet.

As if we didn't say we had a break, the hospital would be ' non compliant.

It was the same in the Civil Service, you had to do the work of the next grade up for at least a year to get promoted.

https://petition.parliament.uk/petitions/642631

Please think about adding your signature

Already signed. Though I put it on my Facebook and it was ignored !!! I wondered if it's sensitive for those on management in my Trust ( most of my friends being HCP/ Drs etc

I like the idea but it's too vague for me to sign it. Many managers are clinical staff and regulated anyway. What level of manager are you talking? Is this clerical/non clinical management only or all management? When people say management do you really mean the back office staff who do the grunt work, all the blame and none of the thanks? Is it only band 7s and up or is it ALL staff with management responsibilities?

My head of service is an ex clinician who takes absolutely no nonsense from anyone. Meetings end the minute they’re timetabled to and she keeps a good eye that we’re not racking up unpaid overtime and have enough hours in the day to do what we need to do.

My band 7 line manager however can be a bit of a workaholic and it’s hard not to feel pressured into following suit, but we’ve had good discussions and she tries hard to remind us that she works like that because it suits her and that we are not expected to follow suit.

Me too.

It's very vague.

My area of the public sector is the same, unfortunately. Not public facing but we’re a small team doing the work of a team four times our size, and management cover it up so they don’t look bad to their managers and so on and so on. There’s no money for recruitment but the workload is never brought in line with the resources. People are often on sick with stress.

I’ve worked in the private sector where periods of working like this are short and financially rewarded. In the public sector it’s just expected you’ll work yourself to the bone because you care.

I think many areas of the public sector are just falling apart.

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

They get away with it because of the endemic nepotism in NHS leadership.

Seach for info about the well-paid CEO at Chester when LL was murdering babies. Yes, the former nurse who allegedly bullied people who spoke up.

He's in all the papers so public knowledge.

Now search for his wife who is a “non executive” NHS director and former university chancellor for NHS education courses!

According to Linkedin she is "values driven"🙄

Now I'm not saying she had anything directly to do with LL, but it does seem to be a lucrative little "members club" for people to aspire to belong to.

So this is what needs to change. This rotating door needs breaking up.

We actually need proper QUALIFIED managers and not people like the aformentioned CEO and his "values driven" wife and their NHS chums.

The NHS is managing (and that's a term I use loosely) because of the good will, staying late, extra shifts from the staff on the shopfloor.

I'm yet to meet a decent senior manager.
And if you raise it, you're demonised.
My last senior manager was so shockingly awful that all the long term, experienced staff left under her reign.
She's since left and the department never recovered. All locum staff.

Poor choice for said managers generally comes from nepotisim within the NHS imo.