Pointless NHS Roles

[ChanelNoFive]

I am an ex-NHS worker. (Department administrator)

Is it unreasonable to think there are so many pointless corporate/non-clinical roles within the NHS. Mainly high up and middle management roles. Examples:

• Events organisers
• Workforce & Organisational Development Leads
• Strategy Leads
• PR/Photographers/Marketing
• Improvement and Culture/Diversity teams
• Roster coordinators
• PMO

Obviously there are non-clinical roles that are essential for the runnings of the NHS. But are a lot of them really needed? I remember seeing all the high up corporate staff thinking “what exactly do you actually do?”

Who do you think should run huge hospital trusts and how much do you think they should get paid?

The bit that kind of fascinates me is around coding/contracting/commissioning in acute trusts.
As far as I understand, and I hope I'm missing something, a team of maybe 20-30 staff code the notes after every inpatient stay, according to enormous manuals, so we know how many people stayed how long in various clinical specialties and what clinical procedures they underwent.
This enables an annual exercise where a hospital trust is told how much money it will be given to run this year, and a team of analysts/managers estimate how many stays/days/procedures of each kind that will cover, and negotiates with CCG/ICB how much of each kind of care they plan to do in the next year with the set amount of money.
Then throughout the year analysts perform contract monitoring to see if they're doing the amount of everything they said they'd do and report any variance.
The coding can also be used for various ad-hoc data analysis and support research etc so there is some value there, quite potentially serious stuff too like picking up variance in outcomes across organisations.
But I always wonder, if they just hired some seriouslybgood hospital managers and gave the hospitals the same amount of money without the requirement to produce all that data, so they didnt need to employ at least 50 coders/analysts per trust or all the ICB/CCG managers they negotiate with, would things be better overall for patients ? Presumably that's what they did before SQL server!

Full disclosure here...

I have done a LOT of job evaluation in the NHS over the years (both Whitley Council and AfC).

Here's an extremely brief summary:

The scope and range of roles is absolutely staggering

Having seen these jobs from the inside out you could never doubt the value of a medical photographer, a medical devices engineer, a therapy services manager, a catering assistant, a consultant's PA or so many other roles

People get paid more predominantly for having expert knowledge and skills, and dealing independently with risk; for dealing with distressing situations and for working unsociable hours

People tend not be paid more for being exceptionally busy, being nice, being hard working or being especially good at their jobs (unfortunately)

It's not really the jobs that are the problem when things go wrong. It's the over-accommodating manager who is untrained in holding others to account, it's the supervisor that lets people away with stuff, it's the absolutely ridiculous sick pay scheme and culture, and the prohibitive redundancy scheme

It's the sneering attitude of the general public who are oblivious to the billions of pounds being spent, the millions of patient episodes happening, the thousands upon thousands of staff involved, and the level of organisation and record keeping that goes with this. People don't want administration but they also what a system that's accountable to the nth degree... necessitating. Lots of administration.

The irony - "It does not make you look cleaver"

I am not being obtuse. I am simply asking you to explain your assertion - if you can that is.

You repeatedly post that medical staff should not have a pay increase, should not be allowed to strike and should not be allowed to work abroad and now you say that financial resources should be redirected to the front line? Why such a change of heart?

And once again which services exactly would you streamline on the front line?

I don’t doubt it. And I also know how utterly terrifying it is to have a husband in ICU. However, that experience has nothing whatsoever to do with the OP’s position regarding what they see as unnecessary non-clinical jobs. The pain team - clinical - ought to be of benefit and I am sorry that this wasn’t the case for your husband.

@insidr it is what they did before services were commissioned out to the private sector. When everything was in house.

Was it better for patients?

#redirected to the front line for more scanners, diagnostic aids and medical devices that are better at diaignosising and easier to operate and see the results.

HTH

@DistinguishedSocialCommentator who's going to use those diagnostic tools if you're streamlining the frontline?

The NHS is one of the biggest employers on the world. Of course it needs managers. Some of these will appear to be useless some I imagine genuinely are. As a PP previously said - any company with a ginormous budget will and should have a lot of managers.

Juniro staff and nurses instead of ddoctors or others that have trained on more complex machines

As machines become more advanced, part of the advancement is to make them easier to use. Therefore with minimal training, most people could safely carry out tests, right!!

I'm sure you are not up to speed on AI but this has been incorporated into many areas of science inc medical devices and the result is as I stated earlier

It is only a matter of time before any Joe Bloggs from any street would be able to fly a passenger jet. Thats right, I'm being very serious. You have trains in London that are driverless. We have driverless vehicles and robts used for operations.

AI is also being used to make new medicines 20 times faster than before in some case

With the right gov in number 10, within a few years we may not need as many doctors as AI maches will ask questions, check blood pressure, eyes, ears etc and send of referrals for tests etc and even read results and a summary and conclusion would then be passed to a doctor for the final rubber stamping. its only a matter of time as AI is moving in leaps and bounds

Again a huge misunderstanding of the role of a medical photographer. Do you really expect a surgeon to scrub out to get their phone, take a few pics, managing to not get any shadows where there shouldn't be any, making sure the photo is an accurate representation of what is being photographed.

That may need specialist lighting, or do you expect a medic to do that too?

How about filming a complex operation?

These people are highly skilled, they cannot be replicated by a mobile phone or even an expensive DSLR camera.

We need more admin staff not less! Who do you think types the letters & deals with booking, cancelling or changing appointments? Our admin staff are low paid & massively overworked. Cutting admin staff leads to underbooked/ wrongly booked clinics & a 6 week wait for typing routine letters - which patients & GPs then email & phone admin about, creating more work

Coding is amazing!! They use those codes for so much research, they can compare what therapies Lex to shorter hospital stays, to make sure people get the best treatments in future. They can work out which drugs had the best / worst outcomes. And because codes are used universally across the world they can do it on a grand scale. Coding is seriously awesome!

SNOMED CT (Systemized Nomenclature of Medicine – Clinical Terms) is the most comprehensive and internationally validated system to record clinical information in the patient record. It is a structured clinical vocabulary for recording clinical information in patient records, also known as a 'terminology'.This means that an international language for medical records can be used, allowing research at a huge scale, whilst keeping patients detail anonymous.

This is another example of where front line workers don't understand the value of back office work!!

Yes SNOMED can also be used for contract management, but that also makes it easier as a report can be run via the codes, saving admins trawling hundreds of records!!

@GoogleWhacking

That sounds utterly brilliant - what a fantastic thing to be able to do and have access to.

@GoogleWhacking that is so interesting, it really does sound amazing!

I wonder if this thread will change the minds of posters who think the NHS has too many managers / pointless middle management roles? The purpose of the ones listed in the OP have been clearly explained. In my experience sadly views like this are really entrenched and people still don't believe / trust even when facts are provided. It's a really sad state of affairs, really.

Thank you @pumbaasmiles @Merryoldgoat i didn't understand it myself until I heard about it at a conference years ago and now I genuinely am amazed at it.

AI can do some clever things but not reduce the role of a medic to rubber stamping! Perhaps this weird perspective is what colours your contempt for human medics.

@GoogleWhacking another coding fan here! The data from it is really useful and where contracts have historically not been paid on activity and so the coding is less good the data is worse. That’s a problem for all sorts of things, from research to public health to planning to tackling health inequalities.

It is a good example though of where things could be made more efficient through AI though. If done well automated coding would be far less time consuming and improve the depth of coding (ie the amount of info you have including if there are co-morbidities). Traditionally it’s only been “useful” to record those in the coding if there’s an impact on tariff (how much trusts get paid for each interaction). I can’t imagine a scenario where you don’t need coders but they could be well supported with AI.

"I value my job more than other people's jobs - lets cut them to save some money"

There are quite a lot of diversity roles. Gender awareness is a growing job area in thd NHS. Director of diversity, managers ensuring diversity. Remember to use your pronouns when you attend meetings around diversity. Costly events.

I’ve been saying this for years. Other countries have state health systems that don’t have these huge numbers of pen pushers and the results are fast treatment for patients. Friends have had operations within a week and physiotherapy including X-rays and added on therapy (GP thought friend would benefit from deep tissue massage) started the day after GP appointment.

This just isn’t true though. The data on it doesn’t tell us that we have more “pen pushers” than other countries. Yes, there are systems that work more effectively than the NHS but when you compare with other OECD countries we have close to the lowest spend on admin proportionate to overall spend. Good, effective services need to be well managed.

People always cite France and Germany on these threads as alternative models but the bottom line is they spend a higher proportion of GDP on healthcare than we do.

I disagree. In the near to mid term, mark my words - AI will downgrade many professional posts EG, what only docs and senior nurses can do aTM, many with not even a milligram of medical experience will possibly take a day/weeks training to run a new machine/device that easily takes accurate readings and also reads/diagnosis the results and then the results are sent to the spelacials and often with very good recommendation on the next plan of action which will be tailr made to the persons physical frame, past history, symptoms, blood groups etc and the specials either rubber stamps or tweaks the results

Indeed we will need doctors for ops but even some of the straightforward one and even complex one are added by robots I beleive

Your batshit AI utopia will save the day then when we have no medics left because we won't treat them properly. And meanwhile, in the real word...