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?”

Honestly, so many unnecessary roles …..

sepsis nurses, Aki nurse, physician Associates, the person they paid to hand out masks at the staff entrance during covid ( a box on a table would have been fine)

Can you explain your problem with a sepsis / ski nurse? How are they pointless?
And I doubt the person handing out masks was employed specifically for that purpose. It would have been an HCA and they were physically giving them yo people to to make sure people actually took them and wore them. I assure you, many would have walked straight past a box.

I don't see the issue with this and why you find it so shocking. It's part of infection control and departments are expected to ensure they have adequate resources in place. The person counting won't have an official title of "hand sanitizers counter"

Yes, I agree. However, these are massive capital planning projects, which need a large amount of strategy development, leads and project managers to deliver, all of which most posters here seem to think a huge organisation like the NHS can do without.

The NHS needs restructuring from the foundations up, if there weren't cleaners, cooks, porters, HCA's, records clerks, receptionists etc the Doctors, nurses, radiographers, physiotherapists, occupational therapists couldn't do their jobs. Take out a few higher up the chain & patients wouldn't know a thing about it, patient outcomes are what matters, not who has a fancy job title with a big office & salary to match. If all of the NHS was brought back under one central administration a lot of the higher up jobs could be got rid of meaning more money could be spent on what matters, the patients. Put more money into the foundations, that way there would be better staff retention, less staff leaving to go to the private sector or taking their skills abroad. When trained nurses are saying they would be better off working in Aldi there is something wrong, give them all better pay & conditions.

Statistically the NHS is actually under-managed compared to both private sector organisations within the UK, and international health systems. The UK spend 2p in every healthcare pound on managers whereas in France and Germany spend 5 and 6p. Managers make up around 3.5% of the nhs workforce compare to 7% of the private sector workforce.

They are also underpaid compared to comparable jobs - the CEO of the NHS which is the world’s 5th or 6th biggest employer earns around £200k. 10x less than the CEO of Thames Water for instance.

I’m a clinician. If I want to put a chest drain in in an emergency it is in the cupboard right there because management and admin have conducted procurement, negotiated a contract with the supplier, managed the supply chain, and paid someone to stock the shelves. This is not a good use of medical or nursing staff time.

It’s a lazy line at election time to want more front line staff (we do) but there is no point if we can’t do our jobs. What would help is capital investment into top notch IT infrastructure, but this is unaffordable to most trusts.

This. Also the NHS has too many admin bands. In this day and age there is no real distinction between a band 5 and 6 for example in terms of output. Everyone is using the same systems. Then all the bands need managers...Also it is difficult to move up a band or even across, you need to apply for the job like everyone else even if you have worked there for years. So much time is spent on recruitment which could be saved by having a better system.

All of those roles can be useful. Every role can also be pointless if the person assigned to do it is lazy and isn't getting much done; it is easier for admin and back office roles to be useless than for frontline roles; more workforce management type of roles might actually help with identifying poor performance, though there has to be a willingness to actually get rid of the lazy ones.

The NHS is very top heavy. Lots of unnecessary roles.
Roster coordinator is vital though and usually not even a band 5.

I am not talking about very specific and needed jobs (supplies, accounting, comms, HR etc).

I am talking about the infuriating waste of layers of ineffective managers managing their very important and busy management tasks. in very important management meetings. It's like a vortex of work creation, separated from the people who actually get shit done.

This post does make me a little cross. As someone who works in one of these ‘pointless roles’ (Project Management) its sad to hear that the 50-60 hours a week I work, trying to make systems and processes better for clinicians and for patients is a waste of time.

A huge amount of skills is required to run a business, which effectively is what every NHS Trust is. You need the right people with the right skills to be able to run different parts of the business. Clinicians are great at treating patients - so why big them down with management tasks and take them away from their own roles. Of course you need a team of corporate colleagues to ‘run the ship’ whilst the clinicians treat the patients.

*bog them down

There’s a lot of naivety on here about how huge public sector organisations work.

People don’t just turn up and do clinical work because someone’s just walked in and needs something.

Government policy, the law, research and evidence, local priorities and demographics, changing public health issues and loads of other things shape how the organisation works. They have to understand and respond to these things and provide a service which reflects them, with a workforce which might not be set up to deal with them. Someone needs to put this stuff into practice, train people, manage the resources, get messages out there to the staff and the general public.

Someone has to make sure the staff are considered enough to make sure they are well, have enough work and enough rest, that they all know what they’re supposed to be doing so that they’re not all going in totally different directions, that they’re able to operate to the standards set for them by various bodies, that they have the skills and knowledge to do their jobs, that their performance is managed and addressed if it’s problematic, that they don’t have to deal with the media etc directly, that they don’t have to pick their way through reports and legal documents individually to understand what they’re supposed to be doing this week, that staff don’t investigate themselves when complaints are made …. So so much more.

At a superficial level it would be easy to look at these levels of management and think they’re a waste of space but just applying a little bit of critical thinking helps.

There are, however, often efficiency savings which could be made around processes and decision making in my opinion.

Those roles have always been there in some form or other. Now they're named as they're specialisms and have more visibility.

Just out of curiosity did you ever manage a project or organise an event covering your NHS region?

I know of a major company who took out a layer of management total salary cost of £1 million a year. No-one noticed the difference!!

I'm PMO. If we didn't do the project work ( setting up new programmes/ways of working, reorganisation to make things more efficient, building new wards, introducing new electronic systems etc. etc. etc. - if there is anything new going on it will have project management input) who would? As it is we need clinical input (not just clinical, but there is rarely a project which doesn't have a clinical lead), are you suggesting that our highly trained clinicians should stop seeing patients so that they can get projects done? Or that we should employ outside companies to do the work at vast expense?

There are so many things affecting efficiency that you can't put the blame at any one person's door. Yes there are crap and pointless managers but there are everywhere. Waste is huge, a lack of autonomy about where we can procure goods (driven by governments awarding contracts to their mates), substandard estates which are a constant money drain, patients who don't turn up for appointments (a huge issue), etc etc.
It's a simple rhetoric to blame a top heavy management team for the NHS failings but in reality, it isn't there and most of the management roles create a buffer so clinicians can do clinical work. The reality is that the public expects the same level of online presence, customer service, patient input and scrutiny of the NHS as they would any other private organisation (and rightly so) and therefore these jobs need to be there to achieve that.

YABU.

The NHS is not just providing clinical work, its a huge employer so needs to look after its people. It needs to plan to deliver healthcare so needs people covering strategy and managing projects. And do you think competency is a managerial thing, you can all sort out what quals and training you need? Seriously how narrow your field of vision is.

I cannot believe you and so many other mnrs think so 1 dimensionally about a huge organisation like the nhs. You clearly have not a clue about how organisations function yet worked in one for donkeys. Maybe that's what's wrong with the nhs, maybe too many of its clinical staff lack basic understanding of the work others are doing in the corporate body and spend too much time focussed on that versus their actual job.

I must say, I have the same experience. I do not think, personally, the NHS is poorly funded but rather badly managed and a lot of wastage.

https://x.com/seanpk/status/1800146181793968169

We need Elon.

YANBU. Universities are going the same way. Lots of “leaders” and fewer and fewer “doers”. Promotion criteria explicitly rewarding “leadership” rather than “getting stuff done”. All these “leaders” just, as you say, create work for each other and the “doers”, and then say they can’t possibly do as much because they are busy creating work for one another, so they drop their share on the “doers” who of course end up in a deeper and deeper hole. Sheer madness.

Staff survey indicates as do many posts on here about the awful culture where they work. Cultural change is hard to embed and takes time and this is in the remit of OD. I can see value in that as this may have a direct impact on patient care and outcomes. I don’t know why anyone would see this as pointless. Effective rostering also is key to safer staffing and has a direct impact on patient care as well as reducing the need for temporary staffing again a direct impact on patient care and the organisations financial sustainability. It’s naive to believe that colleagues from other cultural backgrounds don’t feel they always have the same opportunities as others and that overseas recruited staff don’t have their own particular needs and issues. If we want to have happy, healthy and motivated staff to care for patients as we would want to be cared for, want staff to stay in the organisation for as long as possible and work in an organisation that has a reputation for valuing all staff what else would you suggest? Lots of knockers as to what’s going on underneath the NHS yet when there is action to try and do something about it it’s deemed as a waste of money. I think we all can agree that reform is needed and that the issues are longstanding and complex and often have interdependencies. We have to start somewhere and forming realistic yet ambitious plans from a strategy to make things better surely is better than doing nothing.

The OP is mot challenging their existence but their volume.

Exactly this! I’m not NHS but public sector PMO. Projects would absolutely not be delivered (properly or to time) without us.

Yes exactly this.

My organisation went through a phase of this . Endless navel gazing meetings and meetings about meetings.

Then they realised they needed to cut costs, got rid of a lot of those staff - and freed up lots of my time!