NHS England to go is Keir being unreasonable?

[43percentburnt]

I don’t work for the NHS but have friends who do (and are increasingly looking at leaving - in some cases to move abroad).

https://www.bbc.co.uk/news/live/cx29lrl826rt

Is the removal of NHS England a good thing? Or is this a Labour gimmick?

To include an Aibu for Keir -

Yes Keir - you are being unreasonable

Or

Good job Keir, please get rid of NHS England - you are NOT being unreasonable

I think everyone wants a better NHS and wants reform.

But this announcement is short on the details of how they are going to do that, and long on the details of how many people they are going to dump so they can grab a headline.

So basically a page out of the standard playbook of how we're going to fire X number of people that are an easy target to blame (the evil managers who sit around all day doing nothing) and make things better through "efficiency savings".

Where have we heard this before. And is it likely that it will lead to a better service.

But do we not have the same happen with doctors? We train them then they go elsewhere, usually the States, for more money.

My answer would be, and very unpopular I imagine, that they should have to stay in the UK for a couple of years at least before they can leave.

Edited for typo

The headlines are made by the media, if it truly was about grabbing attention, they'd have done it earlier or waited for the Trump stuff to die down....

Listening to the actually announcement, the main reason for doing this is to reduce duplication and put accountability back with ministers.... freeing up at least some of the current £2bn running costs, to go back to patient care.

I don't understand why Tory supporters aren't pleased with this, unless its sour grapes and nothing Labour can ever do will make them happy?

It's nonsense to say that it adds nothing to patient care, plus it has a big role in improving the patient experience (e.g. improving patients ability to self manage appts) and improving productivity (a single project I worked on in a ccg role saved over £150m a year for the nhs).

The projected savings govt has said this will achieve are 500m not 2bn and in reality it will cost more than it saves in the short term. The duplication being cited isn't as significant as 50% so a lot of this is just cost cutting

The think tanks didn't support the changes but they have rightly questioned whether the effort of doing big structural changes that won't deliver any improvements to patient care is a good use of time. Why would you invest so much time and effort to something that will improve and save so little

I don't understand why Tory supporters aren't pleased with this, unless its sour grapes and nothing Labour can ever do will make them happy?

There’s support in the parliamentary party, including from Hunt. The only reason they didn’t do it is because it was their invention.

No wonder they want to get rid of it...

You ve twice now totally mis quoted me... where did i say these changes will save £2bn??? i said that was the cost of this organisation.

Self manage appointments? ha ha thats not even nationwide if at all... i cannot do this, been trying all morning to contact the eye infirmary over why have i have a letter for one appoint but a telephone message for another on the following day... when all previous appointments are one visit every 6 weeks.

GP surgeries have done this themselves via commercial s/w, though still, ours, is only for non GP appointments.

I have to fill out an online form for self referral physio, basically an email, i have to ring if i wish to cancel/rearrange.

So tell me again, what has NHSE been doing in this regard?

Yes very true, one former health minister even went as far to say he wished he'd done it....

I was more referring to posters on here.

What do you mean by no wonder they want to get rid of it?

It's obviously somewhat misleading to say we shouldn't pay 2bn a year to fund something when the reality is getting rid of it only saves a fraction of that amount

And yes I agree the ability to self manage appointments is terrible but I know work to ensure this consistently available nationally has begun fairly recently but who knows whether it can continue if half the staff are paid off.

Part of the problem with IT across the nhs is that individual providers were able to enter into their own arrangements for systems that don't talk to each other. Clearly that is something that needs national oversight to solve but it's a slow process given many are tied into contracts

You seem determined to believe its a pointless organisation so I will leave you to it

Totally agree @Melcl1987

paper appointments are the trusts’ doing and NHSE is wanting to stop that.

I work for an ICB. I save public money by stopping unnecessary prescriptions and educating prescribers. No idea if I’ll still have a job at Christmas.

How will the demise of NHS England affect the forthcoming NHS 10 Year Plan?

It's infuriating that people who have never done any healthcare are saying that NHSE staff are non clinical...you do realise that lots of clinical work is prescriptive and follows an SOP and really is just one small part of the public health puzzle? Once you have mastered the taking blood, BP's, prescribing and basic life support stuff lots of the actual skill in clinical work is communicating with people & listening. I've worked on wards, in clinics, in the community, in research and now NHSE. My national role is by far the most challenging of my career - I'm working with the best psychiatrists, professors, consultants and health leaders, every single ICB in the country as well as inward facing for ministers and DHSC. And I'm a pen-pusher and bloat now according to Susan in Stoke?

If your child is seeing CAMHS right now, or is on the waiting list or is accessing an inpatient bed for an ED, Neurodiversity, a SMI, anxiety, self harm, suicidal ideation, childhood trauma or safeguarding interventions they are following that pathway because my team have written that SOP, allowing for frontline staff to get on with tending to DC, who I used to tend to, but my skill set outgrew frontline work and I was promoted. We are researching new treatment pathways to roll out interventions/medicines that give children the best outcomes, we are checking how quickly your children are getting beds/onto referral pathways round the country, pointing out inequalities and the crazy waiting list in some areas. I am holding to account poor performing ICB's, we are writing policies and data returns for ministers to highlight that DC in poorer areas get worse MH support, hence widening the inequality gap and we are implementing scalable, cost saving interventions into the laps of ministers whilst being being responsible and thoughtful about public money. And do you know why I'm so good at my job? Because I have lived experience of childhood sexual trauma, an eating disorder, and self harm. I get it. I'm not a middle class manager who got here by nepotism or incompetence. But yes, make me redundant because I'm bloat.

👏👏👏

NHS-X, NHS-D and their predecessors? Each one effectively a reboot of the previous with a new injection of cash masquerading as a new intitiative on issues such as the longitudinal record. (from a technology perspective).

Rather like the desire to bring in self management of appointments (or any improvements in appointment systems) - the talk is always there but the lack of effective delivery once the money is spent is depressing, as was the endless finger pointing. IME many of the staff were equally frustrated with their lack of progress and good staff simply left.

NHS-E has failed for 14 years to make any real improvement on procurement and delivery quality in IT so what is the point of continuing in the same way? And yes I'm aware that much if it is related to the stucture of the fiefdoms but if NHSE could not manage the fiefdoms or bring them to accountability then what was the point of having it as IT central for the NHS?

I've always found Yes Minister to be as much an educational documentary as a sitcom but Series 2 Episode 1 is far too close to some of my experiences dealing with the NHS on technology issues - especially the lack of patient focus in the bureaucracy.

I agree with you on the Lansley reforms but not on the efficiency of the system in 2010.

Some of the really shocking experiences I had with NHS procurement were in the '00s when it seemed parts of the NHS wanted to burn through the money being allocated rather than use it as a one off opportunity to really modernise and improve life for patients and staff.

Over and over I had experiences of decision makers and procurement managers insisting on the proverbial Rolls Royce with hand embroidered leather seats to do a job which could be more than adequately implemented with a ford fiesta. It wasn't uncommon for these decision makers to be contract staff just wanting to jazz up their own CVs. Others would insist on the Rolls Royce but with a break in the process to put everything on a horse and cart before rejoining the Rolls Royce for the second half of the journey because "we always use a horse and cart for that bit". All of which adds cost, inefficiency and poorer patient experiences.

Then of course there were the systems which in every other country are centralised but in the UK cannot be centralised, not because it isn't possible or advisable but simply because Fred in region Y wants his own mini system to manage (job protection) and Mary from region Z wants a different technical solution (CV polishing) and so we end up with 20-30 implementations and much greater cost and with no ability to share data.

If the money wasted on self created failures just in that area had been spent well it could have transformed patient and staff experience and really aided effciency in managing patients and services. Instead, 20 years on, the improvements are still being discussed on yet another budget.

The Lansley reforms (IMO) completely failed to address all this and just added more layers of bureacracy. If Streeting has been talking to his predecessors from the '00s that may be why he is taking this bullish appearing approach now.

That's one of the scary things. No one knows!

Efficiency was extremely high from the patient viewpoint in 2010. Patient satisfaction was at 70%, it’s now at 23%. Those of us who have worked in the system are well aware of all the faults, mainly because the NHS would insist on doing everything in-house instead of hiring expert talent in specialist non clinical areas. The much derided PFI initiative is an albatross because of the failure to employ commercial contract managers. The providers saw Trust boards coming.

You do realise that the ex nurse cadre represents a signifcant segment of the management in trusts currently? Likewise the pervasive trope that consultants have been 'castrated' by the management class (which doesn't reflect reality). Clinical expertise doesn't necessarily translate to financial acumen or strategic nous.

I think the general public would be quite shocked if they knew how many non clinical roles are occupied by the clinically trained. Often in the context of a portfolio career.

Well said!!

Nope, i've NOT said that its a pointless organisation either... you do like your misquotes don't you?

The money can be better spent... thats all.

Over time, several £100 million is not a fraction.. well, i suppose it is, but a rather large one.

So far, you've not put forward single argument to keep the status quo, the one thing you did mention, Patient Managed Appointments, hasn't even been started nationwide.

NHS IT will cost billions, integrated IT is extremely costly, short lived, requires an awful lot of cost, time and skilled people to stay up to date and cyber secure.

Talking of Cyber, NHSE manage Cyber Security of the NHS estate in England. No small task.

That makes me wannacry

I didn’t actually say all NHS hospitals are filthy and falling down - our local hospital is amazing, but unfortunately doesn’t have an A&E - and I note you admit your local one is actually falling down, so demonstrating that NHS hospitals are indeed falling down, not just one of them, unless you live in the same place as my relative… It is also the case that the hospital my relative was in had at least one mouse appear on the ward (when they eventually found space on the correct ward, 4 days into the bed-chess), and visible, thick dust in places it shouldn’t be. Imvho, for a hospital, that counts as filthy. The population it serves is far too large for its size, also, as new housing has never been accompanied by a new hospital. It also had a major power cut while my relative was in there, a hospital-wide IT failure, and persisted in sending confidential letters to the wrong address, despite all other parts of the NHS having the correct address - NHS card with correct address on, GP practice with correct address, etc. The hospital should have been rebuilt years ago (although, tbh, my oldest child had a stay in there as a baby over 20 years ago, and its hygiene standards were poor then, as pointed out in its inspection at the time). It didn’t feel like a safe environment and I felt sorry for everyone working there in those conditions, but more sorry for my relative, because they were so vulnerable. Also, the reason they ended up in hospital for such a long time was because of a failure of primary care (to the extent of actual negligence). Having grown up with parents who both worked all their working lives for the NHS, I was horrified by how unsafe everything felt. Chronic underfunding has certainly left a lot of hospital estates in a parlous state. I live in fear of getting ill, now, and in particular fear of ever ending up in that particular hospital. I still feel exceptionally angry about it. So, not really a good idea on your part to use the inflammatory word “absurd.” No NHS hospitals should be operating in such appallingly overstretched conditions anywhere in the country.

Absolute nonsense that there are no Frontline clinicians working at NHS England. In my work there and under its previous Digital guise I’ve worked with: GPs, pharmacists, radiographers, physiotherapists, dietitians, district nurses, cardiac specialist nurses, paediatric nurses, paramedics, mental health nurses… most of whom also work in clinical roles and keep their registration status.

I found out via Teams. I hadn’t spotted Amanda’s email, I had a message to tune into the news.

I work for NHSE and have been told by the head of our team that those who keep a job will move to civil service contracts. I don't see how that wouldn't happen if employment by the NHS is stopped. So useful to see all the others in this thread who are affected. Sending best wishes to you all ❤.