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

It's a briiant move. Get rid of trillions of overspends and allow the actual staff who know how best to run the NHS get on with it

I think amidst a bunch of lying populists, Starmer is that rare thing, someone effective.

So even though I feel sad for those whose jobs are being lost, I trust him. He did a good job of a public sector job as Head of public prosecutions. He seems to know what he's doing. He's a good guy. Let him get on with it.

He's already sorting stuff out that needed doing. If this is part of it, bring it on. The problem with the NHS was mainly the terrible, hubristic Tories and the arrogant tosser Lansleys reforms - still. If this unpicks that, so be it.

Once upon a time Matrons ran hospitals, efficiently. Now non Medical staff have the power to do what they like.
I now live in Cape Town, If you think Public Medicine in UK is bad, go to some of our rural hospitals in the centre of provinces like Mpumalanga and Limpopo. No sheets, monkeys in the wards, not enough staff or medication, as Officals need a new BMW and let's be reasonable: patients we can always get, but a new car is a necessity!! Even in parts of the Western Cape it is not good, but thankfully the big Hospitals we do have are world class. But we all need Health Insurance out here, especially the ex Pats

I gave another poster 3 examples of poor ineffective management, the most important one "Performance targets" which my DD is dealing with right now...

How could she deal with and have a higher throughput of patients pre these targets, than post?

Reason is when she was allowed to use her clinic judgement, patients, once discharged, didn't reappear a few weeks later, therapy sessions were patient led (up to a point) less overall needed.

Now some idiot (nhse idiot?) has dreamt up "you have x time with a patient, when this goes over, you have to fill out a long form to tell us why, you also have to explain why you didn't discharge x number of patients and why you didn't take on x number too"

Pointless and time consuming paper work, her TOIL claims have sky rocketed.

Yes effective management is required but the NHS isn't a private business, expected to make a profit, answerable to shareholders... yet...

Totally the right thing to do. Having worked in the NHS I've seen a pattern where after every hospital trust Board restructure some ineffectual or bullying Director was offered a redeployment opportunity at NHS England instead of being made redundant (or disciplined for misconduct). Pleased to see it go. Hope the bad ones finally get their comeuppance...but expect it will just be a nice settlement or early retirement 😔

Or move over to the DHSC?

You are wrong about accountability and answerable to shareholders - what greater accountability could there be than demonstrating you have spent the publics money effectively? The public are shareholders.

Removing NHSE and any holding of accountability of Trusts by ICBs won’t make this element of your daughter’s job disappear. Trusts will still have to show the effectiveness of how public money is spent and this is driven by clinical, patient outcome and performance data. Trusts have complicated layers of governance and reporting, and they make their own decisions about how they put this in place. Contrary to the popular press narrative and what politicians rattle on about they are not micromanaged. Trusts using clinical staff to do it manually rather than by an effective electronic patient record system or admin, and then award them TOIL which they’ll likely never get to take back, is probably one of those decisions and not a good one.

If Trusts are directly linked with the government body steering the NHS to show their effectiveness and be directed, the pressure on Trusts and their staff will increase not decrease.

And if the NHS services in whatever accountable structure is put in place are not meeting their clinical targets to provide the right treatment at the right time, the “mismanagement” conversation will continue.

NHSE and ICBs take workforce very seriously - staff training and development, their resilience and support to do the front line delivery so they can exercise their clinical skills and do the jobs they are meant to. That’s one of their roles. They hold trusts accountable on this. The government are talking in broad strokes about more doctors and nurses which yes, are needed and a very convincing argument to the public but who will look after this aspect of workforce so that clinical care is good and safe (and have the skills to know what good looks like).

Well, yes, I don’t think you can directly blame NHS England for Lucy Letby, East Kent maternity deaths, or police investigations into the possible manslaughter of 90 patients who had general surgery or neurosurgery in Brighton, can you? Hospital cover ups do happen. Humans will be human, it’s not just “pen pushers” who have failings, and dominant personalities within individual hospitals can have quite a toxic effect, whether they are clinical staff or management.

It's hard to comment on your example specifically without digging in to the detail but it obviously seems like a poorly thought through target.

When I worked in nhs england I did some work on reviewing and designing targets as part of the development of planning guidance. Often this involved assessing requests or ideas for new targets from dhsc (which originated from ministers). Most of the time these were pretty poor ideas which would have unintended consequences of the type you mention, we would then have to build a rationale for not putting the target in place.

So I woukd question whether halving the workforce and removing nhs england will exacerbate rather than improve this situation. I did often find that dhsc staff were less willing to push back on ministers requests where there was evidence they might have a negative impact

The planning guidance this year did include a much smaller number of targets but I wouldn't be suprised to see that reversed next year if streeting decides he needs more control and oversight

Having spent quite a bjt of time in the private sector I can say the nhs doesn't have a monopoly on promoting toxic leaders

The issue with this Performance Review is it takes away her clinical judgement & that vulnerable patients are not tick boxes.

So another PR is a set time with a patient.... yes fantastic until said patient soils themselves and needs to be cleaned up, adding 30mins to her time with said patient... she was told "thats not your job, the carers should be doing that"

she replied "ok i'll leave them in their shit for 4 hours until they turn up shall i?"

Bare in mind, she is band 6, so can stand up to DH management, a lower band might not, get stressed out and then go off sick.

All this has to be written down, filed... submitted.

Another is limiting therapy.... just leads to them being readmitted to hospital & eventually to the community teams....

These things are dreamt by people who have never worked in the field and who are too arrogant to take advice.... pretty much what i saw in the private sector too.
As i told her, in 18months, these PR will be quietly dropped, new ones introduced and whole wasteful cycle will be repeated.....

It is a good thing.

There are also people around who have worked in the field and are too arrogant to take advice. Pointing you back to Brighton where, according to the BMJ, there are now over 200 possible manslaughter and serious harm cases being considered. And at East Kent maternity Trust, there was infighting between midwives and obstetricians, bullying, junior staff being blamed for the mistakes of senior staff, and managers who tried to address the issues being sacked so that the mistakes could be covered up. It gives one the impression of a lot of cats in a bag, with nobody apparently wanting to accept direction from anybody.

Yep there is some of this. Given the enthusiasm for this and similar for welfare cuts, politically it’s an easier way to deal with a shrinking economy than tax rises and borrowing is out. So maybe more ‘leadership’ cuts to come.

I feel the nhs is overburdened with layers of bureaucracy. Removing one tier of this and reorganising the system should be a very good move. However I’m not sure the current government have the requisite skill sets to do this. A government that based all its ‘fully costed manifesto’ on growing the economy then raised ni rates and thresholds, thereby stifling growth is not economically literate. Inventing a ‘£22B black hole’ in the finances that even the OBR can’t identify yet they found at day one fools no one, however they work on the premise that if you repeat a lie often enough it will become accepted as true. Announcing a £22B ‘carbon capture scheme’ using untried technology the same time seems lunacy. A subsidised mass tree planting scheme would be cheaper and definitely effective. Besides, winds blow and our clean air won’t stay here so we will be constantly cleaning up everyone else’s air. They really don’t appear to have a sustainable plan other than kill off as many elderly and disabled as possible to reduce the benefits bill. I always believed socialists looked after the weak and vulnerable. How wrong was I. 🤷‍♀️

Maddy70 (can’t do bold) EXACTLY. Too many pen pushers on ridiculously high wages.

I can only speak for the areas of nhs england I worked in but we had a national expert advisor for each specailty and they would help develop each target or performance indicator. These would also be reviewed by a voluntary advisory group made up of relevant clinicians / healthcare professionals. In some instances consultation with a wider range of stakeholders would also be conducted.

It's not clear at the moment but I strongly suspect a proportion of these clinical rep roles will go as part of these cuts so that will make it more likely policy is made without clinical input.

Even in the generalist roles there were quite a significant proportion of people who had previously worked in 'frontline' type roles.

Unfortunately I am sure there are still things that aren't as well thought through as they should be that make it in to practice but there are at least some targets or incentives that have had a genuinely beneficial impact.

Removal of any layers of management has to be a good thing surely? Managers at that level are highly paid and there has been no evidence over recent years that things have improved since NHS England was introduced. However it's pretty likely that they will replace it with something very similar which seems pointless.

If Trusts are directly linked with the government body steering the NHS to show their effectiveness and be directed, the pressure on Trusts and their staff will increase not decrease.

Why? I completely fail to see the logic in this. How does reporting to a different body increase pressure? I worked in the NHS pre and post Lansley and the amount of time spent “feeding the beast” rose exponentially after 2013.

When an a & e becomes full and is no longer safe to accept patients, they have to phone NHSE and they have to make a decision about where to divert ambulances to. There are people on call 24/7 in all areas in NHSE who do this. These jobs will still need to be done.

Deciding how the funding is allocated in each area to GPs, adult hospitals, children’s hospitals, mental health, maternity services will all still need to be done. Performance managing it all will still need to be done. What if a hospital doesn’t do the number of operations they said they would? Who finds out why and where the money is going?

Dentists, pharmacies, optometry? Funding and contracts? NHSE.

NHS workforce planning will still need to be done. As PPs have said a lot of the digital functions are managed by NHSE.

There is some duplication between DHSC and NHSE and ICBs, so that does need to be sorted out.

All this crucial work will still need to be done in each… region. So some sort of regional strategic health authorities will need to be created. Oh wait…

Having said that it is true that it will mean many of these functions are moving back into DH. Just like they were before the awful Lansley reforms in 2013 that everyone hated. So in some ways it’s not a bad thing. But then I also wonder should the NHS be run by an organisation separate from government and politics? I’m not sure.

As PPs have said social care desperately needs to be reformed and joined up.

Thoughts are with all staff affected by this turmoil.

@BIossomtoes Very simplified, the government give money to NHSE and ICBS. ICBS report and explain how money is spent jointly with Trusts and ensure that critical and priority services are in place in trusts as per NHS planning guidance and are of the right quality and safe - that’s why there are clinicians of high experience in ICBs and NHSE.

Trusts don’t have the infrastructure to do this because they are about care delivery, and if they have to get it they’ll be employing the kind of people that can do transformation of services work that are probably going to be made redundant. If they need clinical steer they’ll be looking to their own clinicians potentially or employing them. That’s not patient/delivery. That’s pressure right there to recruit and implement to be able to do it. And then they'll have to report how they spent it, is it effective, making a difference, evaluate and monitor it.

Some activity will stop. Whoever is left in whatever organisation just can’t do everything.

Think about all the things that are being done to reform SEND with local authorities as another example and what is needed by children and families. Health is crucial to SEND. And it’s NHSE and ICBs who are leading Trusts on provision and holding them to account for their SEND involvement, as well as doing their own part in commissioning it properly and making sure it’s good. And SEND is the law, not a nice to have.

It’s shortsighted, badly planned and communicated, and a punchy headline for labour at best to show they’re doing something, but it’s not necessarily the right thing. It’s purely optics. Even if they prioritise some things, on which no guidance has been delivered with their communication about cuts, what a shit message to send to your entire NHS workforce.

And to add, children's services already get a raw deal whether it’s health or care.

I agree @IReallyNeedABreakon optics, headlines and mostly a distraction from a shrinking economy and other issues.

Although welfare cuts are more likely to impact people negatively as a real loss.

If Labour pick up on the enthusiasm for both, some of which you see on here, it’s an easy political out. It’s not taxes or borrowing and even some Labour supporters are saying go for it. Starmer gets to do more cuts and get those headlines.

Agree. Don’t get me started on welfare cuts, I’ll never get to enjoy any sunshine this weekend. 🙂

The lack of system thinking 🤦🏼‍♀️ You can really tell the people on here that have never had to implement and operationalise national programmes of healthcare before and have no knowledge of how big the health system is in this country. I'd like to see managers in avian safety be called pen pushers and told the only people who are needed in the industry are the people who bolt the planes together.

Okay, so yes, let's lean into this 'fact' that it is a good thing. Go ahead and remove the layer of bureaucracy that is NHSE (national)/ICB (regional) management structure because we hate pen pushers and fuck 10,000 workers whose jobs mean nothing. Now approach the on the ground CAMHS clinician's, practitioners & social workers (outpatient) and trusts with inpatient acute wards (so ward managers, consultants and MH nurses & HCA's) and tell them they are now managing: data returns to DHSC to show where the money is being spent, inpatient and outpatient occupancy management, referral pathways management (target is 1 week for inpatient, 4 weeks for outpatient for eating disorders alone, then there's SMI, conduct disorders, ND, self harm etc to also manage), writing policies and SOP's upwards to the bureaucrats in DHSC (who do not write policy currently for anyone but their ministers to consider and most of the time they will reject it because they only care about cost not outcomes and can't write SOP's for clinical use as they govern and don't have clinical experience), fielding media enquiries and releasing press releases and evaluate new million pounds worth of universal interventions such as MHST's and YP hubs, horizon scan for new universal and targeted interventions and medicines, then evaluate them, add in business case writing for resourcing & staffing, waiting list management and health inequalities and health promotion work. Plus working unilaterally with all the other regional CAMHS services to make sure it's standardised. This is just in C&YP MH.

Then roll out implementing and operationalising this in all the other clinical areas such as primary care, orthodontics, oncology, adult MH, elderly care, maternity, neonatal, pediatrics, gynaecology, MSK, ENT, immunisations, screening and on and on. Do you really think matrons and clinicians want to, and can do this? The system needs managing, even though people think management is a dirty word - it's a huge system. You cant just let it manage itself. You can't add this onto the workflow of clinicians and nursing staff who are also treating & caring for patients. It's massively unfair.