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

The MoD employs 60,000 civilians. I'm reasonably sure at least some of their roles must be important to the MoD!

I can write the narrative for that one.

Our hero soldiers on the front line working day and night, while the 60,000 bloated civillian workforce do nothing day in day out but push paper around.

We aim to cull 30,000 of them, even though we're not actually sure who does what.

When I’m talking about the front line of the military I’m talking about the front line. I have no experience of working in the military but surely we don’t have our lads and lasses driving armoured vehicles in enemy territory wondering whether there are enough eggs in the stores for everyone’s breakfast tomorrow?

Same with the health service. Should our surgeons be contemplating the national cost vs outcome ratio on a national basis of a particular surgical procedure, or whether they will have enough sterile equipment ready for tomorrow’s operations, whilst they have Mr or Mrs Smith opened up on the operating table? No. Exactly.

In both situations we need highly skilled people ‘supporting’ the front line.

What people simply do not realise is that ‘the NHS’ is actually a monumentally huge collection of other organisations where something like 1.3 million people work.

Every single employee deserves to have a designated ‘line manager’ to oversee their activities, performance and welfare at work. The maximum span of control for fairly skilled workers is about 7 direct reports. Even for huge teams of people doing very straightforward roles (cleaners, porters, post-room staff, switchboard operators) no manager can oversee more than about 20 people.

It’s a complete myth than we can just ‘leave everything to doctors and nurses’ and all will be good in the world. That way chaos wins.

It’s about time we started valuing good management, good meetings, good non-clinical decision-making, because this is what will make our NHS better.

I have known many clinicians who are nationally at the top of their game on a clinical basis, yet who are terrible managers, who treat actual managers with complete contempt, and who cultivate unfair and inefficient fiefdoms.

Let’s get the right skills in the right place.

(oh and a lot of this is about pensions. A lot of the NHS quangos are about maintaining functions, but outside of NHS terms and conditions and pensions. Ditto civil service).

“I have known many clinicians who are nationally at the top of their game on a clinical basis, yet who are terrible managers, who treat actual managers with complete contempt, and who cultivate unfair and inefficient fiefdoms.”

What will inevitably happen is that there will be continuing national scandals along the lines of the manslaughter investigations at the Royal Sussex County Hospital, or maternity unit deaths in Nottingham and East Kent, and politicians will react to public opinion by adding back non-clinical roles and layers of “bureaucracy,” to counteract arguments that lack of oversight is facilitating toxic, bullying environments, poor management and direct harm to patients. There are always reasons for “red tape, “over-regulation” and “bureaucracy” to have crept up in the first place.

It's stupid anyway having staff that don't need to have fighting skills have fighting skills. Especially in an era where recruitment is difficult. Why make it even more difficult to recruit a good egg buyer by insisting they can run a 5 minute mile in full kit and blast away with a machine gun ?

And also, there is the impact that has on getting people back to work. If you have some disabilities, they will often rule you out as a fighting soldier. But the physical requirements for egg buyer are a lot more easily met by most people. So if you want to get people back to work, making sure they don't need to have pointless physical skills as well as the normal requirements for the job is a good way of doing that.

PCN is primary care which isn’t technically an NHS employer. They can’t claw it back from
non-NHs orgs, even those funded by the NHS.

Well it’s certainly impacting my spending already. I was going to buy a new car but that’s no longer happening and I won’t be booking any holidays. I’ll be saving every penny I can in case I lose my job as I can’t see where I’d find a new one at the same salary locally, maybe those in London will be ok. I’ve spent my entire career in the public sector so moving to private would be difficult I think.

According to the BBC, the government has a good deal of data on welfare benefits.

“The Department for Work and Pensions (DWP) is rolling in real-time data. "Cluster analysis maps" reveal to ministers exactly who is claiming out of work benefits and where they are.
As the numbers continue to increase, the data is being cut by sector, postcode, age and type of illness. Every pattern is being analysed.” (Faisal Islam, today).

What NHS data has informed decision making about a surfeit of “bureaucracy “? I do think it should be explained better to the public, in both cases. It hasn’t been yet, in either case.

It's going to be interesting to see whether they release all of this "targeting" information and what public effect that is going to have.

@madamweb

Okay so you are part of our healthcare system then if you have participated in such meetings. What was your role and what action did you take or contribute about the lack of decision making taking place in the meetings you were at?

This does happen in healthcare, as well as every type of business. It’s incredibly frustrating when it happens and if you’re part of what’s happening it’s okay to call it out, because time paid for by public money should be used effectively.

@blossomtoes you asked a question earlier in the thread about why it will increase pressure in trusts which I took the time to answer.

There been many posters on this thread who have in their passion for their jobs in healthcare, put forward multiple reasons explaining the complexity of system, and it’s quality and safety to be a good NHS, rather talking about “targets and monitoring” which just boils down to counting beans. It’s much more nuanced than that.

There’s no evidence, reasoning or credibility in your comments about why things should happen or not happen that I can see which convinces me it’s good thing. It comes across like you’re drinking the daily mail kool aid or just enjoying expressing uninformed opinions for kicks.

So I texted my former colleague to check the position when he took redundancy. For him he needed to wait 4 weeks after redundancy before taking up another position with the NHS. He said terms could vary though so to make very sure you understand your own terms if it comes to that. I understand that a PCN is not an NHS employer but from his answer it seems he could have gone for an NHS job after 1 month of redundancy.

@IReallyNeedABreak Not wanting to speak on someone else’s behalf, but what does that actually mean? It’s a very broad question and doesn’t explain what you actually want to know.

I have two friends at NHSE both worried about losing jobs and one who has just been made redundant from a local authority. There are no jobs out there at the moment. Private companies are cutting back because of NICS. It does feel to me like this lack of jobs could well tip us into recession. We need people to be working and spending

It comes across like you’re drinking the daily mail kool aid or just enjoying expressing uninformed opinions for kicks.

I wouldn’t touch the Mail without tongs and I worked in the NHS for over 20 years so I’m hardly uninformed. Before Lansley there was a degree of job creation that led to front line staff becoming increasingly frustrated by the amount of “work” needed to supply the maw of the Strategic Health Authority as it was then. After Lansley it exploded while productivity across the NHS decreased.

The healthcare system is complex for complexity’s sake - according to the Hewitt report one healthcare organisation was required to submit 250 reports to DHSC and NHSE in a single month. The number of staff hours required to collate and write those reports costs a small fortune while hospitals crumble for lack of funding. The tail is wagging the dog.

Doesnt the government realise that the 25000 staff in NHS England, DHSC and ICBs could end up on benefits - initially Job Seekers Allowance but eventually depending on individual circumstance - Universal Credit! Plus who will do their jobs. A lot of people about to lose their jobs have very specialist skills and they have just added 25000 to the total unemployment count. Sir Keir Starmer and Wes Streeting havent thought this through in the slightest. I'd refer everyone to a brilliant article on the Kings Fund website (though I wont repeat it here).

What a lot of people forget is why the Tories established NHSE as a body distinct from the Dept Health. It made it easier to sell off. Couldn’t sell off dept health but this could further their privatisation aims - if it had been successful 🤷‍♀️

Who in their right mind would want to buy NHSE? 😂

Nobody. It's utter bollocks.

It’s not that anybody would want to buy NHSE and its constituent functions to make a vast profit…

But over time, away from core NHS terms and conditions of employment (and I presume away from certain financial regulations) it can be reshaped and contracted out.

A bit like how cleaners, or porters can be outsourced… but for commissioners, analysts and planners.

It would be a PR win/win if it worked as it would be hailed as ‘reducing NHS management’ whilst focusing funds on the ‘frontline’. It might not make a LOT of money… but without certain obligations around say pension contributions, pay progression and redundancy entitlements, it could look quite attractive to some businesses to run it. Especially if it was fragmented into smaller parts.

A key question for the general public is this… do we want a health service that is well-planned, well-resourced, accountable, sustainable, safe, flexible, adaptable? If so we need ‘managers’.

And a second question therefore is who should the NHS actually employ? Clinical staff obviously… but should the NHS employ its own cleaners and porters… they’re not clinical…? What about the joiners and the procurement managers? The histopathologists? The commissioners and the analysts? The managers? Because the latter is what this is all about really.

To be fair NHSE do contract out work to other companies all the time. We don’t have any individual contractors anymore but we do have contracts with external companies.

As do Trusts.

Yes, I realise this - am an NHS manager myself (currently ICB, but the bulk of my experience in acute trusts).

What you have described here is FESC - the Framework for External Support for Commissioners.

That was a Labour initiative.

But system thinking would design out additional layers if it were done properly. surely you can see that by having one oversight system this would be better for clinicians and patients alike?

Well nobody would right now as they made a right pig's ear of it - but according to the friend who worked in policy for the dept of health, before transferring over to NHSE back at the start of it - word at the time was that this was the root of the decision.

The Tories belief in the superiority of the private sector over public meant they had to uncouple major functions from public control and ownership with the ultimate aim of creating something which would be saleable. It clearly was a terrible decision and ill thought out. She said at the time that they had broken the NHS.

There is so much wrong here. Firstly, the main reason NHSE was created was to give the government some necks to put on the block and provide ministers with some air cover when things were going wrong in the NHS.

Secondly, even if there had been some secret government conspiracy to ultimately sell NHSE off, what possible commercial opportunity would there be for either party in selling/buying an organisation which is not particularly expensive to run (NHSE’s annual running costs approximately equate to the cost of running the entire NHS for one day) and whose only functions are to set the strategic direction for the NHS in England, work with local health systems to improve care, and to monitor and evaluate the performance of the NHS?