To think the NHS Significant job losses are a good thing to get rid of management pushing paper around all day and increase the number of hands on staff

[Husbandrippedmeoff]

What does this mean, will they be slashing the number of people who work in management?

Do you work for the NHS are you worried?

So you don't know what it means, but you think it is a "good thing"?

I'm not sure no, what do you think?

Absolutely no one is "pushing paper around all day" whether in the NHS or NHSE (I suspect you don't know the difference).

A huge organisation like the NHS needs oversight and accountability, and we need people doing that. You can't just put everyone in front line jobs with no management or strategy.

YABVU

This will not result in a uplift in frontline staff, none of these changes ever do. No savings will be made for years due to redundancy payments.

In my trust they have already been doing "slashed management" everyone over a 7 has had to reapply for their jobs with many being downgraded or redeployed with pay protection for 2 years.
We can't even get headed paper or envelopes, let alone employ actual staff.
My admin department of 12 has 3 vacancies we aren't allowed to put out due to costs and 4 on long term sick due to work stress. The 5 of us remaining will also be off with stress soon if this carries on
The NHS as it stands is literally being run on the goodwill of the staff they have left, and talks of another below inflation pay rise will lose more. Fannying about spending money dismantling NHS England is not the answer.

I'm not sure it will have it's intended benefit. Getting rid of middle management doesn't mean that there will be more hands on staff.

What they really need is better and more integrated computer system. It seems ridiculous that someone can have a hospital bed moved to a different ward/bay and then the doctor has to hunt around the hospital trying to find them also why do they still have to send referral letters rather than a button to press with a note attached sent directly to where they are being referred to and instantly put on the waiting list? Why isn't there a universal system showing basic things like currently taken medication, important conditions that could affect treatment or how to interact with the patient (such as phonecalls probably aren't the best option for someone who is completely deaf).

Maybe they need better management to make it more cost effective.

Sorry my mistake not pushing paper around all day I meant pen pushers.

Is it correct that only 10% of NHS employees are doctors and 26% work in admin?

This tired old line about NHS managers is so dull. The NHS provides and organises healthcare for not far off seventy million people. Surprisingly enough, that takes rather a lot of 'managing'. Doctors and nurses are just the tip of the iceberg when it comes to the range of services that are provided.

Im not management, but was a clinician for a long time, now in a corporate role within the NHS. I know loads of managers and many of them are extremely dedicated, hard working, constantly up against it, and know that they and their teams are seriously under valued by just about everyone, but they keep going anyway. They're certainly not shuffling paper or enjoying long lunches

I would be very surprised if this results in more frontline staff. Staff alone isn’t the answer anyway. Where I work we could have more staff but we literally do not have any more space or capacity to provide additional services.

i don’t know what the answer is. But I don’t believe that announcing the end of NHSE without any guidance as to what will happen next is the answer.

As a nurse I am worried. I am worried about my pay and conditions and what Starmer will do next.

It's NHS England that is being abolished, not the whole concept of managers in the NHS. As has been extensively hashed over on here, in any large organisation such as a hospital a certain amount of management has to happen, to keep the lights on, pay the bills, manage supplies, keep an eye on the money, ensure the organisation is compliant with the law, fix the PCs when they break, arrange essential training for the staff, make sure health and safety issues get fixed and so on. It's only ever in relation to the NHS do I seriously hear people suggesting that either this shouldn't happen (and so I guess the hospital just keeps working by magic I guess?) or that the front line staff should do this in addition to their regular job? Those seem bonkers to me. Now like in every single large organisation of course there is some chaff within the back office functions that could get cut alongside the essential stuff, and like with every single human (front line clinical staff included!) there are people who are super-humanly excellent at NHS management, people that are pretty good, people that are bang average, people that are lazy and crap and people that are so bad they're borderline dangerous and dragging everyone else down with them. If we could only identify and get rid of the bottom two tiers that would be excellent but incidentally you need a pretty good HR function to do that safely and fairly - another useless pen pushing set of people!

Back to your actual question, will abolishing NHS England make a difference and lead to more front line NHS staff? As a current NHS manager in a hospital (if you hadn't guessed!) I'd say yes and maybe. NHS England is a bureaucratic tier of management created by the tories to be between actual care-delivering organisations like hospitals and GP practices and the government. Previously we had similar but there were multiple regional bodies (NHS London, NHS South West, local primary care trusts etc). In theory not a bad idea as usually you can be more efficient by centralising and creating one big organisation out of multiple smaller ones, but it hasn't really worked IMO, it's gotten bigger and more bloated over the years bringing in more and more functions and more and more divorced from the reality of being on the ground. I also think it's lacking accountability as a body. However I wouldn't be so sure we can just take the huge NHS England budget and simply just put all that back into hospitals or front line care (bit like the old misleading brexit headlines). There's a lot of boring bureaucratic NHS stuff that someone is going to have to keep doing, whether that's the department of health, local care boards or hospital managers. E.g. in the last few years NHS England absorbed Health Education England into itself, that's the function that liaises with universities and colleges about placement management for student nurses and doctors, makes sure curriculums are up to scratch and oversees postgrad training for doctors, very complicated and important stuff. Now NHS have pretty much done a crap job managing all that and HEE were poor before then too so I'm not complaining it's going to have to move again but someone has to do it and ideally centralised at at least a regional if not a national level as it would be chaos if hospitals and GPs were trying to do it. Also, overseeing GPs, managing who is allowed to set up GP practices, performance managing them and deciding how much they get paid (and then actually paying them) is another complex job. At a guess I'd be saying even if you are very ruthless about cutting the more 'managerial' end of what NHS does (efficiency initiatives, patient safety promotion, equalities stuff), at least some of which I'd also say is worthy of attention even if NHSE didn't do the best job, you'd only save maybe 30% of the NHSE budget , and even if you did put that money direct into front line care, the NHS budgets as a whole are so small I don't think you'd see a huge difference when spread around the whole of the NHS.

TLDR = yes it's a good idea to get rid of NHSE, no it won't mean many more nurses on the wards.

Long answer to a short question but I hope you see how complicated these things are!

And please don’t believe the media rhetoric about pen pushers. That is not my experience at all and I have worked in the NHS for over 25 years. You can run a service/Trust without management and admin staff.

The NHS needs managers. There will still be many managers, rightly. Also important to keep the number of job cuts in perspective - the NHS employs over 1m people.

The Lansley reforms were flawed so it's good they're being addressed, but change is always disruptive.

"Is it correct that only 10% of NHS employees are doctors and 26% work in admin?"

Most likely yes. If you think the NHS could run with more doctors than admin then you are very deluded.

Admin staff are vital, who would deal with referrals from GPS, make appointments, organise surgery, deal with paperwork, run a busy consultants diary, type letters, code the procedures so the trust actually gets paid, organise discharge paperwork and so on. Admin staff are absolutely vital, ask any doctor!!

I work for the NHS and I am worried. The only reason I am able to work effectively is because I've had managers who were removing masses of bureaucratic load off my plate.

Someone said it was NHS England that was being affected not the NHS although they didn't say what the difference is?

I explained in my post above. NHS England is like a governing body that 'manages' the different parts of the NHS, hospitals, GPs, community care organisations and so on. That is what is being abolished.

The individual organisations, the hospitals, the GP practices and so on will go on employing managers and administrative staff as before. Your local GP surgery isn't suddenly going to be asked to sack their practice manager and receptionists (although some would say they should be 😜).

How an individual NHS organisation chooses to manage itself is up to that organisation, there's actually nothing stopping them getting rid of all their managers and admin if they chose to and spend the money on clinical staff instead, no-one does of course because that would be mad (and before you say of course the senior trust management would say that being managers themselves, not the case at all, over half of our senior management team at my trust is either actively practicing clinicians or former clinicians, that's not unusual). Anyway this announcement about NHS England doesn't mean NHS organisations are being asked or encouraged to reduce their management overheads, if anything perhaps the reverse because some previous NHS England functions are pushed down to local trusts. But of course reductions in management staff are on the table because budgets are so pressured, for the last 10 years or more a lot of trusts have been cutting back corporate functions anyway and the government presumably will continue to encourage them to do so...

People are mixing up hospital management with NHS which is a bloated, expensive waste of money.

Hospital management can also cope with having a bit of fat trimmed imo.

With NHS England that should have read.

My admin department of 12 has 3 vacancies we aren't allowed to put out due to costs and 4 on long term sick due to work stress. The 5 of us remaining will also be off with stress soon if this carries on

This is part of the problem with the NHS. Office staff off on long term sick due to "work stress"? How stressful can admin be? Bet they'd be back soon if the sick pay wasn't so generous!

Not sure if that stat is correct but its meaningless anyway. Not sure why people always think taking away admin saves money, good admin staff are worth their weight in gold, they can take a huge amount of paperwork/admin tasks off higher paid clinical workers such as medics, leaving them to do more clinical work. Its always a false economy getting rid of admin but its often a suggestion from people who dont understand how the NHS/clinical staff work.

I work for the NHS but not admin or medical. We have a big meeting tomorrow to discuss the impact of the NHSE proposals just to answer people's questions/worries where possible.

Some of our admin staff are having to do their normal jobs plus cover reception duties on mental health community or inpatient units. Also covering phonelines for MH Crisis teams. This sort of work is extremely stressful and can be distressing, add it on top of your other duties, plus covering numerous absent staff can cause massive stress to these staff. They are often Band 2 or 3 staff also, so not paid a lot for it either!

The UK has one of the lowest spend on management and administration of healthcare systems. France spends 2.5x on admin. If anything the NHS is undermanaged which is why so much of it is inefficient. The last thing we need is for clinical staff to be diverted form healthcare duties to arranging appointments and organising rotas Is France’s healthcare system the cure for the NHS?

Well we did before Griffiths Report in 1983. NHS ruined now with more and more management systems which don't really achieve much. The doctors and nurses managed well because they KNEW what was needed.

Yeah sure, let the doctors do my management job, they’ll love that. You’d think of if I was just pushing paper around I wouldn’t have to work late (unpaid), miss lunch breaks or hold my bladder for longer than is healthy. I think I’m doing hospital management wrong.

This 100% - don’t believe the soundbites in the headlines.