To think NHS management needs serious scrutiny?

[MyHeartyBlueShaker]

I have no issue with the hardworking frontline staff but I can’t help but feel that NHS management and the way resources are prioritised need a serious investigation. From money being wasted on bureaucracy to strange spending decisions, it feels like something isn’t adding up. AIBU to think this should be looked into more closely?

The OP did! Her first post stated that she wasn't talking about doctors and nurses. She's claiming that the NHS issues are solely down to non-medical staff which is utterly ridiculous. I think you are misreading my post - what I'm saying is that if we are to increase scrutiny, which the OP thinks is necessary, then to do it properly, you need a 360 degree analysis. You can't pick and choose which bits with zero knowledge of where the problems are.

@SunnySideDeepDown If you read what I wrote carefully, I wasn't arguing for a single contractor or indeed a single process, just a standard qualification procedure and a regional or national database of pre-approved suppliers capable of doing the work. There would be a whole raft of plumbing companies so a hospital could appoint any of them, and reasonably expect transparent pricing.

But op is talking about misuse of money and wasting resources which medical staff have no say over, medical staff don’t have any say on how money is spent, surely everyone knows that? Medical staff are already under scruntiny everyday due to their documentation, this is done daily, many times throughout the day. What do you suggest needs to happen with medical staff? Their job is patient care, if things go wrong then investigations happen. I don’t know what else you expect to them to do?

What's the single biggest avoidable cost in our trust? Paying for locums. Why do we need to pay for so many locums? Because the trust is bad at recruitment, and a fuckton worse with retention. Managing new staff joining the trust better, especially those who have not worked in the NHS before, would make a better first impression, promote trust loyalty, and significantly increase how long substantive staff stay with us, saving a lot of money. But we have to pay for locums because without them the services would close, and as the next hospital is some distance away, people would quite literally die.

Second thing the trust could do to make us more attractive for junior doctors to work (both rotating residents, and trust grades) is to revamp the accommodation. We are relatively remote, with a small local rental sector. The trust used to have quite a lot of onsite accommodation. This cheap and commute free accommodation made it easier to recruit. Then the standards changed, and the accommodation was considered substandard. Instead of spending a small amount of money to revamp it, it was closed. And now we regularly have staff delayed in joining us, or leaving after a very short time, because they're spending a fortune on B&Bs because that's all they can get. I've suggested revamping the accommodation. I've suggested buying a few HMOs (property is cheap round here) and renting them to staff. I've suggested the trust renting the properties and subletting to our residents. Any of which would pretty rapidly be paid for, and then save money, by reducing locum fees. Nope, not happening. It's depressing.

i used to work in a support role in the NHS, and now work in an NHS adjacent role, and there’s definitely areas where improvements could be made in how things are managed.

I don’t think it’s solely about management in the sense of the role though. Most big problems don’t have simple causes or solutions.

There are serious structural issues with the current model - budgets are siloed by organisations and teams which leads to poor spending decisions by whoever holds them and a spend it or lose it mentality. There’s also cultural issues which span both clinical and non-clinical teams; a lack of appetite for improvement or scrutiny, defensiveness, etc.

I don’t know what the solution is but I’m not sure the current drive to remove “duplication” will deliver the change people want. Less support staff/orgs will simply mean less gets done and the best people will leave because they don’t want to do three people’s job for the same salary - I already know quite a few great colleagues that are leaving/have left, taking their knowledge and skills with them to the detriment of patients.

Don't you get bored of posting the same thread over and over again?

Every single time you show that you know nothing at all about how the NHS is managed. Why are you so obsessed?

Thought the lockdowns were suppossed to do that.

The courts and prisons are struggling. Should we protect them as well by not buying valuables and expensive cars so that we are not victims of crime in the first place. After all why should the NHS be the only organisation that gets our "protection"

My local hospital wastes hundreds of thousands on management consultants and agency staff. The NHS is very inefficient. However I think the main savings to be had are in Type 2 diabetes care which is 10% of the entire NHS budget for a condition that can be prevented for the huge majority of sufferers and put into remisssion for 80-90%!of people who have been diagnosed.
Nobody is talking about this yet it is a national scandal and disgrace.
Too many companies benefit from the status quo. Drug companies want people to be ill. Food companies want people to buy highly processed foods.

Have worked in a front line clinical role for 25 years and I totally agree…. Too many example of this but not the will to go through it all again!

Agree with you. Type 2 diabetes is very manageable and avoidable and is mainly due to lifestyle choices but yet here are wasting millions on medication. A simple diet change would help some many people but a lot of patients want the medication rather than changing their diet

You’re not wrong, @MyHeartyBlueShaker there’s little accountability for management who usually point the fan at clinical staff when the s**t hits.

I think the issue is who the managers are.

The junior managers are normally ex nurses, who realise that earning £60k-100k ‘managing’ (administration) is a lot easier and more rewarding than tough patient-facing shift work.

And the senior management on huge salaries generally rotate in and out of the big management consultants, with no meaningful clinical understanding.

What you need are senior doctors who enjoy managing, and so suspect that these are vanishingly rare.

But I don’t have a solution, aside from breaking the NHS into far smaller regional units which are more manageable. But then you lose the economies of scale that the NHS enjoys.

But I don’t think it can really be argued that it is well managed.

I should also highlight the food that patients are being served is a disgrace. The senior management don’t care about healthy meals and are too focused on saving money using less than adequate contractors to “make” the food. White bread with marge and jam, sugary cereal and biscuits is what the patients are served on my ward for breakfast. Then UPF, crisps and biscuits again throughout the day alongside lunch and dinner. Many patients don’t end up eating the food it’s that bad.

I thought healthier food was cheaper Thats what the fat shamers on here are always saying. Surely if thats the case the above wouldnt be happening no?

The main thing is that the managers who were previously clinical staff have no or little training to become managers. All were trained to be a nurse or a clinical role. Nurse and manager are two very different jobs, you could be a great nurse but a terrible manager, hence the bullying culture within the NHS.

@ThisSillyFox ’

‘The main thing is that the managers who were previously clinical staff have no or little training to become managers’

In addition many nurses just don’t have the aptitude. You can get on a nursing degree with really poor A levels, far lower than a meaningful management course.

But the corollary is that managing a hospital isn’t like managing a bank or an insurance company, so professional managers who have no medical knowledge just impose a copperplate solution which is totally unsuitable for a medical setting.

I never mentioned anything about healthier food being cheaper, I said the food served was a disgrace. Any issue you have with fat shamers, take it up with them. The food isn’t made on-site, in my local hospital, it’s brought in prepackaged and heated up. The catering team don’t have the time to freshly prepare food for thousands of patients like they use too. Senior management made the decision to use companies that prepare the dishes that use UPF and poor quality food.

dont knock the admin
there are less of us
many of the doctors are now having to do their own admin!

yeah because its cheaper That was my point.

I disagree. Many nursing degrees you had to have 120 UCAS points to study nursing the same as law and business. When I was at uni, that was what was needed and that was only four years ago. Management degrees are rather pointless, academic work and no hands on experience doesn’t prepare you to become a good manager.

There are these things in place already. There are lists/registers of companies that are NHS approved, but even so they can't just wander onto site there is the whole of HSE legislation to adhere to as well as NHS regs. There is a national supply chain with negotiated pricing. You can't just buy supplies or bring in a contractor for a project you have to go through capital projects/planning and demonstrate you have 3 quotes OR if it's e.g. specialist medical kit get a waiver from finance to say only one company produces this kit worldwide, etc. The levels of bureaucracy in the NHS aren't just about the NHS systems but a whole host of external legislation as well. Then just when you think you are getting somewhere, 5 years is up. The government changes or brings in a whole new raft of measures promised in the election and you have to start again.

There is significant evidence to suggest that it’s actually under managed - constant fire fighting and being able to actually achieve anything meaningful other than meeting targets are 2 of my biggest bugbears

*unable obv

NHS is a huge organisation - there’s community, primary care, mental health, care commissioning, secondary care, acute care research, paediatric, women’s health, sexual health, public health to name a few…….each sector is organised and maged differently

Because it saves lives everyday. It could be you or your family member soon, so you’re going to want it to be accessible, free at point of access and high quality. So if you want all of that, you need to take personal responsibility to stay as healthy as possible.