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?

Except quotes change all the time. What use is it to have a directory of previously used suppliers when you don’t know 1) if they’re still operational, 2) if they’re available and want the job, 3) if their quote is now competitive.

That doesn’t save the NHS anytime at all!

Procurement processes are in place for a reason, to keep costs low, competitive and fit for purpose. Having a list of suppliers is pointless. The companies bid for contracts if they want it and the process follows - your point is pointless in my opinion.

@ThisSillyFoxunfortunately it’s not just the medication that costs the NHS with diabetes it’s also diabetes causing blindness, cardiovascular events related to having diabetes and kidney disease not to mention amputations 😢

@ThisSillyFox100% agree that hospital food contributes more to disease than to health

I agree. I worked for years as a PA to various directors and saw first hand the bad management and significant waste of money. I will say the medical and nursing directors (with 1 exception) were brilliant and in believe in part due to their medical backgrounds.

I know plenty of type 2 diabetics that have had to have their feet amputated because they didn’t managing their own health. There’s only so much cliche staff can do, a lot of patients don’t look after themselves.

I know a senior manager in a hospital told staff that someone who had been sacked the month prior had passed away - suicide. Her family were still being contacted...

She hadn't passed away. She's still alive to this day and people are so angry about the lack of compassion from this person. The CEO was contacted because of how senior this manager was but nothing was done.

I agree. I think there is a culture of promoting people sideways in management within the NHS - divisional managers seem to be moved around constantly meaning they never really get a decent grip on things, don’t follow through on long term projects and are generally terrible at long term financial planning and succession planning.
Spoken as someone who works within an NHS organisation (clinical ) who is sick and tired of sitting in multiple meetings with managers who consistently fail to take things forward or have any significant impact on organisational change.
in my 25+ years of NHS experience it’s never changed.

Is there any reason that senior doctors make better managers than other HCPs? Does medical school have a management module?

Threads like this drive me bonkers. An OP who spouts something straight out of the Daily Mail playbook, followed by a raft of “here here”who seem to think that nurses get their degrees on the back of fag packets and that none of the managers in the NHS have any kind of management training, and worst still those that think it only needs front line staff to function.

IME there is a level of management which is often overworked who directly line manage front line staff. And while there are a lot of good people in support departments, there are levels of management above 8a who do not seem to add much value and who seem to exist to go to endless meetings. I think this is the level NHS England is looking at, and it is quite right that they do.

Couldn't agree more. Telling female nurses they need to be re-educated because they don't want to undress in front of men. Spending a fortune on legal fees defending this abusive position, money that could have been spent on helping people.

EDI positions costing a fortune all while we hear how they don't have enough money. It's crazy. Someone needs to order a review on spending, efficiency and policies and remove the insane dictators from their roles.

I thought of an example which drove me bonkers. Our service got money from Health Ed England for training of a particular type of health care provider. 9 months training, 1 day a week at uni and a qualification at the end. In the past, people who passed the course (most of them) rolled straight into permanent jobs 1 grade up. Trainees are quite time intensive, but its a difficult role to recruit qualified people into (there just arent enough of them) so it is worth the investment. Then we got told that senior management had decided on a hiring freeze. Just about when the training was coming to an end. By the time we attended all the bloody meetings and made our case and got to reverse the freeze in this instance, most of the trainees had been snapped up by other people. So we had outlaid time and energy for nothing.

Really? My dad died from prostate cancer last year A paramedic told my mum he "wasnt sick enough" when she called them out

In my personal experience they could save money and time by better communication between healthcare professionals in all disciplines.

I had hypertension during pregnancy and at 38 weeks spiked a ludicrous reading at a hospital checkup.

Midwife wanted me to go to DAU to be monitored.

Registrar marched me to labour ward and told me to call DH and baby was coming today.

Different Dr said actually we’ll monitor for a while.

Another dr said you need a steroid injection as well probably deliver later or tomorrow.

A FOURTH dr said no steroid you can go home.

FIFTH dr said no you stay overnight.

Consultant appeared in the morning and asked why I was still here and I should have just been assessed at DAU the day before.

Why all that bollocks? What a waste of of time and resources. I was sent home to book a CS for 39 weeks. Didn’t even do that for me there.

A one off anecdote doesn’t reflect a national organisation and situations are often nuanced - if the ambulance service was stretched that night, they had to prioritise. I appreciate it sounds like that led to poor care for your dad though, which is awful. No health system (or any organisation) can get it right constantly. All it takes is a few staff members to go off sick and the service is on its knees (and if they were to over staff, they’d be blamed for wasting money).

I actually agree here. I work with senior consultants who would make awful managers - they’re extremely bright but their communication skills can be lacking and their time (and desire) to commit to management roles isn’t there.

Why would someone on £100k+ want to work in management for less or not much more? Most people in specialist fields want to actively stay there, in roles they love.

I’ve just read another post about someone whose firm used to pay for each staff member to hire a car to drive 2 hrs to a meeting. No one challenged this as being a complete waste of money.
Do people know that in lots of NHS settings, staff don’t even get free tea bags? They certainly don’t get to hire cars for travel.

It’s double standards. You work in an organisation with no bonuses, tiny uplifts if any, and generally low salaries vs qualifications. And then are berated for having any inefficiencies, when all companies have them. You just can’t win.

Well, it’s pretty much common knowledge that the NHS is top heavy with management, but lacking in quantity and quality of people on the front line, ie nursing staff. The NHS is a money pit, and it doesn’t matter how much money is thrown at it, it never improves.

If Trusts were to join forces for genuinely non-local aspects, wouldn’t this be more efficient? For example, why would each separate trust require its own hierarchy, policies, advisors, etc on health and safety? Equal opportunities policies? Recruiting? Legal teams? Insurances? Boards and governance? I appreciate the size of the nhs and why it works locally via trusts but surely there must be duplication of effort? Do trusts already join forces where something that spans all trusts is needed?

school immunisation teams. The NHS admin manager sends the dates to the schools. We have no extra money or staff to run these programmes, we are just expected to organise all the pupils, chase the consents, then provide an empty ground floor space for the team. They turn up, usually late and complain about the traffic. We chase the pupils on the day and they sit and immunise. We are run ragged, they are provided with teas and coffees.
If they reach the targets, management get bonuses. We get zilch in schools. Let us jab the kids and we could do it more efficiently and save a ton of money.

I think this is a bit too black and white. The problem with management structures is that they proliferate. At the moment, in my department , if there are any problems, say dysfunctionality, they employ another manager. This is the problem solved. Except of course it isn't.

The culture of our management is very hierarchical, with the clinical "workers" below the managers. Obviously, I can only speak of our department. But it's the Tail Wagging The Dog at present.

TBF, very few of our managers have amazing A levels and degrees. I'm not sure that these things necessarily mean you're going to be a good manager , however.

NHS managers don't seem to be particularly competitive places but there's definitely a culture of if your face fits and if you are greasing the right poles you get on.

So thats what my dad is/was an anecdote. My mum was begging for help cos he couldnt fucking swallow. When he died on their kitchen floor after going into cardiac arrest from a fall because he was so weak he was very very thin.

Stuff your "anecdote" up your arse.

Ok I’ll bite. I’m a senior manager in the NHS. Here is a genuine run down of my day (name changed as some of this would be obvious to my peers)

7:30 teams meeting from home with HR and a member of staff who is being made redundant. Discussed support they would need and then how work would be distributed once they are gone.

drive to work

8:15 “bed meeting” - senior managers/mateons/site managers going over the sit reps for all 3 hospitals in our trust. Discussing ED status, how to unblock the front door, reviews of long length of stay patients and staffing on all wards and triggers to move staff if needed. We were way below safe staffing due to sickness so matrons left for an urgent staffing review

9:00 All hands meeting across the team to discuss plans for the day, any escalations of urgent clinical risk

Went to theatres as two lists couldn’t begin due to equipment issues (broken C arm and a stent not on site). Spoke with patients, apologised and asked team to reschedule. Surgeons opened a second emergency theatre to help un block surgical assessment unit.

10:30 1-1 with my service managers x 2

11:00 Finance meeting, already 350k in the hole for pay. Clearing backlog of waiting lists by running weekend clinics and theatre lists - surgeons/doctors/nurses/theatre staff all to be paid. General theme - cut waiting lists without spending more money

12:00 second bed meeting. Pressure has eased at front door, estimate discharges for the day; guesstimate of tomorrow mornings position - increase staffing in advance

2pm - complaints meeting. Go over all patient complaints for the division. Check responses and progress. Understand themselves of complaints (long wait times, clinical communication).

Adhoc meeting with governance re the above, uptick in complaints re clinical communication with patients, add to agenda for next clinical meeting/governance

3pm - back to theatre, lists overrunning. Need approval to either pay staff to stay or cancel patients. Approval given, one patient cancelled as ODP cannot stay. Meet with patient and clinician to explain and rebook

work on slide deck for performance meeting

Ensure all invoices/payments under my division are made (theatre supplies, equipment, services)

Check additional hours claims, approve

4:30 Cancer performance meeting. Need to improve 28 day faster diagnosis standard without spending money. Potential for CNS to contact patients before consultant appointment - consultants not happy. No progress

5pm final bed meeting as above

Final wash up tasks for the day

There are about 10 of me doing this in their own divisions and I have 3 people under me doing their own workload which I don’t even see.

You say this but there are lots of cases going/ gone through employment tribunals where NHS management have completely failed in their legal responsibilities to the point of actually discriminating against staff in some crazy belief that their DEI policies are legally correct.

Having meetings about your DEI responsibilities are a waste of time if you don't get the basics - what is, and what isn't lawful- correct.

And there seems to be a concerning amount of this in the NHS. I'm particularly thinking about the gross misunderstanding of responsibilities to all staff around trans issues, but I'm sure there are other examples of it

How do you know she knows nothing about it - because you disagree with her?

I don't in work in the NHS, but in a not for profit that has a lot of interaction and contact (and meetings..) with the NHS, and there are a lot of pointless meetings. But the thing I find depressing is that there seems to be a culture of failing upwards. Bad managers are almost impossible to get rid of, so they either get moved to a different department or actually get promotions because people want to get rid of them and it's the easiest way to achieve it- give them an excellent reference and never have to deal with them again.

The current CEO of our local trust had a bad reputation amongst people at his previous trust, he's moved here and now we're stuck with him.

Organisations are actually having to set up extra meetings without him because he is impossible to work with. I doubt anyone in the private sector would be able to fathom how the useless bastard ended up heading not just one, but now two, NHS trusts.