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?

@Noodledog if each trust is a standalone organisation then isn’t it like if you were to change job in the private sector?

I really truly don't mean to be rude here, but that's a lot of meetings and talking without much/any doing? I mean why did you have to go to theatre due to broken equipment? I'm sure the surgical teams were aware that they had to apologise and reschedule. Matrons reviewing staffing levels - what was actually done? We're constantly below safe staffing levels.

That sounds very traumatic for you all, I’m so sorry you all had to experience that. Your poor dad (and you and your mum) deserved better care.

I won’t pretend I know what happened that night with the service, but it clearly fell short. I’m assuming you may have lodged a complaint and hopefully you will be, or have been, provided with more information.

It is still an anecdote as the devil is in the detail as to why they didn’t come out, it doesn’t mean anecdotes and individual situations don’t matter, they clearly do, but it means it can’t be used to represent a whole national service. Every business/service fails at times ☹️

Meetings are how people communicate effectively. No meeting, no joined up working. No joined up working, poor service and increased risk.

All managers in every organisation have to spend more time than they want in meetings. Because decisions need to be made in collaboration. No one likes meetings but they’re essential, especially in a health care setting with multi disciplinary teams with expertise in different areas.

The department I left 2 years ago is absolutely overrun by B7s with clipboards, all young women without a managerial qualification between them (but all the DEI training you could shake a stick at), all selected because of their willingness to suck up to the B8C.

Such was the mess, an external ‘cultural change’ company came in to review what was going on; amusingly damning report citing ineffectual, inefficient, under-qualification with no clear job description, no performance indicators, endlessly meeting with no clear agenda or effective task allocation or follow up. Those who weren’t ’working from home’…

All of which any of us older clinical B6s could have told them.

But, it is partly The Public’s fault. We demand forensic accountability from the NHS thus someone is being paid to count paper clips.

Radiation dose is an important thing to record, but we’d be required to enter it on 4 different systems, per patient, thus it becomes a full time job for someone. And so on.

I used to work for a supplier to the NHS. Almost every year about February, we'd get a call to tell us they have "found budget that has to be spent" and what can we do before the end of March.

This also happens with a number of other public funded bodies.

That suggests poor management and dreadful scrutiny.

Lol, a classic manager! No, most meetings could be an email. Take your example day you described - which/how many decisions were actually made? And I'm a HCP in a management grade (although mainly clinical).

Take the huddle - managers meet and say there's a bed crisis. They then (as far as I can see) then go and hassle ward nurses to ask why Mr X is still in a bed, when Mr X isn't medically fit/they're awaiting transport/they're awaiting a package of care etc. The nurses are already trying to get them out, what does that add? Other than taking staff nurses off the floors to field calls from nurse managers.

My direct line manager is on calls most of the day, every day. As far as I can see she's achieving next to nothing while the rest of us do the actual work.

It's not a one off anecdote though, is it? Thousands of anecdotes up and down the country of poor care, poor decisions, poor communication. It no longer takes a few staff members to go off sick before it's on its knees. It's pretty much always on its knees, wherever you look. Yet when Wes Streeting described it as broken (an accurate description for most who have used the NHS recently) he's told by senior managers that the language isn't helpful and undermines trust and confidence in the service. If the Health Secretary isn't allowed to speak openly, what does that say about how people actually working in the NHS feel?

I have another 'anecdote'. Dh got ill with what he knows is pancreatitis. He knows because he has periodic flare ups and recognises the symptoms. Off he goes to A&E (because pancreatitis is a medical emergency). He's seen pretty quickly, actually (Monday night), had bloods and age chest xray done. They get his pain under control with morphine and discharge him the next day, without medication, saying there's nothing showing in the bloods. He's still in pain but figures they're the medical experts. So they discharge him with instructions to call the ward if he deteriorates and they'll re-admit him. Two hours at home, he's been sick three times and rates the pain as a 9/10. So he calls the ward and is told, no, he has to go back through A&E. Only this time it's absolutely rammed. He even passes out from pain on the way there in my car. Both the receptionist and triage nurse shake their heads in disbelief that 1. He was discharged in this condition and 2. The ward have told him to go back via A&E. Hours waiting for pain relief, hours stuck on a hard chair in a corridor (among many, many others 'anecdotes' including an elderly lady awaiting an mri who said she was promised paracetamol 3 hours ago. "Don't complain, mum, it's not their fault" says her daughter. Because we all know the NHS is on its knees and it's "not their fault". But that doesn't get you seen and treated any quicker, does it? Doctor sees dh, says "bloods clear, you can go home tomorrow", despite DH now presenting with a lump at the top of his stomach (he was diagnosed with a hernia last year, which nothing has been done about). Throughout the night he's not slept, has vomited many times, his blood pressure is still high and he's still on morphine. Yet the doctor says "bloods fine, nothing to see here, we'll discharge you later today". When we attempt to argue the toss that it's pancreatitis (and not reflux, as they are now saying), the eyes roll, the doctor gets shirty and frustrated. He'll be discharged again I guarantee it, and he'll be back at A&E this evening with excruciating pain. We know this, because exactly the same thing happened last year.

Of course no health service in the world gets it right consistently. But the NHS isn't even getting the basics right at the moment. 14 years of Tories destroying it has led us to this. These are not anecdotes, they're every day events, multiple times per day (I know this because the same ward that discharged dh too early has done the same to several others we saw back in A&E again).

Totally agree

Whataclusterfuck
EXACTLY.
It’s the experience of almost everyone in the country at some point. There was a long thread several years ago about post natal and maternity services in hospital. It was pages of trauma, negligence, and often downright cruelty. I don’t think I’d be able to read it again it was so upsetting. I doubt anything has changed for the better.
My experience of A& E lately was horrifying also.
And when you speak up you are belittled and the current system is defended.
PALS must be very busy reading complaints, but my confidence that anything actually get changed, other than more “ targets” and “ charters” is zero.
I don’t think the previous Labour government helped much with their obsession with tick boxes but now many departments seem almost perversely defiant of their practices because, on the frontline there’s little they can change and probably have given up trying, and at management level they too busy riding their own personal gravy train.
It makes you feel utterly powerless, and however many good clinical individuals I have met (and I have met people I suspect are angels on earth) nothing can ever change.
Because we need to “ protect the NHS” when in other countries health services are expected to protect the population. It’s all kinds of fucked up.

Not to mention that the hospital still functions on days when that manager is on holiday, off sick, evenings and weekends, etc. The staff just get on with it!

Yep, I mean don't get me wrong, we need managers and there are plenty of occasions where you do need a steer from seniors. But I also think in general a lot of their time is filled with bullshit jobs that don't actually need to be done.

@HepzibahGreen

PALS must be very busy reading complaints, but my confidence that anything actually get changed, other than more “ targets” and “ charters” is zero.

Indeed they are. We've had to make complaints via PALs a few times recently, sometimes urgently, but they typically take several days to make first contact, and then you go through the "Mill" of lots of different escalations.

My MIL died over New Year, and it's taken until now for the formal complaint to actually be escalated to the formal complaints procedure. We initially contacted PALS whilst the neglect and cruelty was happening in real time, but they were constantly on answerphone and never got back to us until after the hospital had killed MIL.

Then we gave them full details thinking we were starting the complaint procedure, and a few weeks later someone else got back to us with a half-cocked, error ridden "explanation" of what had happened, which we told them was basically lies and bull shit and we asked them escalate.

Another few weeks later, someone else called back with lots of platitudes and "lessons will be learned" crap, but we still hadn't had a proper explanation and again said we wished to escalate it as a formal complaint.

Another few weeks, same with another call back.

Must have had over a dozen different people calling back now, saying the case has been reviewed, and just giving even more pointless platitudes and "learning" from it comments, each time, we asked for it to be escalated to a formal complaint and thought that was what was happening, but it seems to just get passed around different people/departments.

OH finally hit the roof with them the last time they called and demanded that it wsa finally escalated to be made a formal complaint, not "ping ponged" around middle managers, and the poor guy he spoke to couldn't believe how many phone calls he'd had back and had to admit that he was still only the "first level" complaints level over the PALS level, and that he promised he would, finally, escalate it to the formal complaints at Board level.

I think they just try to wind you down when you complain to avoid them having to actually record it as a formal complaint needing proper investigation.

Don't get me started on maternity care/ childbirth. On both occasions with mine, dh had to advocate on my behalf. First time I was told to walk around the hospital 'until I really needed pain relief' (it was my first child, so guessing they thought I wasn't used to pain/ didn't know how bad it would get). After trudging downstairs and bending double, dh requested pain relief, only to be told "we have to examine her before providing it". Well fucking examine her then!!! 6cms dilated, having just trudged back up the stairs (because that's what I was told to do).

Second time, I was told I had to wait to be triaged upon entering the unit. So I patiently waited for 20 mins, in agony. Dh ended up saying "if you don't get her to a room right now, she'll be giving birth in the corridor!" Dd was born 10 mins later (think I'd been expected to cross my legs while I was triaged). There had been no time for any pain relief. I almost needed an emergency cesarian, such was dd's distress - but it was too late for that anyway, given then I'd reached transition!

You think the CNO and CMO don't have a budget? 🙄🤣

Because she posts these threads all the time and every time people ask her for examples and specifics about what roles aren't needed, or what should change, and she never has anything to suggest.

@TankFlyBossW4lk ,

‘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.’

But what does? Of course, there are some people with BBC at A level who have a genuine flair for ‘management’ (if you believe management to be an individual skill which I don’t. I just think it is a combination of logic (which grades can predict) and communication (which they can’t)).

However there are few management roles outside the health service that you can apply to with those kind of grades and no management experience.

Hi New,
I completely agree with you. There are few management roles with this much responsibility that people with so little experience can apply for.

The thing is, there's no real personal culpability with NHS management. All of our managers are shunted around if they don't perform well and people just moan about them. Those ones that are thought of as good are usually just doing the bidding of a senior manager (sometimes manager Dr) with an agenda.

The fact is, if there's patient harm, there's always a doctor/nurse to sue.

Take the broken equipment. Do you think the surgeon is going to arrange for it to be fixed? Call EBME? Call the rep to come and look at it? Do you think surgeons cancel patients themselves? Certainly not in our organisation, they will only cancel if it’s for clinical reasons - if it is any other reason they flatly refuse unless accompanied by a manager. I’ve had to return to the hospital at 6pm before because some poor half starved patient hadn’t been told his surgeon had run out of time and the surgeon flatly refused to cancel the patient/tell the patient and left the hospital.

The matrons moved staff around to make critical areas safer. They pulled the nurse managers into the numbers. They called around the nurses who were on off days.

Yes, and it has done for years. Throwing endless money at the NHS achieves nothing. 🤷‍♀️

For the equipment, I was going to say those are glorified admin tasks but they're not even glorified... Admin could do those tasks. Interesting that I said 'surgical team' and you read 'surgeon'.

Oh great, so they pulled nurses from the wards to make them less safe? I have NEVER in my life seen a nurse manager actively nursing a patient. And again, calling people on their day off to see if they want a bank shift is an admin task. Not that I know anyone who would say yes, DH wouldn't even answer his phone.

You're not exactly helping the cause here. If anything your posts are proving the NHS is inefficient as it sounds like they're paying an 8a to do tasks that a band 3 or 4 could do (under direction).

I work with a load of people who technically are excellent but have no idea what management requires. Unfortunately, the system dictates that they can only have seniority if they go into a management role.

The alternative is to hire people trained and experienced in management. A good manager can manage whether it is in a hospital or a restaurant. They tap in to the service delivery knowledge and experience of people doing the job, and handle the management accordingly.

Everyone is having this discussion. All the fucking time. In the press, in government, on Mumsnet. To the point that everyone in NhS management is sick to death of trying to defend their existence to people who know nothing about what NHS managers do.

Do you work in healthcare? A good restaurant manager can manage a busy clinical ward? Without any healthcare training? No knowledge of the condition its clinicians are treating? No knowledge of the complex commissioning set up? No relationships with related departments?

Are you sure on that?!

I highly doubt that. Patients aren’t pizzas. Life and death, tribunals and potential mass lawsuits are very different from a burnt crust and £10 off your next dinner.

An ok - you’re clearly not interested in having a debate around this. Your response belays a complete lack of understanding of scope of roles.