To think that one of the NHS’s biggest problems is that it’s almost impossible to sack anyone?

[SnugShaker]

I know the NHS is under huge pressure and that many staff work incredibly hard. But from what I’ve seen and heard, one major issue is that it’s extremely difficult to dismiss underperforming employees. Unlike in the private sector, where people who don’t pull their weight are usually let go, the NHS seems to have layers of bureaucracy that protect staff, even when they’re not competent.

I’ve heard of people who do the bare minimum (or less) staying in their jobs for years, making life harder for colleagues who have to pick up the slack. Surely this impacts patient care and efficiency? AIBU to think that making it easier to remove underperforming staff would improve things? Or is there a good reason for the system being the way it is?

Absolutely true - work in NHS.
I fed back on concerns regarding a couple staff members on various issues - such as poor note keeping, discriminatory behaviour towards patients, rudeness etc. Other staff had also raised concerns on this staff member. But who got in trouble - myself and another staff member who raised concerns were accused of bullying, poor commuinication.

GP surgeries are private companies - they’re not run by the NHS, they’re under contract to provide a service on behalf of the NHS. They’re businesses which are there to make a profit

They don’t move through the bands on time served. You move within your band only if your manager approve the pay gateway. You can’t move to a higher band unless you apply for a vacancy at a higher band and are succesful.

there’s also not a pay increment every year either

it also only takes 5 years to get to the top if a band and then you’re stuck

You do know that 6 months sick pay depends on length of service and not everyone gets it? It’s also in a rolling 12 months too? Similar to many public sector roles

The automatic pay band movement is much reduced. Unfortunately there are too many people who apply for higher banded jobs who are just incompetent but have the ability to ace interviews fortunately they tend to be moving to non- clinical senior posts.
The other problem is the recruitment - someone resigns as they are overworked their job does not get advertised until they walk out of the door. Their replacement (chosen by highly competitive interview 🤣) cannot start until all their pre-employment checks are done (internal candidates as well) and external candidates will only give in their notice once offer confirmed. HR or more likely HR partners are incompetent at best. So without a team member for about six months during which time someone else resigns.
We had someone applied for a higher band job in a critical area and was offered it despite being known for making repeated minor errors rather than readvertise

Agree with the bullying culture.
I worked with a woman who had trained at the same hospital and never worked anywhere else.
She had basically been over promoted , couldn’t cope and would literally scream and shout at staff and patients. Many complaints were made, nothing ever changed except she was removed away from some clinics.
I heard she retired, presumably on a huge pension.
such a shame as the rest of the staff there were great and the days she was not working were good.

There are major issues with the competence of management in the UK across the board

NHS worker here. I agree with you to a large extent actually - it is very difficult to address poor performance systematically (and yes, it does exist). But I honestly don't see a way forwards. I used to find it easy to criticise the system but the higher I rise, the more despondent I get about how to improve it. It seems to me that there are two big barriers. The first is the obvious issue of not being able to recruit enough suitable people for a lot of posts so you end up having to work with basically anyone who will do the job. The second is that I do think performance can be genuinely very difficult to measure effectively in a lot of NHS roles. Any sort of payment or promotion by results type of system flounders on the fact that health is complicated; people can get better or worse for a range of reasons out of any individual clinican's control; and it would disincentivise doing jobs where survival or recovery rates are inherently low / disincentivise working with complex and difficult situations. Measuring the quality of care is very hard actually, and whilst patient feedback can be incredibly valuable, it isn't fair to rely on that alone (people who are unhappy are way more likely to give feedback through formal channels than people who are satisfied; complaints often say more about systemic issues with waiting times etc or about unrealistic patient expectations than about the weaknesses of individual staff members - although of course criticisms of the latter are sometimes valid too!).

In my own field of psychological therapy, I have seen situations where people have deliberately avoided taking on certain clients because they know their difficulties are likely to be chronic and therefore the therapy outcome measure won't look good! I have seen people try to force distressed clients to complete measures of their mental wellbeing at inappropriate times because they need these numbers to justify spending time with them. I've seen people encourage patients to over-report their initial distress so that it looks like they've improved later. I've seen people ditch patients because something goes terribly wrong in their lives so inevitably they're not going to be better off overall by the end of therapy, and therefore will count as a black mark against their performance. This stuff is all so ludicrous and is driven by fear of losing jobs (psychology is so oversubscribed in terms of would-be entrants to the profession, and its evidence base so precarious, that this seems to be one of the few areas where performance management can be a bit more brutal).

Indeed @JohnofWessex. I haven’t seen anything in the public sector that I didn’t also see in private.

Came on to say this

It’s a massive problem in Local Authorities too. I speak as a manager who has desperately tried to sack people.

I couldn't agree more. I had an underpeforming staff member (they didn't log on at all for 3 days one week (WFH)) and HR told me I had to have a meeting to tell them they were expected to log on and work!!!!

Added to that our part of the NHS has no probationary period so once your in, you are pretty much unable to be sacked. It is ridiculous

I work in a hospital and we sacked someone last December. It was hard - had to evidence, use informal and formal proceedings. It means managers can’t just sack people they don’t like but it does mean you have to really want to get rid of someone to put that much effort in.

my own experience (10 years in the nhs and previously private sector), is that you always get a mix of good and bad employees and most are actually pretty hard working. The most dedicated I’ve come across are in an nhs provider. Bring us a major incident and our families come second as we all muck in where needed… yet still there’s so many threads slagging off nhs employees.

The first is the obvious issue of not being able to recruit enough suitable people for a lot of posts

I keep hearing about how many graduates with allied healthcare degrees are unable to find work. Does the recruitment process need to be improved?

Many years ago I was talking to my ex brother in law who was a head of department in a school.

He said that sacking teachers often didnt work because of the shortages of potential replacements who could be as bad if not worse

YANBU. My brother is extremely senior in the NHS, and he would agree with you 1 million %. I’m in utter disbelief at some of what has been ignored it brushed under the carpet for decades! It needs sorting, and absolutely wouldn’t happen in other industries.

So did I. I left eventually after 20 years. Not because of the pay (actually v good), the hours (got paid lots of overtime at a great rate), the bosses or the patients; but because I was sick and tired of working my butt off whilst many around me were lazy arses who knew they could get away with doing nothing all day, ringing in sick when they fancied a day off and arriving late/leaving early.

I now work in the private sector where you would be sacked/disciplined for all this behaviour. Everyone works hard and as a team.

Anyone who works hard in the NHS will 100% feel this way. Those defending either don't work there or are the lazy arses im talking about.

Im fed up with hearing how hard working NHS workers all are, just by default of 'working ' for them. And dont get me started on the bloody clapping 5 years ago 🙄

From my experience, it very much was the frontline staff

It's the entire public sector, sadly.

Plus as a previous poster stated, the bullying now is utterly out of hand. Should you dare raise concerns, however legitimate, about the competence of a colleague or their bullying behaviour, you're the one that ends up being isolated.

Add that to people lying about their experience and qualifications and the general uselessness of HR and the NHS is not a happy place to be right now.

When I joined twenty years ago it was still a good place in general with most departments and teams kind and supportive to each other. I've been horrified to see it deteriorating year on year.

I still believe in the principles of the NHS but whatever it is now, it's not the NHS I once loved.

I am a GP working 3 days a week (this comes after many years of working 100 hour weeks plus as a junior doctor). I’m also a single parent. I’d love to work more days and could very much do with the money - you do understand that we only get paid for the days we work right? So it’s hardly fair to imply that people working part-time are somehow underperforming or “poor staff” giving a “poor service” as you put it. Just more GP-bashing…

The reason I work 3 days a week is to protect my mental health both for my own sake and also for my patients sake. I have bipolar 1 disorder and the job is extremely stressful with long hours (many of which are unpaid). Excessive stress for me could trigger a bout of depression or even worse, mania. Not sticking to regular times for eating and sleeping etc can do the same. If that happened I would end up on sick leave and unable to work at all which helps nobody.

Not all GPs have bipolar disorder of course. People with bipolar 1 in the U.K. have about a 40 percent employment rate generally. Uou have to remember that we are human beings too with our own issues and problems. Most GPs I know work part-time and for the majority of them, it’s simply because the job has become very intense and stressful, and almost impossible to do “5 days a week” (which will usually result in having to do paperwork on day 6 and possibly day 7 as well, meaning you would never get a real break from work). As well as often having to consider childcare issues (there are a lot more female GPs than in the past). Among GPs it’s basically acknowledged that the job full-time is now undoable due to stress, ridiculous workloads, and long hours. But especially among GPs my age, we are frustrated by it as we would like to be able to work full-time and access a full-time wage. However, working part-time has become the only way to continue working and survive, without risking complete burnout and mental breakdown.

The job was very very different in the past and not nearly as stressful or busy, so you really can’t fairly compare what previous generations did (they were also much better renumerated and had final-salary pensions etc). GPs now are also much more likely to be women who have to consider childcare etc. Not that men shouldn’t have to consider this but in the real world we all know it still tends to fall on women.

Hmm we have had two admin reviews where people have lost their jobs so no… I don’t think this is true!

Restructuring is different to sacking poorly performing individuals

Honestly and I know that I will be ripped to shreds here, I think that inefficiency is just baked into the model that we have. The NHS is free at the point of use and is managed top down so it’s just full of over management in an attempt to “save resources” (by limiting access), measure stuff and feed information around the system to create more process and HCPs are treated like children with so little agency. In many other systems, the patient is the customer and that means that resources go to where the market is and the systems organise much better around how best to make that process work. As an example, one of my kids recently had an accident needing stitches in France, took them to the emergency department where there was no waiting other than filling in details for the system and got the stitches and various prescriptions, but then a nurse visited us at home to take the stitches out 5 days later. That nurse worked with 3 other nurses as part of a team - they each take it in turns to be on call for scheduling appointments and work the hours that they set between them as part of the team. I got to text them to set up the appointment. Not a manager or a receptionist in sight. Sure, I had to pay 17 euros for the appointment, but it was absolutely immense and worth it. People in the U.K. honestly don’t know what healthcare could look like.

But in terms of public sector work, yes, it’s awful from my experience of the civil service. The sick pay, claims of bullying/discrimination if people are just incompetent, the fact that underperformers are just moved on. The fact that people call their union and they tell them to go off sick. Honestly, it’s madness. In many cases, if you could just pay people out their notice period and get shot of them for good, it would be far cheaper. No one ever really reviews it - I mean, if the team is managing fine with someone off sick for “stress” that is really underperformance, why not just get rid of their job rather than keep them because “they can’t recruit anyone better”. The private sector would do this, but lots of public sector managers don’t actually want to trim their teams.

I have always said that you have to practically murder someone on the premises in the public sector before you’re sacked. Very lily-livered.

Correct that this is an issue too in higher education. Very generous and slow performance and absence processes heavily weighted in favour of employees. However well-intentioned it means a lot of managers give up trying to manage these problems and those staff just continue, much to the frustration of everyone else. I didn't realize how much quicker and easier it is to address in private firms.