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 agree
Public sector needs to be brought into the real world

I'm in local government and two of my close colleagues have been let go in the last few years because they couldn't do their jobs. It happened quite quickly.

I’ve know several people sacked in the public sector over the last 15 years or so. One really recently. It was complicated because the colleague was ok at his job. That made it far more complicated because it really seemed as if this person was having some kind of weird mental health breakdown and clearly there had to be consideration of that person’s previously good record.
The other had a extremely poor attitude and did something absolutely bloody stupid. Very short shrift given. Out in no time although he did try to overturn it, even travelling to London to appeal the loss of his professional registration.

You were lucky to get overtime! Any additional hours we work as recorded as bank and therefore paid at normal rate…….i don’t mean additional shifts I mean where you end up staying 4 hours after your shift end as there’s no one else to cover

Maybe they're just copying the MP's.
They can get away with anything AND get promoted for it.....

That’s my experience too, I worked in the NHS for 28 years. The more incompetent or lazy you were the higher you were promoted, especially if you were male it seemed.
The worst manager I ever had the misfortune to work with, went from staff nurse to hospital manager in two years. There he made life nearly impossible by instigating fixed 6 week rotas, including 6 nights, on the staff. If you couldn’t do it then you were forced out. He was clever enough to get the Unions involved and it wrecked a number of peoples lives.

Over three decades in public sector here and I often muse on why any of us work hard when we don’t have to. Most of us do work hard in my area.
Managing other people’s complaints about the incompetent slackers is probably the hardest part of my job. I have a set of stock phrases now as I know I fundamentally can’t do much about them. The HR policies would not support me and PIPs are horrendously hard work and often counter productive as the slacker just goes sick or grievance.
Most of our staff are fantastic though.

I was in a middle management role in public sector, my boss complained that one of my team was taking ridiculously long time to complete a project, I was basically told to kick her ass, so I tried to manage her and make it clear senior management needed to see progress etc.... next thing I lmow she goes to my boss to complain about me doing this and my boss backs her and I'm in the shit!
I say 'was' in that role as I got out soon after.

Yes

@StinkyCheeseMoose
This always raises a rye smile from me ....Private good/public bad is the kind of reductionist drivel you'd get from a teenage wannabe economist.
There are a great many examples of corruption and failures in private companies and the market...Water companies, Carillion, TSB (and most of the majority banks nearly bankrupting the country). The VW group diesel scandal....My particular favourite is the capture of the children's social care "market" by private equity firms which allow companies to go bust leaving vulnerable abuse children in unsuitable settings.
Equally scandals and incompetence in the NHS, the top of government (partygate was hardly the civil services finest moment) etc are also alarmingly common.
There are examples across the board in both the private and public sector of poor performance and a lack of accountability. If anything the commonality is a British thing (although see VW).
We have poor structures and systems for accountability in the UK in my opinion. Scrutiny via journalistic investigation or legal cases has diminished and we are still over reliant on leaders who come from a certain private school background that privileges over confidence and chutzpah over analytical skills and long term strategic thinking.....

On reading this thread I question whether, in fact, as we are always hearing, the NHS is underfunded or woefully managed?

As a hospital consultant of 30 years, I could not agree more.

A minority of staff ruining it for everyone. It is very hard to get rid of them and HR processes are slow and cumbersome. The difficult staff just get moved sideways from team to team, and the problem continues as they are the one raising grievances and accusing others of bullying. It is extremely stressful working with these people on the team.

And the main issue is that the patients lose out. We can’t recruit better staff whilst the toxic members are in post. And if these kind of workers are unpleasant to colleagues, I worry how they are with patients.

I once heard a group of staff discussing amongst themselves how much annual leave and how much sick leave they had left to take. Of course there is genuine sickness, but I promise there are people taking the piss.

I am a GP partner and therefore run a practice. I have been a GP for 30 years and the job has changed massively. But none of my staff underperform.
My salaried GPs work 3 days a week. This is probably 30-36 hours a week with unfortunately many of them logging on from home on non work days to complete paperwork. I'd like to reduce this but would mean reducing available appointments. My nurses work all day. The only time they are not seeing patients is when the patients fail to turn up. But at least it gives them a bit more admin time. My receptionist's don't stop. My practice manager works her socks off and will stay late. And yes we have a robust probationary period, and I have sacked staff for underperformance. When I haven't they have left because they can't keep up.
And yes we make a profit - but that's my only income. We are not in deficit like hospitals because if we were I would personally be in deficit.

All (non big corp) GP practices are run like this. There is so little funding, there's no room for poor performance or slacking. But i don't disagree that bigger public sector organisations including hospitals will not work like this.

Well, I hate to remind everyone, but if Angela Raynor gets her way with the Employment Rights Bill, then things are going to get a lot worse in terms of sickness and absence and the legal handcuffing of managers.

Useful summary here: https://www.davidsonmorris.com/employment-rights-bill/ but the bill is well-documented online.

While the issue is live I agree wholeheartedly with your last line. That’s the trouble with these threads isn’t it, we all get defined by the problematic stories when for so many of us these types are very much in the minority.

It’s really grinding me down, I get told weekly how shit I am by members of the public, stakeholders, elected members who believe these stories apply to all of us. I like my work, it’s important, I’m good it and a busy day flies by. I’ve had jobs (in private sector) where there wasn’t enough to do and the tedium did my head in. The bullying, incompetence and general shitarsery by Peter Principle managers in the private sector was also worse, in my experience.

I have worked in the NHS and seen how it wastes money. If it was run efficiently there would be no need for more funding.

The whole thing needs complete reform. The model no longer works. It won't happen though because any attempt to improve it is politically toxic.

Unfortunately, we are expected to worship the NHS like a religion and never criticise it. We are told it's the envy of the world, but it obviously isn't, because no other country has ever tried to copy it.

We are supposed to believe that all the staff are selfless, hardworking angels living on cold baked beans and economy sausages. It is true that many are dedicated and good at their jobs, but a significant number are not.

What we need is a government with the courage to overhaul the whole thing and not be dissuaded by the howls of "They're destroying/privatising the NHS", or wicked attempts to scare people into thinking they wouldn't be able to have treatment if they couldn't afford to pay for it.

The fact is, most of us already pay for a "service" that often isn't available to us when we need it.

Anyone remember when bright minds tried to get a grip of this by mandating annual reviews where the top 10% would be recognised by a management panel but the bottom 10% also had to be agreed by ‘moderation’ (horrible meeting deciding who to pick). The bottom 10% would then be put on mandatory PIP. If they didn’t improve in 6 months they would be managed out.

Those bright minds did not think this through or understand civil service culture and lack of HR support. We all complied. Morale tanked. Good people were targeted because they would be less trouble to target. The bottom 10% took out grievances and never improved or got sacked. The unions went crazy. The EDIA people showed there were more ethnic minorities put in the bottom 10%. The whole thing got dropped.

Then it was a push to improve the managers. Get them to be proper leaders. Just ended up with a load of expensive training that made little difference (although some was good).
I generally think natural leaders and good managers aren’t that prevalent in the public sector as they’re not a good fit. Too frustrating and not paid enough.

We do have some great managers but they struggle against the culture.

This is just a civil service trope. There are lazy people everywhere. People in the NHS are actually under a lot of pressure. Have to reapply for thier own jobs etc.

Previous generations of GPs were not part of the commissioning process and required to attend a ton of meetings about what & how many services to commission from hospitals and community health providers

I have to attend a lot of these meetings and shake my head at GPs having to spend their time on them

It does need reform but the problem is we can't pause the NHS while it's done. in order to reform it properly we'd have to run twin processes and funding where on the one hand for example we keep doing hip replacements on Older ppl who fall over and also fund the well evidenced preventative work that stops ppl falling in the first place which will take several years to work through the system but will eventually result in fewer hip replacements

I can't see how that can be done

Who would replace the people you would sack? Who are these angels willing to take on the job? Which is very hard and often thankless, as is clear here

I agree that there needs to be some change but there are on the most part very dedicated people working very hard in the NHS and trashing them is very sad

Oh yes the perfect journalists who can root out all of the corruption and solve all of the problems.
I have recently read articles which are poorly researched (about things which I know a lot about) and often just plain wrong or stuff about their daily lives of the standard of "I need to write 500 hundred words quickly"

I worked in an allied profession. All on call was overtime. Some months I doubled my pay.

Any extra hours worked(ie staying late) were either claimed as overtime 'calls' (over £20/hr when I first stated there 25yrs ago) or as TOIL rounded up to the next 15mins every time.

I work for an nhs trust. We employ a lot of graduates /under 25’s. (I’m in my mid 40’s). What I have noticed is that many of the younger staff whip their phones out at every available moment…. Waiting for a meeting to begin - facebooks/snapchat scrolling commences, a lull in work - phone out. The older generation would look for something quick to get done before the meeting begins - their mobile phones in handbags or lockers. We have so many staff that under perform and could be let go following a performance review if it were a private sector employment.

Also in 20+ years of working for more than one NhS trust I have only ever seen one person sacked, and one manager asked to take early retirement. I did witness a locum being let go with immediate effect when he flipped out and held a colleague to the wall by her throat. Sordid affairs, one colleague had a camera in the female lockers - he was given a managed move and a slap on the wrists. I’m also acutely aware that there are people who have slept their way to the top - and sit there on huge salaries entirely awful at their job. It is probably one of the most corrupt employers - apparently the police is similar.

As an nhs manager this is so true. I spend hours with hr and occupational health talking about staff who find reason never to be in work and the gp signs them off without even seeing them face to face. It’s soul destroying. People play the system !