NHS, What's the priority?

[Jux]

Read this; the NHS has always been top heavy, I can remember my mum complaining about the number of admin vs the number of medical and nursing staff, the plushness of their offices vs the facilities for non-admin staff, and so on, even when I was 4 or 5 (nearly 50 years ago).

Whatever changes have been made in the NHS, it still seems that the basic problems - not enough nurses, care assistants - simply doesn't change.

Why?

Have no answer- Im a nurse (band 5)- all of our band 7 and band 8 (managers) are being 'de-layered' and are having to reapply for their posts, however the Trust is now mass - recruiting for Band 5 nurses. Not sure how that will work, but honestly- having extra 'frontline nurses' will help us massively.

Feel sad for those who have worked their way up through the bands though.

Wow! Still reeling from reading your link!

I feel so sorry for 'Nurse Anne' and others like her. You're all heroes, as far as I am concerned.

I wish I thought the eventual privatisation of the NHS would solve problems like these, but I just don't, I'm afraid. Was it always like this? Surely there was a time when wards were properly staffed.

What do you think?

It's a brilliant blog, isn't it?

A lot of people say that bringing back the Matrons was going to make everything all right again. Ashamed to say, I don't even know if they've done that and it hasn't worked, or they haven't done it!

They need more staff and to treat the staff properly. That's the bottom line.

I work in the NHS and I would say that all the introduction of matrons achieved is putting another layer of management in. It's demoralised and deskilled ward sisters and made getting anything done even more complex. In addition to Matrons our Trust has a chief Nurse and deputy Chief Nurses. I swear I have no idea what they do but I suspect it is not hands on nursing.

[Sigh] The NHS spends an insanely small amount of money on management compared with other health systems and other sectors. Of the £100billion spent on the NHS (a truly gargantuan number), about £1.5bn is spent on management. 1.5%. Other health systems tend to spend about 5 or 6% (I'm not talking about the US, either - I mean fairly efficient and equitable systems like Germany). There are about 1.5m people working for the NHS. About 50,000 of those are managers - and about 50% of them will lose their jobs in the next year or two. No other institution tries to run with such a small percentage of the workforce being managers - not public sector organisations such as councils, and certainly not private sector organisations such as accountancy firms, supermarkets, retail organisations etc.

Anyhoo, it appears that GPs are going to become defacto managers, and there are about 35,000 of them, so that may create some extra capacity (though at a cost - they make more like £100k a year). And GPs tend to be pretty bright as well. But they'll have to find some way of seeing patients also, and of doing joint decision-making (not their natural forte).

As for "what does a Chief Nurse do?": double-sigh. Crap ones don't do much. Good ones lead the improvement of the care provided by the nurses in their organisations. Yes, they lead. Leadership is an important trait. It's too easy to be dismissive of leadership roles ("overpaid" "incompentent" "don't do anything real" blah blah). I remember going to a classical music concert for children when I was about 5. The conductor gave a demonstration of what happened when she didn't conduct and the orchestra led itself: it sounded pretty awful pretty quickly.

I personally think the NHS has a two-fold problem in this area: not enough top leaders (and who'd want to be for relatively paltry pay and humongous amounts of grief) and a large chunk of the frontline staff who are all-to-often not prepared to follow. Consultants who believe that it's their god-given right to carry on doing paediatric heart surgery even though the volumes are too low to do it safely, and are perfectly prepared to get parents to demonstrate to "save the heart surgery unit that saved our daughter". Nurses who just will not change what they do, to make wards run more effectively. Etc. It's not everyone, of course. But it's not no-one, either.

Northernlurker, so they do have matrons! Now I know.

slhilly, thank you for that, and I do see why you're sighing and fed up. Yes, an orchestra is made or broken by the conductor and leaders are important.

There just seems to be something so fundamentally wrong with the way the NHS is run/managed/Idontknowwhat though it may be as simple as too many people get sick and not enough people even want to work for it.

I just want to get a clearer picture, and so far my very cloudy picture is getting a bit clearer, so thanks all for that.

But if we were going to try to mend the NHS, as it were, what do you think would make the biggest difference, or is most important etc?

For all that I'm not a natural political ally of Lansley, and think his implementation is bonkers, I think he's right to say that it's critical to have GPs take both clinical and financial responsibility - and it's also critical that they take on the responsibility of making the major changes to our health services that are required to deliver better care (QIPP, in NHS jargon). It has to be GPs, because they are the gatekeepers, with responsibility for the overall health of their patients.

I think Lansley is lining GPs up to be the scapegoats for the cuts: the NHS has to make savings of something in the order of £20bn: under his proposed regime it will be GPs who need to make the difficult decisions and face their patients who can't get operations when they need them, the expensive medication they need etc.

GPs don't go through their expensive years of medical training to manage budgets and procure services. They're not trained for it and it's nonsensical for them to spend time being administrators and accountants when they should be treating patients.

I'm not a GP, by the way.

Also agree with slhilly's post: the NHS is indeed very management lite compared to almost any other organisation, commercial or not.