Are most NHS managers like this?

[Coffee1990]

I work in a maternity ward. We have had a string of managers who don’t end up staying very long, I think this manager is leaving soon as well. The ward has major issues that I need to report and I need to have the time to sit down and talk through these issues. It doesn’t matter what time it is or how busy we are... the managers are always too busy to talk, except when they want to talk to me then I have to make myself available for them. They are rarely in their office and when they are the door is shut. We hover outside nervous to knock because we are always met with a rude response such as... “We are in a meeting for god sake people keep disturbing us and then closing the door on us”. When I do get 2 minutes to catch them they say things like “I’m too stressed to be dealing with this right now, no offence” To be honest I am offended because it’s almost every time. I feel like I’m not a valuable employee and they couldn’t care less about the staff or the patients! Sometimes I want to say okay if no one here will deal with this shit show of a maternity ward and give the patients the care they deserve then maybe I will go to the newspaper and give them an anonymous report of all the goings on in the hospital... then they will soon listen to our complaints.

Patients if you are reading this - my managers will not listen to staff complaints even when we are trying to protect patients. The only way to get their attention is if a patient complains. So please please fill out the feedback forms and write a review and contact PALS immediately if you are not happy with your care.

I wish someone would support us. The CQC doesn’t see the truth because the managers are told exactly which day they are visiting for an inspection so the managers have time to deep clean the ward, hire extra staff and get extra supplies, so that when the inspectors come the ward looks perfect. Also when the inspector comes around to speak with staff the manager is with her!! So we can’t speak up about anything if the manager is there.

I feel so upset about this system, is there anyone else who can understand?

I'm sorry to hear no one is taking your concerns seriously especially when they concern patient care. It is very different from my experiences in a not dissimilar setting. Managers here and where I've previously worked very much have a open door policy. The fact that Manager attrition is poor would lead me to believe there are wider issues perhaps higher up at Directorship level.

You have a number of options for escalation. Your area will have a risk lead, you could speak to or email them. Also report your concerns via Datix, or your equivalent risk reporting system. Datix reports are discussed at senior level.

Trusts also have speak up guardians. They will help you raise concerns which may relate protection of patients and ensure staff feel valued and heard. You can report anonymously if necessary. Someone will want to listen to you and hear what you have to say.

Datex your concerns? Email them to the managers manager?

Do you have staff meetings where you can add items onto the agenda for discussion ? If so, do that.

Definitely Datix your concerns about patient care. You can do this whenever you feel something has happened ( or nearly happened) which shouldn't have, and if it happens regularly, then you need to Datix it regularly.

I'd send an email to my manager formally requesting a meeting to discuss concerns you have about care in your department. If it's in writing, you should be able to get a meeting arranged.

If you get no joy with that, then you can escalate up the line, but give them a chance to respond and set a meeting date.

You can also escalate things to different departments also if necessary meantime eg. concern about dirty ward - enlist help of infection control, domestic supervisor etc. and be proactive in doing so i.e I've noticed this cleanliness issue, and I'm aware it may impact on patient care, how can we resolve this going forward.

Datix and report. Fill out incident reports and send them to risk management. Is there a Matron you can email requesting a staff meeting
If you're a midwife you can call the RCN/RCM for advice. Are the cqc doing visits at the moment?

Datix your concerns and they will go to both your manager and their managers for review!
They will have to listen then and if there are other colleagues who feel the same and feel
Comfortable with doing so, ask them to also report via datix then there will be a number of the same concerns raised in which they will have to act upon.

As for CQC I worked on a Cardiology ward that sounded very similarly run in regards to management and unfortunately the only way CQC found out how they run the ward was for vocal staff to just ignore the fact that the manager was going round with the assessors and just be open and honest telling the assessors the truth.
They we of course pulled in by the manager but she was then assessed as incompetent to do her job and was re-trained and had other ward managers come down and support her in changing her management style and the ward benefitted from this significantly.

Patient care should come first but the welfare of staff is equally as important :)

Good luck!

No advice OP as I’m not an NHS employee but I just wanted to say thank god for conscientious people like you who actually do give a damn about patients. I had a negative experience when I had my DS two years ago (nowhere near as bad as some of the horror stories I’ve read on here mind) and I kick myself for not being honest on the feedback form. The ward was bursting at the seams (I heard them telling a woman in active labour they were full but “they’d see what they could” ), the facilities were shocking (showers not working, blood on the toilet floor left all day, some staff not washing their hands after using loo) and the consultant was cold and robotic - she got my name wrong despite it being written on the board and breezily told me I could have high blood pressure for the rest of my life and flounced off (I had pre-eclampsia). Sorry for the rant, I’m still pissed off about it now but was so focused on my prem baby I just couldn’t be arsed with it at the time and couldn’t wait to leave.

I’d encourage you to contact CQC directly using this form: www.cqc.org.uk/give-feedback-on-care?referer=promoblock

CQC are inspecting at the moment if there are concerns about risk in a service, hence why the information you have could be very useful. They are not currently carrying out routine inspections.

Regardless, CQC inspections are (largely) unannounced so the service won’t know they are being inspected until the day itself. There may be some exceptions to this, but unannounced is the norm. And whilst of course the inspection team will need to spend time with the manager, including touring clinical areas where there may be informal conversations with staff, they absolutely wouldn’t be allowed to be present during staff interviews or focus groups. You can always request to speak directly with the inspection team.

Go to your Freedom to Speak Up guardian (and report on datix if you feel comfortable to do so..... if you don’t feel comfortable enough to datix, I think this is also something you should mention to the guardian) and like PP have said, you are entirely free to speak to the CQC

What about your clinical governance meetings?

Can you ask individual patients to complain/contact PALS?

It sounds a bit like you are just turning up and asking to speak to your manager. Can you email and make an appointment?

Sadly I knew this would be maternity and is one of the reasons I have become too mentally unwell to work as a midwife anymore. Maternity managers are generally horrific. Unavailable, rude and if anyone raises issues with unsafe staffing and failures in patient care, you’re essentially told it’s all your fault for not being “resilient” enough. When I was training, I spent much of my second year on nursing placements and it was like night and day. Far less bitching about each other’s practice, much more a team, managers who supported you, a break in 12.5 hours, and a culture that refused to cut corners with patient care.

I’m sorry I don’t have a miracle answer to this. For what it’s worth, some maternity units are better than others, so you might find another Trust is better recognising good managers (rather than just promoting those who’ve been there the longest or tell them that everything’s fine when it’s clearly not). I would love to say “tell this person, fill in this form and it will get better”, but sadly after 9 years I realised it wouldn’t. I only wish I’d seen this sooner, rather than keep on battling through, whilst battling PND (which I was not supported with at all, despite OH recommendations for a phased return)... only to end up with disabling panic attacks at the mere sight of an NHS uniform, sound of a siren etc

Overrunwithlego even what are billed as “unannounced” inspections are anything but. A colleague of mine contacted CQC after getting nowhere with the Freedom to Speak Up Guardian - reporting safety concerns. A week later there was a staff email saying “We’ve had information the CQC are making an unannounced visit in the coming weeks and will be checking x,y,z safety paperwork” so please make sure it’s done. The CQC were again informed by my friend about this and advised the CQC to request records from further back (when vital safety checks and paperwork hadn’t been completed).... they weren’t and the Trust received a Good rating on what is recorded as an unannounced inspection. It’s a nonsense.