Luckygirl well said
One of the reasons you need more managers is because so many "services" have been farmed out to private companies, who need to be monitored, changed, have contracts drawn up, tout for the cheapest etc. A mammoth task.
Outsourcing does not necessarily mean cheaper.
Some of the administrative mistakes we and others have experienced recently have been made by outsourced companies and have resulted in wasting the time of medical staff.
PFIs have cost the NHS dearly.
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Health
NHS problems from the horses mouth
(111 Posts)Why is nobody listening to the experts.
This is a letter published in the Telegraph today
SIR – I’m a retired consultant, and I know that so-called managers have multiplied dramatically over the past quarter of a century.
Hospitals used to be run by the consultants, who are the only people with the knowledge to appreciate what is necessary in healthcare. The medical executive committee consisted of one consultant from each specialty, and it discussed what was necessary for the proper functioning of the hospital. Its decisions were communicated to the hospital secretary, who implemented them.
Now, the hospital secretary has been replaced with a CEO, who is in charge of countless other managers. This grotesque experiment in managerialism has resulted in huge increases in expenditure without any improvement in patient care, as these managers are not medically qualified. They are appointed in order to prevent doctors spending too much money.
Unless this is reversed, with consultants put in charge of all medical decisions, the NHS will collapse. The health service exists to diagnose and treat. Doctors do this with the help of nurses, physiotherapists and others. They do not need managers, whatever politicians might imagine.
Not strictly true though.
While the medical and nursing care I received during my recent hospital stay was exemplary and I have no doubt they saved my life, the clerical side was dreadful with my discharge letter having loads of incorrec info on it.
However the various outsourced services I have accessed since I got home have been very efficient.
Doctors dictate hospital discharge letters though kittylester, and are responsible for ensuring they contain accurate information. They should also check and sign them. The medical secretaries are allocated to consultant teams.
I do know that casdon.
But, actually, a junior doctor typed my discharge letter and it was checked and signed by the ward consultant.
Reconsidering I totally agree with this letter and it's the main reason I retired as a senior nurse early fed up with being told how to run nursing services by accountants.
Callistemon21
Luckygirl well said
One of the reasons you need more managers is because so many "services" have been farmed out to private companies, who need to be monitored, changed, have contracts drawn up, tout for the cheapest etc. A mammoth task.
Outsourcing does not necessarily mean cheaper.
Some of the administrative mistakes we and others have experienced recently have been made by outsourced companies and have resulted in wasting the time of medical staff.
PFIs have cost the NHS dearly.
The outsourcing itself costs the NHS because commissioning staff have to employ the best (cheapest) provider and contracts have to be drawn up.
Mistakes are sometimes made because even for one condition, services are sometimes provided by different hospitals or teams. The NHS IT systems don't allow different providers to communicate efficiently. This is the result of the so-called internal market.
kittylester
I do know that casdon.
But, actually, a junior doctor typed my discharge letter and it was checked and signed by the ward consultant.
So it wasn't errors by clerical staff, but by a doctor ie a member of clinical staff.
My recent discharge letter was written and signed by a senior nurse and went straight into my online record.
Katie59
Work expands to fill the time available, the amount of red tape is just unimaginable, it would not surprise me if half the NHS budget is spent on admin.
No, it's not. It's about 3.4%.
MOnica I am a patient at Addenbrooke's in Cambridge. I have never been "double-informed". All information, including appointments, goes directly into an online system called "My Chart". Automatic text messages are sent before appointments, but they are computer generated and don't anybody to spend time sending them.
It is possible for people to opt to have traditional letters, but it's not the default.
pascal30
Consultants and medical staff should be autonomous and managers who are not clinically trained should not be in charge of anything involving medical decisions... In my experience the MH service was hugely overloaded with managers...
So doctors should be free to order unbelievably expensive tests and procedures? What happens when they've ordered expensive drugs or scans for the first patients in the financial year and they've run out of money for all the rest?
It's naive to think that medical staff can be autonomous.
Kate1949
I posted on another thread that a close relative who works in the NHS said that there are an unbelievable amount of managers thinking up 'initiatives' which cost a fortune. Someone called it manager bashing.
It's actually the DfE in Whitehall which thinks up most of the "initiatives".
*So many medical staff are leaving because of stress due to overwork.
How many managers can say the same?*
My sister did. She was a manager of a large, under-resourced trust and was working six days a week and long hours. Her manager left and wasn't replaced, so she took on her work, as well as doing her own work and trying to fill gaps left by more junior staff who were leaving and not being replaced.
My sister left and found a job with a private healthcare company, was paid the same and had a fraction of the workload.
growstuff
LadyGracie
They obviously need managers but not to the detriment of medical staff. There are layer upon layer of managers, a total waste of money.
Maybe the government should stop issuing more and more targets.
This - ever changing edicts issued.
Also - my sis and BiL are retired consultants - they wanted to work as doctors, not admin/resources management ,
I don't see that because someone is an expert consultant in heart surgery or paediatrics or any other specialty they know much about how budgets should be allocated, staff managed, buildings maintained or complex organisations managed. Harking back to the days of Matron and Sir Lancelot Pratt isn't going to get us very far.
50 years ago I was Matron's secretary. Now there was a formidable lady.... And a delight to work for if you did your job properly. She did a ward round morning and afternoon. The ward sisters, who were themselves to be treated with respect, were very much on their toes.
She also knew every cleaner, every porter, the electrician, the joiners etc.
I loved it.
No one is saying that we should do away with ALL admin staff and managers. Just that there are too many.
Agreed kittylester
kittylester
No one is saying that we should do away with ALL admin staff and managers. Just that there are too many.
That would be fine if the government reduced the scrutiny and target management imposed on the NHS. For anybody who’s interested, here is the latest English one. Every one of the requirements requires people to make sure they are delivered, on top of the information required to ensure clinical standards are met and services are managed within budget.
assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1065712/revised-2021-to-2022-nhs-england-mandate.pdf
More government micro-management - it helps no-one. Look what it is doing to education.
I am not suggesting no managers at all - I don't think anyone on here is; but the reason more managers get employed and the reason they are so busy is because of government interference - outsourcing, assorted edicts and targets.
It is a disjointed mess.
The thing is that times have changed. The time when the consultant was king is over.It does seem like a call for the 'good ol' days ' when 21st century health care needs 21st century responses. There's a lot of inefficiency in the NHS, and it does need a reform but I don't think harkening back to the past will yield the answer.
growstuff
Katie59
Work expands to fill the time available, the amount of red tape is just unimaginable, it would not surprise me if half the NHS budget is spent on admin.
No, it's not. It's about 3.4%.
Believe that if you want, the total cost of management administration is 15% plus, but that does not include the time taken to carry out the administration at clinical level.
Recent studies show nurses only spend around 1/3 of their time caring for patients because there is so much management and admin that has to be done.
My own experience of 30 plus years nursing bears this out, you never have time to do the nursing properly, friends tell me the care sector is even worse.
Casdon
kittylester
No one is saying that we should do away with ALL admin staff and managers. Just that there are too many.
That would be fine if the government reduced the scrutiny and target management imposed on the NHS. For anybody who’s interested, here is the latest English one. Every one of the requirements requires people to make sure they are delivered, on top of the information required to ensure clinical standards are met and services are managed within budget.
assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1065712/revised-2021-to-2022-nhs-england-mandate.pdf
There is similar micro management imposed on the farming industry.
The difference is that the farmers and food industry have to pay for it the admin themselves.
Casdon
kittylester
No one is saying that we should do away with ALL admin staff and managers. Just that there are too many.
That would be fine if the government reduced the scrutiny and target management imposed on the NHS. For anybody who’s interested, here is the latest English one. Every one of the requirements requires people to make sure they are delivered, on top of the information required to ensure clinical standards are met and services are managed within budget.
assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1065712/revised-2021-to-2022-nhs-england-mandate.pdf
Ah! But if they reduced the scrutiny, consultants would order expensive tests because they wouldn't be accountable for the cost, value for money or efficacy. How would consultants know that their treatments were even working? How long would it be before the public started shouting about the trillions of pounds the NHS was costing?
Katie59
growstuff
Katie59
Work expands to fill the time available, the amount of red tape is just unimaginable, it would not surprise me if half the NHS budget is spent on admin.
No, it's not. It's about 3.4%.
Believe that if you want, the total cost of management administration is 15% plus, but that does not include the time taken to carry out the administration at clinical level.
Recent studies show nurses only spend around 1/3 of their time caring for patients because there is so much management and admin that has to be done.
My own experience of 30 plus years nursing bears this out, you never have time to do the nursing properly, friends tell me the care sector is even worse.
So if nurses are spending so little time on caring, wouldn't it make sense to have more clerical staff? Oooops! But that would increase the money spent on admin.
Sorry I got the figure wrong. :-(
From the 2012 study:
"Best estimates suggest that the NHS spends roughly £8 billion of its £100 billion budget on management and administration."
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