The banker loving, baby-eating Tory party thread (regenerated)

[sidcow]

I don't know enough about the workings of The NHS but what I do know following a conversation with my Mother yesterday (who also used to be a Radiographer) is that my Grandad used to be a top surgeon but had a heart attack in 1968 so moved into Management and became extremely senior in the NHS in the West Midlands in the 70s. 

Apparently he used to get extremely angry about the amount of managers and administrators employed instead of actual medical staff. 

It was a different era obviously but you wonder if that's been a theme for the last 40 years or so.  Maybe, maybe not but my mum is a dedicated believer in The NHS having too many managers and not enough medics to this day. 

She also talked about spending a lot of her Childhood in Hospitals around Christmas time. She would visit the hospital on Christmas day every year with my Grandad. Apparently they used to really go to town on Christmas decorations with wards competing against each other.  One year my Grandad took his (extensive) model railway in and they literally built a whole landscape out of plaster of paris with tunnels and hills running all way round the ward. 

We're having these discussions as my Dad is pretty ill in hospital right now with a rapidly developed serious case of Dementia, Flu and possibly pneumonia. 

[Davkaus]

My gripe with people who moan about "not enough frontline staff, too many managers and admin staff" in any field is...You don't want your highly skilled experts spending time doing trivial paperwork do you? But the paperwork needs to be done.

I'm not saying the balance is currently perfect, I'm not qualified to have a view on that, but I hear this all the time, and I think it's often a misplaced criticism. It's said of my local trust, but it's not that those admin staff are hired instead of doctors and nurses - there are loads of vacancies that aren't being filled. If those admins and managers weren't there, we wouldn't necessarily have more nurses and doctors, we'd have the same number of nurses and doctors being stretched even more thinly being tied up in the PAS instead of seeing patients

There are certainly some middle managers whose jobs don't need to exist, but I'm not convinced it's in the top 5 problems with the NHS.

Edited December 21, 2022 by Davkaus

[fruitvilla]

1 minute ago, Davkaus said:

But the paperwork needs to be done.

The data needs to be collected so the middle managers have something to manage? The front line could be collecting the data. How much paperwork is optimum? 

My experience is not from the medical field, but I speak as an ex-middle manager.

[Davkaus]

6 minutes ago, fruitvilla said:

The data needs to be collected so the middle managers have something to manage? The front line could be collecting the data. How much paperwork is optimum? 

My experience is not from the medical field, but I speak as an ex-middle manager.

Similarly to some of the middle managers that don't need to exist, some of the paperwork and admin tasks don't need to be done. How much? No idea. Maybe each trust could sack off thousands of people without any consequences whatsoever, but they are still going to need their HR, legal, and IT teams, and admin staff for basic tasks that don't require clinical expertise. Patients are still going to need to be admitted and discharged, processed on the IT systems, and clinical notes created and coded correctly.

As I said, I'm not qualified or experienced enough to tell you the optimum number, but while some admin tasks might be pointless busy work, an awful lot of it isn't, and where it needs to be done, I'd much rather it wasn't highly paid doctors spending their time on it.

Edited December 21, 2022 by Davkaus

[fruitvilla]

4 minutes ago, Davkaus said:

Maybe each trust could sack off thousands of people

Maybe create a new department to lay-off people?  

[DCJonah]

2 hours ago, OutByEaster? said:

This isn't incompetence on behalf of this government, it's a deliberate action supporting an ideology that demands that anything that can be monetised for private profit is monetised for private profit.

They're not making mistakes - they want to break the NHS to the point where Richard Branson and AIG and the like can ride in and 'save' us. 

Unfortunately this is it. And whilst we have a majority right wing media who keep the public angry at Meghan Markle, people just don't seem that bothered. 

We've truly **** ourselves over with 12 years of these words removed.

I'm convinced future generations will study how the general public have been so manipulated to vote against their best interests. 

 

[KentVillan]

The NHS employs 1.2m people.

53% of those are qualified medical or scientific specialists.

Of the remaining 47%, the majority (340k) are support workers - receptionists, PAs, etc who are providing support to qualified medical specialists.

The actual number of “senior managers” is 12k. “Managers” is 27k. So the management / senior management bracket is 3% of the entire workforce.

And below that, infrastructure staff (a lot of which is managing all the massive buildings, vehicle fleets, food, payroll, HR, etc which are essential) = approx 175k.

Do any of those numbers look unreasonable when you actually stop to think about all the things involved in providing healthcare and managing hospitals, ambulance services, etc?

And is it any surprise in an organisation of that size (with pay not keeping pace with inflation) that some of those people are useless jobsworths? That doesn’t mean sacking “middle managers” is going to solve anything.

Of course there’s going to be the odd role that sounds silly… tabloids love picking out diversity advisors etc - although the NHS employs and treats people from every corner of the earth, so maybe not that crazy. But if you look at it with a bit of perspective, it’s highly unlikely these roles are causing a meaningful loss of budget for “frontline” services.

It all comes down to funding not keeping pace with demand (ageing population, Covid, etc). You can say the funding model is wrong and there’s an argument to be made there, but I don’t buy this idea that the issue is just a lack of efficiency or the wrong people being hired. It’s clearly a funding problem.

Source for staff numbers: https://files.digital.nhs.uk/7D/4E31E0/NHS Workforce Statistics%2C August 2022 England and Organisation.xlsx

Quote

NHS Hospital & Community Health Service (HCHS) monthly workforce statistics - Staff in NHS Trusts and other core organisations

 

[tinker]

8 hours ago, sidcow said:

We're having these discussions as my Dad is pretty ill in hospital right now with a rapidly developed serious case of Dementia, Flu and possibly pneumonia. 

Fingers crossed for you, sad to see someone who obviously gave so much to helping people be in his situation. 

[Guest av1]

Just saw a GiffGaff advert on TV 
 

The crux of the advert was, lots of things change in 12 months but not our prices, which are fixed. 
 

To illustrate this they showed number 10 as a revolving door. It made me chuckle a bit that even TV ads are taking the P now. 

[sidcow]

2 hours ago, tinker said:

Fingers crossed for you, sad to see someone who obviously gave so much to helping people be in his situation. 

Thanks.  To be clear it was my Grandad who was the surgeon, it's my dad who is ill now. 

Edited December 22, 2022 by sidcow

[one_ian_taylor]

6 hours ago, KentVillan said:

The NHS employs 1.2m people.

53% of those are qualified medical or scientific specialists.

Of the remaining 47%, the majority (340k) are support workers - receptionists, PAs, etc who are providing support to qualified medical specialists.

The actual number of “senior managers” is 12k. “Managers” is 27k. So the management / senior management bracket is 3% of the entire workforce.

And below that, infrastructure staff (a lot of which is managing all the massive buildings, vehicle fleets, food, payroll, HR, etc which are essential) = approx 175k.

Do any of those numbers look unreasonable when you actually stop to think about all the things involved in providing healthcare and managing hospitals, ambulance services, etc?

And is it any surprise in an organisation of that size (with pay not keeping pace with inflation) that some of those people are useless jobsworths? That doesn’t mean sacking “middle managers” is going to solve anything.

Of course there’s going to be the odd role that sounds silly… tabloids love picking out diversity advisors etc - although the NHS employs and treats people from every corner of the earth, so maybe not that crazy. But if you look at it with a bit of perspective, it’s highly unlikely these roles are causing a meaningful loss of budget for “frontline” services.

It all comes down to funding not keeping pace with demand (ageing population, Covid, etc). You can say the funding model is wrong and there’s an argument to be made there, but I don’t buy this idea that the issue is just a lack of efficiency or the wrong people being hired. It’s clearly a funding problem.

Source for staff numbers: https://files.digital.nhs.uk/7D/4E31E0/NHS Workforce Statistics%2C August 2022 England and Organisation.xlsx

 

Well said. 

There's  plenty of comparisons with other OECD countries that can be made, and how numbers of doctors per capita in the UK are well below where they should be, so funding is certainly  an issue. 

But given the things you've mentioned about demand, it surely also makes sense to look at things that could be done to control or reduce that demand. Public health and policies that support public health  improvements are chronically and woefully neglected. For example, funding for energy efficiency improvements and home adaptations that help people stay in their homes for longer and prevent expensive hospital stays.  Or healthy  eating initiatives (too much like telling people what to do for the sociopaths that govern us). Or cycle infrastructure that helps encourage people to be more active and also reduce air pollution. Or policies that help reduce the growing income gap between the poorest and wealthiest.  

Some of the best journalism I've  read recently (or ever tbh) has been MD's columns in Private Eye over the pandemic, which have highlighted  that one of the major reasons those country suffered  much more than necessary  wasn't just the lack of pandemic preparation, or the poor political decisions made in the early stages, but underlying public health issues that.make people more vulnerable and put loads more stress on the health system.  

This won't  improve until we can have a sensible debate (Haha, as if) about these issues, rather  than everything  coming down to funding for frontline services. Public  health should be seen as a long term investment - our government seems to place very limited value on it, which says it all.

 

[Demitri_C]

10 hours ago, sidcow said:

I don't know enough about the workings of The NHS but what I do know following a conversation with my Mother yesterday (who also used to be a Radiographer) is that my Grandad used to be a top surgeon but had a heart attack in 1968 so moved into Management and became extremely senior in the NHS in the West Midlands in the 70s. 

Apparently he used to get extremely angry about the amount of managers and administrators employed instead of actual medical staff. 

It was a different era obviously but you wonder if that's been a theme for the last 40 years or so.  Maybe, maybe not but my mum is a dedicated believer in The NHS having too many managers and not enough medics to this day. 

She also talked about spending a lot of her Childhood in Hospitals around Christmas time. She would visit the hospital on Christmas day every year with my Grandad. Apparently they used to really go to town on Christmas decorations with wards competing against each other.  One year my Grandad took his (extensive) model railway in and they literally built a whole landscape out of plaster of paris with tunnels and hills running all way round the ward. 

We're having these discussions as my Dad is pretty ill in hospital right now with a rapidly developed serious case of Dementia, Flu and possibly pneumonia. 

He is very very right. There are way too many admin ops staff but not enough lower admin who actually do the work. So at my trust and im sure its probably at most. You have divisional directors, senior ops managers, then assistant ops managers, then service managers and followed by clinical pathway managers. None of these people are clincal at all. Why you need all of them?? The senior ops managers are responsible for beds so they liaise with the consultants who make the clinical decision to discharge or keep patients in. But again they cant make alot of the key decisions to take the pressure off the consultants.

The ops managers have more power than the consultants these days which seems absolutely ridiculous in my opinion. Alot of these ops managers are corrupt  lazy ( employing their friends to higher posts even though its against trust policy but no one does anything about it) you have band 8 managers who do not even know how to use the system and cant even look a patient up on the system.

Then they pass the dirty work onto the lower management. 

Thankfully i work remote now so i dont see any of this crap anymore as i would have left the nhs by now.

I personally think the consultants should be in charge for where the money goes not these ops managers who waste alot of it. They really need to cut the volume of managers and get more staff. Honestly if they god rid of alot of these managers they would have enough money to pay nurses more which would attract more people to the nhs

[mjmooney]

10 hours ago, fruitvilla said:

Maybe create a new department to lay-off people?  

As the old cliché goes, "Nobody ever gets laid off from the HR department". 

[DCJonah]

I wonder if anything will ever happen to these people? 

 

 

[Demitri_C]

7 hours ago, KentVillan said:

The NHS employs 1.2m people.

53% of those are qualified medical or scientific specialists.

Of the remaining 47%, the majority (340k) are support workers - receptionists, PAs, etc who are providing support to qualified medical specialists.

The actual number of “senior managers” is 12k. “Managers” is 27k. So the management / senior management bracket is 3% of the entire workforce.

And below that, infrastructure staff (a lot of which is managing all the massive buildings, vehicle fleets, food, payroll, HR, etc which are essential) = approx 175k.

Do any of those numbers look unreasonable when you actually stop to think about all the things involved in providing healthcare and managing hospitals, ambulance services, etc?

And is it any surprise in an organisation of that size (with pay not keeping pace with inflation) that some of those people are useless jobsworths? That doesn’t mean sacking “middle managers” is going to solve anything.

Of course there’s going to be the odd role that sounds silly… tabloids love picking out diversity advisors etc - although the NHS employs and treats people from every corner of the earth, so maybe not that crazy. But if you look at it with a bit of perspective, it’s highly unlikely these roles are causing a meaningful loss of budget for “frontline” services.

It all comes down to funding not keeping pace with demand (ageing population, Covid, etc). You can say the funding model is wrong and there’s an argument to be made there, but I don’t buy this idea that the issue is just a lack of efficiency or the wrong people being hired. It’s clearly a funding problem.

Source for staff numbers: https://files.digital.nhs.uk/7D/4E31E0/NHS Workforce Statistics%2C August 2022 England and Organisation.xlsx

 

Thanks for this. Very interesting what would also be handy is if we can compare these figures to previous years - tab 3 esp as thats a complete breakdown although its abit vague when it says senior management what are they catergorising as senior management? Are they including assistant ops mangers? 

[Genie]

37 minutes ago, DCJonah said:

I wonder if anything will ever happen to these people? 

 

 

Nope, I can see the outcome to the investigation already. “No rules were broken”.

[foreveryoung]

3 hours ago, Demitri_C said:

He is very very right. There are way too many admin ops staff but not enough lower admin who actually do the work. So at my trust and im sure its probably at most. You have divisional directors, senior ops managers, then assistant ops managers, then service managers and followed by clinical pathway managers. None of these people are clincal at all. Why you need all of them?? The senior ops managers are responsible for beds so they liaise with the consultants who make the clinical decision to discharge or keep patients in. But again they cant make alot of the key decisions to take the pressure off the consultants.

The ops managers have more power than the consultants these days which seems absolutely ridiculous in my opinion. Alot of these ops managers are corrupt  lazy ( employing their friends to higher posts even though its against trust policy but no one does anything about it) you have band 8 managers who do not even know how to use the system and cant even look a patient up on the system.

Then they pass the dirty work onto the lower management. 

Thankfully i work remote now so i dont see any of this crap anymore as i would have left the nhs by now.

I personally think the consultants should be in charge for where the money goes not these ops managers who waste alot of it. They really need to cut the volume of managers and get more staff. Honestly if they god rid of alot of these managers they would have enough money to pay nurses more which would attract more people to the nhs

I agree with this, I stick with my opinion, as I always remember another example, a friend of my mothers who is co director of a trust or something. 6 figure salary, works from home and seemed to be always available anytime my mother calls her for shopping, out to eat ect. Even my mom used to question what she actually does.

I'm not saying you are talking rubbish @KentVillan I believe everything you say, but there are also huge savings to be made within the NHS, contracts, senior staff not required. admin staff etc ect. Total reform is needed, but it has gone way to far for it to be a easy task, yes it's down to the government but also the directors and senior staff that run it

Edited December 22, 2022 by foreveryoung

[KentVillan]

1 hour ago, foreveryoung said:

I agree with this, I stick with my opinion, as I always remember another example, a friend of my mothers who is co director of a trust or something. 6 figure salary, works from home and seemed to be always available anytime my mother calls her for shopping, out to eat ect. Even my mom used to question what she actually does.

I'm not saying you are talking rubbish @KentVillan I believe everything you say, but there are also huge savings to be made within the NHS, contracts, senior staff not required. admin staff etc ect. Total reform is needed, but it has gone way to far for it to be a easy task, yes it's down to the government but also the directors and senior staff that run it

Reform is definitely needed, but as with a football club, it’s much easier to reform an organisation when it isn’t in crisis mode - and easiest way to get it out of crisis mode is to fund it properly.

No doubt there are plenty of roles and people in the NHS that are underperforming or don’t need to be there, but if it’s underfunded, it becomes a vicious circle where good people don’t want to work there, or if they do join, are too stretched to perform at their best.

[tinker]

32 minutes ago, KentVillan said:

No doubt there are plenty of roles and people in the NHS that are underperforming or don’t need to be there, but if it’s underfunded, it becomes a vicious circle where good people don’t want to work there, or if they do join, are too stretched to perform at their best.

This is exactly what's happening, good professionals are leaving the NHS and it's not seen as good industry to train for.

Why they stopped the NI raise to fund it is beyond me , why didn't they/ don't they carry on with it.

To streamline it all, reform one hospital and study its departments who does what and when, once it's reasonably efficient then roll it out to the others one by one, use it as a training school for the others to follow their example.

The danger is that the Tories are using the small parts of the NHS that are underperforming to hide the huge problems of their underfunding. It's become their go to tactic, gas light the area of perceived weakness and bring it up when their called out on their gross incompetence.

[bickster]

6 minutes ago, tinker said:

Why they stopped the NI raise to fund it is beyond me , why didn't they/ don't they carry on with it.

It was a bribe to the british public to gain them favour in the polls. It clearly failed