Was reading an interesting article over the weekend discussing management within the NHS. Popular opinion has it that the NHS is over-managed, with masses of funds dissappearing into a beurocratic black hole. But i was surprised to read that only 3% of NHS staff are managers. Put another way, each manager has reposnibility for 33 staff. For an organisation of that size, with well over a million employees, thats actually a relatively low number of managers. Also it was mentioned that almost every report into the NHS over the last 30 years has recommended more management - mopst notably the Griffiths and Wanless reports. But these notions go againts the common perception that anyone employed by the NHS that isnt a doctor, nurse, or some other clinician is somehow a waste. How did this perception come about, and is it justified? Or is it just easy to say that NHS management is simply a waste? And when we see apocalyptic news stories of a few thousand nurses made redundant, then why does that garner more headlines than the increase in headcount of some 200,000 staff (20,000 of which are managers)? (BTW, I'm struggling to find the article in question, but the figures involved were 40,000 NHS managers out of a total workforce of 1,200,000)
This does then beg the question, where is the money going? Is it a case of we are creating ever more expensive methods to treat even more extreme cases which mean people live longer, which then in turn means mroe moeny is spent on the care of the old? Is the NHS saving/prolonging too many lives for its own good?
I think thats exactly the problem. Its much easier to say 'There are too many managers' than it is to address what the solution to problem like the above is.
It does seem a relatively low percentage. I wonder how many people actually do management roles or responsibilities without the title or remuneration that goes with it
personally i find it ironic when the goverment say there in a drive to boost nhs numbers such as nurses and surgeons when they start to lay of nurses themselves and other staff..... it needs to be sorted maybes a whole re write of the system ????
When I spoke to a nurse he told me that much of the spending goes on cutting edge technology to increase survival chances in operations by a few percent. Now as far as I'm concerned i'm all up for the lives don't have a price argument but aren't we being detrimental to the overall quality of service given for everything else just to make one or two operations 2% more efficient? Besides which such small increases in operation success rate are dubious anyway. This is only made worse by the older generation taking up all the bedspace, the system is failing. When you hear of Doctors doing a lot of the management themselves is it any wonder we have a problem? Doctors don't tend to be the most impartial when it comes to where to spend the money because they probably are not as scrupulous with spending as proffessional managers would be. Someone needs to draw the line.
Well, the 40,000 figure was dreamt up by the Tories, so I'd imagine they shoehorned as many people into that category as possible.....
But thats just it though - the layoffs are irrelevant, statistically. In an NHS with a budget of 80 billion quid and 1.2 million employees, a few PCTs being a few million over budget, or a few thousand part-time nurses being made redundant is utterly irrelevant. Yet the press treat it like the fall of the Roman empire.....
I agree but which polotician is going to stand up and say right we are with holding this treatment because its costs too much? No polotician would dare plsu the papers would rip him to shreds and fill the paper with sob stories of the odd one or two people who could survive if the big bad evil gouvernment woudl allow such treatments on the NHS. Yes it has a very very tough call to make but the fact is it ahs to eb made at soem point. My mum works at Bradford RI. In the past 2 months she has had the same patient come in 3 times, she has terminal cancer and has about 6 months left to live tops, The caner is causing pressure on various vessels so they are inserting stents which costs between 4,000-15,000 all ina ll to fit. Cases like this, I believe shouldnt be done. She has costs BRI roughly 40,000 and is going to die in a few months, yes it has caused her slightly less pain and possibly prolonged her life but should it have been done? I know what I said above sounds really cold and heartless, but the fact is the NHS is a buisness running up stupid amount of debt, cutting staff will not save the money required. Making what seems as harsh decisions will do.
but still it is going agasint what they are saying ... yes the press likes to go ott on things but they are still layuing off people who we need if they were replacing with full time no problemos but this is not to be seen ....
If I take on 10 staff on a Monday, and sack one member of staff on Tuesday, is it reasonable to say 'Visage has cut staff numbers'?
That is not what happened though is it, presumeably we can now deport a load of people who were "propping the NHS up" and "needed for the NHS" now. Afterall the NHS has been used as a reason for large numbers of immigrants being here. I wonder how much money was wasted in recruitment and training of staff that are now no longer wanted.
The NHS is a black hole this is something that everyone really needs to accept. The greater our medical, chemical and technological knowledge the greater the cost of the NHS. The question you have to ask is if you were at the end of your life, would you want the NHS which you have paid for your whole working life, to make sure you die in comfort or just let you rot. If you need surgery, would you be happier going under the knife knowing that every bit of technology is available to raise your chances of surviving by a few percent? What the NHS really needs is a full restructuring. It needs to set realistic attainable targets, it needs to look at preventative health care rather than reactive healthcare, it needs to automate administrative tasks, it needs to improve and consolidate its infrastructure nationally rather than having different bits and pieces in each trust. This especially includes its IT infrastructure (a cost that will be in hundreds of billions imo) It needs to look at providing high quality services from top to bottom within all areas of health care, not outsourcing to the cheapest service provider. Restructuring the NHS will take hundreds of billions of pounds to do, to get it right. It will also take several decades to do it, however it will take far longer and cost many times more if they continue the way they are going. The thing that winds me up is there are always 3+ receptionists in every GP clinic I have been to, and sometimes only one or 2 doctors. The receptionists act like they own the place and do not give a flying **** about your medical needs. IMO you only need 2 receptionists max, infact probably less. The first thing I would do if I ran the NHS is to automate the appointment booking system, thus doing away with at least 2 receptionists, maybe all 3.
Well, they take on 200,000 staff over about 10 years, then the job losses total some 20k, so yes, this is in effect what happened.
For all its faults, the NHS does seem to be effective. We are apparently more healthy than America, despite their spending twice as much on healthcare. http://www.chron.com/disp/story.mpl/ap/health/3835350.html
How can the NHS have over a million employees and how are those numbers divided into doctors, nurses, etc? For even a few thousand hospitals, that is a ridiculous figure. Hospitals must need a certain amount of administrative staff, but I fail to see why they need 'management' as in a business sense. They are a public service, not a shop. They need a few senior medical staff to oversee the running of the hospital, not an idiot in a suit. A hospital is and alwasy will be a hospital, so if you want it to run well let people with relevant experience handle it.
Well , off the top of my head cos someone mentioned a few thousand hospitals, at 3000 hospitals that would be just over 300 per hospital. Not a lot for a decent sized hospital, but i guess the figures include gp staff etc so the figure of over a million doesnt seem excessive to me. And to the poster above who mentioned only needing 2 or 3 reception staff, thats dreamland im afraid. I am a gp, list size about 13,000 and we have probably 50 folk in the practice in total. (doctors, nurses, other staff) and it feels understaffed. Incidentally, I am a doctor, not a manager, nor are consultants or nurses managers. If you leave management to those not trained in it the whole thing would go belly up I suspect.
Ah the good old NHS. Actually I think it is a damn fine institute and one that Britain should be proud of. There are a number of issues that come to mind in regards to the vast amounts of money that is spent on the NHS: Diminishing returns: At some point the benefit of a particular cure when viewed against the cost becomes untenable. Unfortunately the press pick up stories and play the heart tugging game and politicians and doctors are portrayed as Scrooge denying poor little Jimmy a scrap of meat. The fact that Jimmy is terminally ill, suffering massive amounts of pain, has no quality of life and is costing approximately £100k per year is irrelevant. The acknowledgement that you can apply a cost to a persons life is seen as taboo and diabolical. The press though are not to blame – they are only supplying to a large demand. And yet we will happily accept the MoD cutting millions from projects to provide basic protection of our troops. Management & bureaucracy: Two sides to this story: firstly you need medical people to run a medical company. Secondly you need experienced managers to run the business. For 1.2m people you have a requirement for a large HR function. You also have to deal with the logistics in providing care for however many million people are treated. That is a huge undertaking. The problem with the NHS is the same as any public sector organisation. Politics permeates everything you try and do and people will ignore the big issues and concentrate on stupid irrelevant matters. Lack of centralisation: Unfortunately this is the one of the hardest issues to overcome. Achieving the correct balance between mass processing and customising your service to the local needs is a difficult one to achieve and they inevitably get it wrong.
