Monday, February 02, 2009

NHS management waste

If you don't actually work in the NHS then it's hard to actually appreciate the scale of the Kafka-esque management structure that has developed over the years. If even a list demonstrated the size of the inefficient bureaucracy that exists then this is it, courtesy of the ferret fancier, here are a few edited highlights of the jobs on offer at your local Primary Care Trust (PCT):

* 5-A-Day Coordinator
* Action On Smoking Coordinator
* Active Lifestyles Development Officer
* Clinical Quality Coordinator (x2)
* Commissioning Improvement Manager
* Exercise Recommendation Coordinator
* Professional Development & Patient Safety Officer
* Schools & Young People Team Coordinator
* Tobacco Control Worker

It is strange that there are so many people employed in just one layer of the NHS' bureaucracy, it is also very strange that the most skilled and educated people in the NHS are so absent from the managerial structure, the doctors; while nurses and ex-nurses are employed left, right and centre in many of these bizarre and useless roles.

Even Kafka would not have had the imagination for such an inefficient structure, remember the PCT is but one layer, there are management tiers above the below PCTs at the Department of Health, SHAs, hospitals, primary care centres et cetera. I haven't even got started on the pathetic nanny state element to many of these jobs. Just imagine if this money was getting through to the front line NHS services, it makes one want to weep.

8 comments:

Henry North London said...

Sometimes I want to apply for these posts but I realise that I would be mind numbingly bored so I dont

The GMC are hounding me in the Health Gulag and I cant get a job , and Im not allowed to locum

Result Im on incapacity benefit and Im screwing up interviews because Im so nervous about the GMC problems

I hate them I wish they would all die, The GMC runs a final salary pension scheme Now we know where all that £390 goes, and why it has risen from £80 a year to 390

the a&e charge nurse said...

Yes, Kafkaesque - still at least we can console ourselves with the fact the NHS is not quite as Kafkaesque as the USA.

Here's an interesting set of observations:
"You could have had the American plan. You could have been spending 17% of your gross domestic product and making health care unaffordable as a human right instead of spending 9% and guaranteeing it as a human right. You could have kept your system in fragments and encouraged supply driven demand, instead of making tough choices and planning your supply. You could have made hospitals and specialists, not general practice, your mainstay. You could have obscured accountability, or left it to the invisible hand of the market. You could have a giant insurance industry of claims, rules, and paper pushing instead of using your tax base to provide a single route of finance. You could have protected the wealthy and the well instead of recognising that sick people tend to be poorer and that poor people tend to be sicker, and that any healthcare funding plan that is just must redistribute wealth. Britain, you chose well. As troubled as you may believe the NHS to be, as uncertain its future, as controversial its plans, as negative its press, as contentious its politics, please behold the mess that a less ambitious nation could have chosen".

I accept that NuLab may be trying to dismantle the NHS but are your claims about nurses infiltrating esoteric management posts backed up by any evidence, Dr D ?

Budgie said...

A and E charge nurse ... you seem always to have a problem with the "invisible hand of the market"

The "market" is not some ravening beast lurking round the corner that your statist gramps frightened you with when you were a child. It is just the collective word to describe people deciding what they want to spend their money on for themselves.

The biggest problem with the current incarnation of the supposed universal NHS (which as Bismarck might have said is neither universal nor national nor a service), is managerialism. Started under the Tories the takeover by managers has been vastly expanded under ZaNu Lab.

the a&e charge nurse said...

Budgie - the words are Donald Berwicks, not mine.
http://heroesnotzombies.wordpress.com/2008/07/19/donald-berwicks-view-of-the-nhs/

You are correct to identify "managerialism" as an impediment to care standards - Dr D'eath highlights the same point, as well as suggesting an interesting trend amongst nurses i.e. a predilection for cushy office jobs, a role which gives nurses an exciting license to boss their betters around, allegedly ?

Having said that, when it comes to 'health' I do not share your benign view of the market - markets invariably precipitate a mindset that revolve around winners and losers, profit and loss, etc.

Not even the most rabid libertarian would trust a health system based entirely on market forces - they usually suggest vouchers, or insurance schemes allied to greater plurality amongst providers, but always underwritten by the state.

Anonymous said...

Good save us from nurse managers! They are always more than happy to employ another "how to reduce hospital carbon foot print" coordinator than another doctor. As a middle grade doctor who spend every other oncall in severe shortage of staff, I have every right to say this.
This is where your money goes.

the a&e charge nurse said...

Yes, we need more medical managers like Sir Ara Darzi and Dame Carol Black don't we middle grade doc ?

Personally I think MTAS and polyclinics are both fabulous ideas.

Budgie said...

A and E said: " ... when it comes to 'health' I do not share your benign view of the market ... "

This is a statist interpretation of "the market" - as an entity separate from yourself that is not understood and needs "control".

The "market" is actually just individual people making decisions about their own preferences and spending. It is outrageous for busybodies like ZaNu statists to decide how I should do this by wilfully obfuscating the personal nature of the collective description.

Being more liberal (but not like the odious and non-liberal LibDums) than libertarian my preferences (which contribute to the "market") include some national provision where these state monopolies can be very closely monitored by accountable elected representatives. And whose employees understand how corrosive such monoliths can be to the public.

John B said...

"it is also very strange that the most skilled and educated people in the NHS are so absent from the managerial structure, the doctors"

No it isn't, because they get paid shedloads for doctoring, which is fairly obviously what they'd prefer to be doing.

You're not suggesting it'd be a sane use of public money to raise administrator salaries 25% higher than doctor salaries in order to doctors into a job that doesn't particularly match what they're good at, and which certainly wastes their 6-15 (depending on how you count it...) years' training?