Tories might not deliver manifesto income tax pledge

ttaskmaster said:
No.
It needs better money management and a massive cull of expensive, pointless managers.
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And projects. An ex of mine had a job for a company where her job was purely to do enough to secure funding from the NHS, the company had absolutely 0 intention of completing the project on behalf of the NHS beyond getting the initial funding from what she was saying. She left the job but dare say there are many similar instances.
 
GhostWKD said:
And projects. An ex of mine had a job for a company where her job was purely to do enough to secure funding from the NHS, the company had absolutely 0 intention of completing the project on behalf of the NHS beyond getting the initial funding from what she was saying. She left the job but dare say there are many similar instances.
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That is what we in the business call fraud.
 
FishFluff said:
I'm going to go ahead and say that you have zero idea how the NHS works if you think it has too many 'expensive, pointless managers'.
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So dismissing one experienced senior Consultant who was very effectively managing a department, and instead employee three managers with absolutely no medical experience or knowledge, each costing more than the single Consultant, is in no way expensive and pointless, then?
Eventually they brought in Generic Role Profiling, so they could justify dropping the salaries of many qualified healthcare professionals, which should have freed up a bucketload of cash, but instead somehow translated into more 'The NHS needs more money' campaigns.

This was the case with many of our departments, although some were smart enough to call them 'management consultants' and employ them externally, rather than directly under the NHS. The smart ones basically enacted a lot of what the actual Consultants were already doing, but very badly and at far greater expense (because they're not medical managers and haven't a clue what half the **** actually means). The not-smart ones just flung a load of money around at anything they didn't understand and invented a bucket-load of stuff to waste money on, much of which shouldn't even be mentioned in an environment supposedly focussed on caring for human beings.

I wonder how much this 'Commission into Leadership and Management in the NHS' actually cost, and who paid for it, anyway...

"It is extremely difficult to find an accurate figure for the number of managers in the NHS"
HA - You don't even know how many you have, let alone how much they're costing - How can you know what they're spending money on?

"most sources of information use different definitions for who is counted as a manager"
Oh, you mean you can more easily fiddle the statistics any way you like, to justify spending even more money on even more unnecessary management, then... Convenient, innit!

"since 1997 England has seen a plethora of policy initiatives that have increased the requirement both for management and administration"
So... money being wasted, by management, on management. Pretty sure I already said that.

In short, they've gone the same way many privatised companies have, contracting externally, consulting externally, inventing ******** initiatives and generally destroying as many elements of what was working fine as they can, to justify going external and commanding more money.
 
FortuitousFluke said:
NHS managers aren't the policy makers being referenced, that would be politicians.
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Policy manages something, does it not, therefore it is management. I use the word 'management', as opposed to managers, quite deliberately.

But politicians devise policy, which costs more money, requires more management, more admin, more action, more consultation, more external contracting....
and of course, "the number of NHS managers has grown in England since 1997".... so more managers, too.
 
ttaskmaster said:
Policy manages something, does it not, therefore it is management. I use the word 'management', as opposed to managers, quite deliberately.

But politicians devise policy, which costs more money, requires more management, more admin, more action, more consultation, more external contracting....
and of course, "the number of NHS managers has grown in England since 1997".... so more managers, too.
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I'd argue that the phrase "money being wasted by management, on management" is misleading if your intention was to suggest that managers outside of the NHS were responsible for an increase in management within the NHS.

Either way you can't blame the NHS for the need to react to policy decisions made by central government. Equally, whilst the number of managers may have increased from 97, the Nuffield Trust have indicated that manager numbers have decreased by 18.8% from 2007. Regardless of what you might think about managers in general the NHS is an incredibly large and complex beast and as such requires managers to oversee the day to day working as well as manage the strategic outcomes for all aspects of the organisation.

The difficulty of reporting on the number of managers is due to the broad nature of that job title. I manage procurement exercises in my role, my job title has manager in it, I don't manage staff or a department, do you classify me as a professional or a manager?

The whole feckless managers draining the NHS argument has been bandied about for as long as I've been following politics and is always used as an excuse for ideological restructuring of health services. As if it's layers and layers of redundant managers that have caused all of the issue the NHS is facing and not an increase in demand alongside more complex conditions and co-morbidities and a backdrop of significant cuts in health, social care and other linked services.

Yep, all of the problems stem from Tess who my mate at Addenbrookes says works in HR, takes 2 hr lunch breaks and leaves at 4 everyday.
 
FortuitousFluke said:
That is what we in the business call fraud.
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Obviously agree, however the NHS really should have had barriers in place to prevent this or to recoup any project spend which was then not delivered upon. Any private business which had such a blase attitude to spend would go under very very quickly and one would imagine have its spend under much greater scrutiny. Instead the NHS goes with a "we're being underfunded just throw more good money after bad" message.

Edit: Just to clarify I'm all for the NHS and what it stands for etc, however I think the amount of mismanagement that it seems to have is genuinely sickening.
 
Oh no, I am not getting my tax cut of 36p per day!
On no, a political party said they'd do something to get votes and didn't really do it!

Time for a revolution!

Oh no, wait a minute, it's just trivial and normal and no cause for any concern at all.
 
GhostWKD said:
Obviously agree, however the NHS really should have had barriers in place to prevent this or to recoup any project spend which was then not delivered upon.
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To be honest it sounds like the process fell down at various levels. The tricky part is that the situation you're talking about would have been handled by procurement, contracts management, and legal predominantly and due to the nature of the NHS those elements will vary in quality depending on the trust, hospital, department etc. It's a bit like local authorities, you get wildly different approaches and quality of delivery in the back office teams like procurement, you can even find swings in quality within an organisation depending on the structure, it's not necessarily indicative of authorities as a whole though.

The one issue I've always had with the NHS is there seems to be a lack of strategic leadership from the top, nothing providing too much of a steer for the organisation as a whole but that's really down to a number of issues. The size of the beast, the different natures of the organisations, e.g. you can't apply the same approaches to a large teaching hospital and a village surgery, and then the most recent move towards devolution of responsibility.

I would like to see a greater level of oversight and management centrally and possibly some for of support and intervention to cover the issues you've raised about money not being clawed back. It does happen and i think it happens more than it used to but it can be a very complex procedure and I don't know if the skills really exist within all of the relevant corners of the NHS.


ttaskmaster said:
Well, that's not strictly true, since that is (in part) how it went down at our Trust - Externally contracted managers externally contracting business consultants, before following those consultants recommendations to hire more managers.

But it was also a generalisation, since managers are part of 'Da' Management' as well as an element of management.


But I can blame them for the choice of reactions, as well as blaming the whole towering *********** of clueless upper structure.


They already had managers - Good ones, who understood what they were managing, had considerable qualifications in what they were managing, and didn't need several layers of more management beneath them to do the job.


I know. I read the report. Quite a ******** excuse, IMO. It's almost as if... "it would be better being privatised" - GASP!!!
Who'd a thunk it, eh?


There ya go.
See remarks earlier about poor money management, particularly since it's these managers (whether NHS or plausibly deniable external consultants) managing the money and instigating a lot of those significant cuts.
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What you appear to be doing is taking one situation that occurred at your trust, and that you're unhappy about, and using it as an excuse to brand the entire management of the NHS as incompetent, I'm not sure that tracks.

I'm not saying that the NHS is hyper efficient, it isn't, but that's not necessarily the fault of the organisation. If you compare it to private organisations you have a more rigid structure with greater lines of responsibility and accountability within the private sector but that isn't the vision that this current government had for the NHS. They wanted more responsibility and control further down the chain, that allowed individual aspects of the NHS to tailor services for their clients, however it comes at the price of reduced efficiency on a wider level and a reduction in strategic control at the top. In my opinion the Tories have set about building inefficiency into the system by making them function less like a private organisation, and at the same time have reduced funding, that's not the NHS' fault, they don't get to choose to ignore central government edicts.

You can bang on about privatisation all you like but I've yet to see a private healthcare system that provides the level of equitable outcomes for the population that the NHS does. You can begrudge paying for it if you like but just say that.

Also how are the NHS instigating the cuts? The Tory's (allegedly) cut as a way to reduce the deficit, they positioned that by saying that individual departments would need to find efficiency savings, but after a certain point efficiency is just a badge used to make it more acceptable to the general population. I don't have the figures for the NHS, but I do know that some councils have had to make 60% cuts to services. There absolutely would have been some efficiency improvements, but 60%? Don't be absurd.

Even if the NHS budget had remained static you have an increase in demographical pressure as the population ages, and then you can throw on top the fact that they're now having to pick up the slack from social care because local authorities can no longer manage it (this is going to be a catastrophe post Brexit by the way as the workforce shortage will explode). Take my home authority, when I worked there I managed a pending care list (domiciliary care only) between 80-120 people, some were in inappropriate settings e.g. hospitals or care homes, some were on interim measures that we had set up to support the flow from hospitals, nearly all were receiving some form of intervention even if it wasn't quite what they ultimately needed. I left the authority 2 years ago when cost savings led them to start making decisions that I could no longer support. I dropped a text to a mate of mine who stayed to check on the current pending care list, it's at 400, now how many of those are sitting on a hospital ward because we have nowhere to put them?

The whole system has been in crisis for years and it's getting worse, but pointing to inefficiency in management is like blaming immigrants for the housing crisis, it might have had a small effect but it's nowhere near the whole picture.
 
But I thought the money we won't be giving to the EU was going to pay for the NHS......... Oh right.
 
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