Just another £1.2 Billion to fix the NHS?

[Murph7355]

Efbe said:

I have been really surprised by this thread on this forum.

Was expecting quite right-wing, "privatise it now!" responses, but it seems the opposite

so how much would it cost to get in you lot of lean consultants to every area of the NHS?

Efficiency on its own wouldn't be enough.

It's needed badly, but the demands on the system also need to be addressed. As others have noted, the NHS should not be for infinite service. The treatments on offer should be available universally but limited to what can be afforded.

[audidoody]

The NHS costs £100 billion a year. And this clown thinks he is going to fix it with three days extra money?

[audidoody]

The NHS costs £100 billion a year. And this clown thinks he is going to fix it with three days extra money?

[V8 Fettler]

NHS issues are primarily caused by incompetent senior management, see variation in the performance of different hospitals for evidence.

[V8 Fettler]

anonymous said:

[redacted]

...who would change the archaic work practices and the lack of accountability re: expenditure? Senior management.

One of my local hospitals can't even keep the wards reasonably clean.

[spaximus]

V8 Fettler said:

...who would change the archaic work practices and the lack of accountability re: expenditure? Senior management.

One of my local hospitals can't even keep the wards reasonably clean.

But when you have overseen a culture where all nurses have been made to be special as they are now degree educated, they do not like doing what they see as menial tasks. So when a spill of bodily fluids takes place they have to have a cleaner come instead of getting the appropriate mop and bucket. Cleaning is not their job so they accept sloppy standards.

Apparently it is now a care assistants job to change nappies on people not nurses in some hospitals.

[Sway]

Efbe said:

I have been really surprised by this thread on this forum.

Was expecting quite right-wing, "privatise it now!" responses, but it seems the opposite

so how much would it cost to get in you lot of lean consultants to every area of the NHS?

Nowhere near £1.2B...

However, the issue is not 'getting us in there'. As I said in my post, a lot of us are already there.

However, the ability to effect change (and the first step in a Lean approach is to define the service offering and what constitutes 'value' in the eyes of the customer) is not driven from the outside. It must be delivered by the clinical and support staff within the NHS itself, with full support and backing of the senior management and politicians.

I've literally just setup on my own, after a decade of being an 'internal consultant', and to be quite frank, am desperate for my first contract (the timing of me going it alone wasn't my first choice). Yet I wouldn't go there as it is now. I have never heard of an organisation so 'change fatigued'. It doesn't matter how good the approach or solutions, the resistance is simply staggering, and understandably so.

I've had underperforming union reps telling me measuring people's performance is a breach of the Data Protection Act and threatening walkouts of a private company. That was fun... It's a cake walk compared to the challenges with engaging and influencing the vast number of layers and people in the NHS.

It needs to stop being a politician's football. The 'initiatives' need to stop...

[V8 Fettler]

spaximus said:

V8 Fettler said:

...who would change the archaic work practices and the lack of accountability re: expenditure? Senior management.

One of my local hospitals can't even keep the wards reasonably clean.

But when you have overseen a culture where all nurses have been made to be special as they are now degree educated, they do not like doing what they see as menial tasks. So when a spill of bodily fluids takes place they have to have a cleaner come instead of getting the appropriate mop and bucket. Cleaning is not their job so they accept sloppy standards.

Apparently it is now a care assistants job to change nappies on people not nurses in some hospitals.

"Liking" is irrelevant. Define the various roles, employ people in the various roles, reward for good performance, sacking for poor performance.

[CamMoreRon]

V8 Fettler said:

spaximus said:

V8 Fettler said:

One of my local hospitals can't even keep the wards reasonably clean.

But when you have overseen a culture where all nurses have been made to be special as they are now degree educated, they do not like doing what they see as menial tasks. So when a spill of bodily fluids takes place they have to have a cleaner come instead of getting the appropriate mop and bucket. Cleaning is not their job so they accept sloppy standards.

Apparently it is now a care assistants job to change nappies on people not nurses in some hospitals.

"Liking" is irrelevant. Define the various roles, employ people in the various roles, reward for good performance, sacking for poor performance.

Their roles are defined, I think you'll find. A nurse's role is not cleaning up piss and changing nappies - not any more. The reason nurses are degree educated is because they are required to be in order to fulfil the role that nursing has become.. why don't you do a bit of research in to a nurse's typical R&R's? It should become apparent pretty quickly that a fairly high standard of education is required.

[V8 Fettler]

CamMoreRon said:

V8 Fettler said:

spaximus said:

V8 Fettler said:

One of my local hospitals can't even keep the wards reasonably clean.

But when you have overseen a culture where all nurses have been made to be special as they are now degree educated, they do not like doing what they see as menial tasks. So when a spill of bodily fluids takes place they have to have a cleaner come instead of getting the appropriate mop and bucket. Cleaning is not their job so they accept sloppy standards.

Apparently it is now a care assistants job to change nappies on people not nurses in some hospitals.

"Liking" is irrelevant. Define the various roles, employ people in the various roles, reward for good performance, sacking for poor performance.

Their roles are defined, I think you'll find. A nurse's role is not cleaning up piss and changing nappies - not any more. The reason nurses are degree educated is because they are required to be in order to fulfil the role that nursing has become.. why don't you do a bit of research in to a nurse's typical R&R's? It should become apparent pretty quickly that a fairly high standard of education is required.

I'm pleased that the roles are defined, that's a good start, but why is there a problem with cleaning if it's clearly someone's responsibility? I'll pass on the researching, thanks, I have no enthusiasm for detail. I'm not too concerned who does the cleaning, as long as the cleaning occurs.

[mrpurple]

spaximus said:

But when you have overseen a culture where all nurses have been made to be special as they are now degree educated, they do not like doing what they see as menial tasks. So when a spill of bodily fluids takes place they have to have a cleaner come instead of getting the appropriate mop and bucket. Cleaning is not their job so they accept sloppy standards.

Apparently it is now a care assistants job to change nappies on people not nurses in some hospitals.

Somehow I don't think nurses not using a mop and bucket is the cause of the NHS's woes in the scheme of things. Not a very well thought out post and bit of a cheap shot that's way off target IMO. But then I would say that as my OH has been a nurse for almost 40 yrs.

[edh]

Sway said:

Efbe said:

I have been really surprised by this thread on this forum.

Was expecting quite right-wing, "privatise it now!" responses, but it seems the opposite

so how much would it cost to get in you lot of lean consultants to every area of the NHS?

Nowhere near £1.2B...

However, the issue is not 'getting us in there'. As I said in my post, a lot of us are already there.

However, the ability to effect change (and the first step in a Lean approach is to define the service offering and what constitutes 'value' in the eyes of the customer) is not driven from the outside. It must be delivered by the clinical and support staff within the NHS itself, with full support and backing of the senior management and politicians.

I've literally just setup on my own, after a decade of being an 'internal consultant', and to be quite frank, am desperate for my first contract (the timing of me going it alone wasn't my first choice). Yet I wouldn't go there as it is now. I have never heard of an organisation so 'change fatigued'. It doesn't matter how good the approach or solutions, the resistance is simply staggering, and understandably so.

I've had underperforming union reps telling me measuring people's performance is a breach of the Data Protection Act and threatening walkouts of a private company. That was fun... It's a cake walk compared to the challenges with engaging and influencing the vast number of layers and people in the NHS.

It needs to stop being a politician's football. The 'initiatives' need to stop...

..and yet we seem to be saying it needs "radical reform".. so it's a really tough one. Good points about change fatigue and resistance. What there must be, in an organisation so huge, are plenty of examples of good practice that can be nurtured. Target driven NHS did lots of good things, but certainly encouraged gaming of the targets.

I'd rather see organisations get more autonomy with freedom to experiment a bit and get it right (or wrong). of course this approach is really tough as when it goes wrong, more people die (how many of us take decisions at work that can result in death? I wouldn't welcome that responsibility) and then the politicians take 9or avoid) the blame.

[Sway]

Exactly my point.

Initiatives, are, by their very nature 'the latest and best thing ever' - until the next one comes along.

The best 'Lean' companies aren't vocally so. It's just the way they do things, the way they view data, the way they respond to it (oh, and it also has big emphasis on those on the front line being empowered to change things, they know best after all).

I was chatting to a PHer last week who used to work for Honda. He didn't realise they're a Lean company, but when I spoke through some of the concepts he recognised them instantly.

Now, in order to achieve this requires wholesale reform. That does not have to be an initiative though.

It has to be a strategy, appropriately scoped, planned and understood. It'll take years, many years. Whilst it's happening, you have to resist the urge to change the strategic goals, or chase after the latest greatest thing. Or, even harder for politicians, to not having kneejerk, I'll considered 'solutions' when a problem happens.

You can imagine my confidence that it'll happen in the NHS. It's too important for it not to happen, which is why it won't - it's too important for politicians to jot use as a way of gaining cheap votes.

[andymadmak]

mrpurple said:

spaximus said:

But when you have overseen a culture where all nurses have been made to be special as they are now degree educated, they do not like doing what they see as menial tasks. So when a spill of bodily fluids takes place they have to have a cleaner come instead of getting the appropriate mop and bucket. Cleaning is not their job so they accept sloppy standards.

Apparently it is now a care assistants job to change nappies on people not nurses in some hospitals.

Somehow I don't think nurses not using a mop and bucket is the cause of the NHS's woes in the scheme of things. Not a very well thought out post and bit of a cheap shot that's way off target IMO. But then I would say that as my OH has been a nurse for almost 40 yrs.

And yet the many senior nurses that I have spoken to have said that the issue highlighted by Spaximus is indeed at the heart of the problems facing the NHS today. The "too qualified to do the menial stuff" attitude that many young nurses have these days betrays a culture within the NHS that everything is always somebody else's fault or responsibility.
It was not always that way, and the senior nurses told me that they see stuff going on and attitudes to patients being tolerated from nurses in wards today that would have seen them hoiked up before Matron had they done the same things when they were younger.

What that culture ensures is that when the provision of basics like hygiene and cleaning and feeding and toilet duties etc breaks down then the whole edifice above it crashes too.
Basically, (for example) the st stays on the floor and become a problem for everyone if the cleaner fails in his/her duties for whatever reason. When the inevitable infection or accident then takes place the nurses see themselves as blameless despite having seen and ignored the (st) problem for hours/days. - And yes I have seen precisely this attitude first hand!

[Sway]

How about changing the R&R to 'do what the customet/patient needs, as long as you're trained to do so, and others better qualified aren't available'.

Needs work, but this concept of 'that's not my job' gives the priority of service to the worker, not the customer.

How many examples are there on the 'good customer service' thread are where people do things that aren't in their job description, because it's the right thing to do for the customer?

[V8 Fettler]

andymadmak said:

mrpurple said:

spaximus said:

But when you have overseen a culture where all nurses have been made to be special as they are now degree educated, they do not like doing what they see as menial tasks. So when a spill of bodily fluids takes place they have to have a cleaner come instead of getting the appropriate mop and bucket. Cleaning is not their job so they accept sloppy standards.

Apparently it is now a care assistants job to change nappies on people not nurses in some hospitals.

Somehow I don't think nurses not using a mop and bucket is the cause of the NHS's woes in the scheme of things. Not a very well thought out post and bit of a cheap shot that's way off target IMO. But then I would say that as my OH has been a nurse for almost 40 yrs.

And yet the many senior nurses that I have spoken to have said that the issue highlighted by Spaximus is indeed at the heart of the problems facing the NHS today. The "too qualified to do the menial stuff" attitude that many young nurses have these days betrays a culture within the NHS that everything is always somebody else's fault or responsibility.
It was not always that way, and the senior nurses told me that they see stuff going on and attitudes to patients being tolerated from nurses in wards today that would have seen them hoiked up before Matron had they done the same things when they were younger.

What that culture ensures is that when the provision of basics like hygiene and cleaning and feeding and toilet duties etc breaks down then the whole edifice above it crashes too.
Basically, (for example) the st stays on the floor and become a problem for everyone if the cleaner fails in his/her duties for whatever reason. When the inevitable infection or accident then takes place the nurses see themselves as blameless despite having seen and ignored the (st) problem for hours/days. - And yes I have seen precisely this attitude first hand!

This is a management issue. If it can't be easily resolved by local junior management using existing systems then escalate to senior management.

[mrpurple]

andymadmak said:

mrpurple said:

spaximus said:

But when you have overseen a culture where all nurses have been made to be special as they are now degree educated, they do not like doing what they see as menial tasks. So when a spill of bodily fluids takes place they have to have a cleaner come instead of getting the appropriate mop and bucket. Cleaning is not their job so they accept sloppy standards.

Apparently it is now a care assistants job to change nappies on people not nurses in some hospitals.

Somehow I don't think nurses not using a mop and bucket is the cause of the NHS's woes in the scheme of things. Not a very well thought out post and bit of a cheap shot that's way off target IMO. But then I would say that as my OH has been a nurse for almost 40 yrs.

And yet the many senior nurses that I have spoken to have said that the issue highlighted by Spaximus is indeed at the heart of the problems facing the NHS today. The "too qualified to do the menial stuff" attitude that many young nurses have these days betrays a culture within the NHS that everything is always somebody else's fault or responsibility.
It was not always that way, and the senior nurses told me that they see stuff going on and attitudes to patients being tolerated from nurses in wards today that would have seen them hoiked up before Matron had they done the same things when they were younger.

What that culture ensures is that when the provision of basics like hygiene and cleaning and feeding and toilet duties etc breaks down then the whole edifice above it crashes too.
Basically, (for example) the st stays on the floor and become a problem for everyone if the cleaner fails in his/her duties for whatever reason. When the inevitable infection or accident then takes place the nurses see themselves as blameless despite having seen and ignored the (st) problem for hours/days. - And yes I have seen precisely this attitude first hand!

I would have to get my OH to respond to this as she is the senior nurse that, up to recently, was directly responsible for over 1200 nurses including matrons, sisters and HCA's. But I can tell you that I have never heard her say nurses not doing cleaning etc is the root cause of the NHS's ills.

However without giving too much away I can say, having been lured out of retirement, she is currently undertaking an interim role to sort out some issues where the, now departed (sideshifted), theatre manager had a background in physiopherapy and had never even been in a theatre before her appointment and, from what I hear, didn't go in them when in post either.....hardly nurses fault I would say.

You might also like to know that when I met her 6 yrs ago she had 12 or so matrons to support her...when she decided to retire (before she had a breakdown)6 months ago this was down to 3 IIRC so this might explain some of the nursing issues if there are any.

eta I don't know the difference between a sister / matron but band 7's comes to mind.

Edited by mrpurple on Thursday 20th November 10:07

[LucreLout]

Cleaning may be outsourced. It may be someone else's job. I think we can all agree that it can't be done by the patient - too sick you see.
Patient care IS the nurses responsibility. It is the doctors. It is the hospital managers. When the ward hasn't been cleaned properly, they ALL have a responsibility to clean it. "Not my job" simply isn't good enough. That we've allowed the staff to become too precious is why we are where we are, and we need to change that attitude first, or the nhs as we know it will not survive - its soaked up more money than we can fund, so more money can't be part of the solution.

[V8 Fettler]

LucreLout said:

Cleaning may be outsourced. It may be someone else's job. I think we can all agree that it can't be done by the patient - too sick you see.
Patient care IS the nurses responsibility. It is the doctors. It is the hospital managers. When the ward hasn't been cleaned properly, they ALL have a responsibility to clean it. "Not my job" simply isn't good enough. That we've allowed the staff to become too precious is why we are where we are, and we need to change that attitude first, or the nhs as we know it will not survive - its soaked up more money than we can fund, so more money can't be part of the solution.

You would pay a doctor to clean a ward?

[andymadmak]

mrpurple said:

I would have to get my OH to respond to this as she is the senior nurse that, up to recently, was directly responsible for over 1200 nurses including matrons, sisters and HCA's. But I can tell you that I have never heard her say nurses not doing cleaning etc is the root cause of the NHS's ills.

However without giving too much away I can say, having been lured out of retirement, she is currently undertaking an interim role to sort out some issues where the, now departed (sideshifted), theatre manager had a background in physiopherapy and had never even been in a theatre before her appointment and, from what I hear, didn't go in them when in post either.....hardly nurses fault I would say.

You might also like to know that when I met her 6 yrs ago she had 12 or so matrons to support her...when she decided to retire (before she had a breakdown)6 months ago this was down to 3 IIRC so this might explain some of the nursing issues if there are any.

I think I am not explaining myself very well. Nurses not cleaning is not in itself the root cause of the NHS's ills. Nurses not cleaning is a symptom of a much wider problem within the NHS. Is there a massive problem with poor quality management within the NHS? Yes, and this is another symptom of the same problem. Is there resistance to change within the NHS? Yes, and this is yet another symptom of the problem.

What is the problem?

Answer: The service is set up for the benefit of the people working in it rather than for the benefit of the patients who need to use it.

So nurses now have degrees and are trained to much higher levels, because that is how we attract and incentivise nurses (apparently) but that means we pass what were considered to be basic, essential nursing tasks to others now - those we decide are only fit for menial duties. And when those people fail then the basics get missed. And because the nurses no longer "do that stuff" then frequently "that stuff " does not get done. Moreover we now see that because nurses are quasi medical practitioners some are beginning to exhibit the same sort of "God complex" that afflicts too many Doctors. Read the reports and see how many patients complain that Nurses these days lack any empathy with their patients......

Bad Management? Absolutely, but when the whole management structure is set up in such a multi layered, byzantine way it's not surprising that competent managers tend not to stay within the NHS, so we are left too often with the incompetent being in charge of things that they have no ability to manage. Do we change this? No of course not because the various layers of management are there to protect people in their jobs.

Resistance to change? Absolutely. When you think you know better than anyone else, and when you think that any worthwhile change might actually involve yourself then you resist it. The fact that too many changes have gone before (and only a few of them to the good) simply cements your view that change must be resisted. So the good stuff (when it comes) is resisted because resistance is what we do to protect our jobs and protect our beloved NHS. We must not criticise our NHS, we must only accept that everyone in it is an Angel or a God, working in a superhuman way in the face of impossible difficulties and a never ending cash shortage. That is the only truth that will run, because to accept any other truth is to accept that the service really does have to change and that putting patients rather than staff at the top of the priority list should be at the very top of that change agenda.