Tuesday 27 January 2009


Usually I have a good relationship with the managers. I guess I really should do, being part of the management structure. But in the "us and them" world of clinicians and managers, I've felt we've collaborated and compromised and cooperated effectively over the last few years.

Not so now.

Managers who have no clinical contact and no awareness of clinical practice in the really real world are making unilateral decisions on how care is to be delivered. Over the last year, consultation has widely been felt not to be consultation at all, but simply a tokenistic process of letting clinicians know This Is How It Shalt Be.
Interestingly, the Board proposed significant changes in service design "for consultation" a year ago. Numerous meetings and letters and discussions and emails later (from very vocal Consultant Psychiatrists and senior nurses and formal representation) and, would you know it, the proposals are identical to what they were a year ago, before consultation. So all these clinicians views, all expressed strongly, given by different people over a good length of time, amount to nothing being changed what so ever? Hmmmm. I'm not sure what the definition of "consultation" is, I know it's not asking opinion and doing what they say, but I'd be underwhelmed if consultation is meant to be a process that doesn't effect any change at all.

As well as service design, managers have recently dictated what clinical activity senior nurses can and can't do. Now, in part the Trust has to have a governance framework for their staff to work within, so managers absolutely have a voice in this. But for neither the nurses nor medical managers nor senior clinicians within the management structure to even be asked about this perplexes me.

Clinical posts have been lost, over the last few years. Management posts have increased in number. And then managers uniltareally decide that senior nurses can stop seeing patients and start supporting managers.

And they reckon it's my patients who are mad . . .


XE said...

I see the problems developing in the NHS, and it frightens me for the Canadian system is relatively similar and I fear we'll soon be going in the same direction.

Kittyxxx121 said...

And who will support you? or are you just supposed to do everything yourself? It'll be a bugger getting up to do the night rounds.

Differently Sane said...

Call me cynical but I thought that was the technical definition of consultation.

Well that's always been my experience anyway.

Reminds me of the Yes (?Prime) Minister episode, with the new hospital - it employs numerous civil servants. But patients? You don't want sick people messing the place up.

If it's any consolation, they'll unilaterally change their mind in about 12-18 months. (They must be see to be doing something :-) .

Socrates said...

And then managers uniltareally decide that senior nurses can stop seeing patients and start supporting managers.

Oh Chr!st!

Fiona Marcella said...

"Service reconfiguration" (ie cuts) after consultation (ie some documents and a few meetings at which nothing changes)? The next thing you know they'll be giving the Trust some silly name and changing the logos - apparently that is what is needed in today's NHS. It has worked wonders for our Trust, or so the board minutes would have you believe. The patient and staff surveys seem to tell another story but who cares about patients and staff when the management structure and logos are bright and shiny?

The Girl said...

Years ago I joked that they would try to save money by stopping the treatment of patients, and then hire more public servants to write the reports on how much money was saved.
Sadly I was ignorant at the time, because that is what they have been doing for a long time. It is a major problem in Australia, too. :(

Dr Michael Anderson said...

It must be unbelievably frustrating to see this sort of thing happening. I'll point you in the direction of a post on The Ferret's blog which suggests what the managers are really there for...


Spirit of 1976 said...

The longer I work in the NHS, the more often I find myself realising that dealing with violence on wards, anorexics trying to manipulate me, psychotic people thinking I'm monitoring them with radio waves etc etc aren't anywhere near as stressful and disheartening as the endless politics, managerialism, backbiting and bureaucracy.

Why can't these people just leave us alone to do our jobs?

f said...

The NHS does this also with service users and carers - consults,then goes it's own sweet (?)way. Do you think hypnotism would help - for us or the managers? Actually what do you think of hypnotism, for patients with Alzheimers, in place of anti-psychotics?

The Shrink said...

"Why can't these people just leave us alone to do our jobs?"
If only life were so simple as clinicians being allowed to do clinical work, eh? :)

F, a lot of what's done with folk who have Alzheimer's disease is helpful. Aromatherapy's been shown to be effective (in reducing BPSD and need for drugs, for example).
This poses questions. Aromatherapy was then done without any oils. The result was the same.
Thus, aromatherapy does nothing above and beyond what sitting with someone giving them undivided one to one time does.

Is hypnotism helpful? There's no compelling evidence to say it is or it isn't. I expect not, in moderate/sever dementia, since thinking is so disorganised that trying to meddle oft times makes things much much worse. In mild dementia I'm not sure. It's not something I'd have myself, or for my nearest and dearest, though.