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back to article NHS Trust boards spew out oceans of paper

Haven't they heard of email? The NHS may be undertaking the largest civilian IT project ever, but the managers sure seem fond of paper. Boards of NHS Trusts created at least 22 million paper documents in the past two years, generated for communications to senior managers, and to each other. The number is probably higher, since …

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Oh God

Please don't get me started on the amount of paperwork I have to go through in my job. Even as a mere hearing aid technician, the sheer number of forms, referrals, re-referrals, stock sheets, target plans...

To quote someone I once knew: "I don't know if it's making us more efficient but it's certainly scaring the shit out of a lot of trees."

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FAIL

This is a title

"Health watchdog the King's Fund reports that while the number of staff rose 35 per cent from 1999 to 2009 (to 1,117,000), the number of managers rose by 85 per cent."

And when the trusts need to save money they always fire the medical staff, preferably nurses. I bet you could sack 2 in 3 of the admin staff without lowering the quality of the medical care given.

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Anonymous Coward

but then

But with out the magical beurocracy everything would collapse!?! Or at least that's the attitude of government, the right ticks in the right boxes on the right forms means that a job has been done and done well. Wait, you mean it means a frontline resource has wasted 2/3rds of their time form filling? Lies! Forms are the answer, they're always forms, with forms comes targets or is it the other way around?

Did the target come first or the form?

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Alert

What Admin Staff?

You need to be careful when you say get rid of admin staff. IT staff are admin under NHS definitions. We have 7 techs to support 7000 users, 3500 desktops and 1000 other devices. The poor sods that look after the the servers and critical network applications only have four staff. And we have to save 10% on staff costs this year.

Bet it won't be a fecking manager that gets canned.

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I can believe it.

I applied for a job with the NHS a good few years back. Through the post came a seven or eight page application form, complete with mandatory disclosure form, discrimination form etc etc. I was expected to fill all this out, photocopy it five times and send the whole lot, complete with five copies of my CV, back to them.

I thanked them for the opportunity, but decided not to proceed. That was simply the process to get an interview, god knows what the job would have been like.

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Bronze badge

Forms..

I did same and was expected to fill in a form online.

Guess it depends who the health authority is.

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Anonymous Coward

Blame the government

"... while the number of staff rose 35 per cent from 1999 to 2009 (to 1,117,000), the number of managers rose by 85 per cent."

Simple explanation - the NHS payscales. Whatever the popular belief, the NHS still pays staff at rates much lower than the private sector. To get a member of staff into a level of pay somewhat resembling the private sector, they are moved into Management Bands. They may then be labelled a "manager" but most still perform the job they were employed and trained to do but at a fairer rate of pay.

"The NHS has over 42,000 managers and the Department of Health burned through almost half a billion pounds in fees to external consultants in the year 2009-2010".

The previous administration decreed that the NHS would be a national project with the "Spine" project at the centre. This was a major paradigm shift with all sorts of threats to individual NHS organisations if they did not conform or met certain deadlines. How would any organisation react if faced with such threats? Employ contractors and external consultants - just like the HMRC when they reorganised the Tax Office.

Don't blame the NHS for failings in an inept, uninformed and ill-researched government programme. Almost all NHS staff I know work there for vocationally and philanthropic reasons. It's not the pay or the easy life. A normal day for an IT person at our organisation is about 9 hours - and we get paid a fixed salary, no overtime.

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Anonymous Coward

emails get printed as well

so we get to handle everything twice.

The way to reduce this particular cost is simple:

Set a limit on the number of sheets of paper permitted to enter the organisation per year. A hard limit.

Reduce it by 10% the following year and so on.

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Badgers

42,000 managers?

That's like having a "we don't do anything at all" award. My respect for medical staff just rose, because with 42,000 managers hindering them, they've got to be superhuman to help anyone.

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Anonymous Coward

you

nobody ever got the sack for filling in the forms the way management wanted them too.

Plenty of nurses get the sack for helping people.

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Anonymous Coward

42,000 managers managing 1,300,000 employees

3% of the workforce

How many managers do you think Tesco has for its 500,000 employees? Midranking ("Band 8") managers in the NHS typically get 70 to 90k. Executive Board members typically get £100 to £120k, with a tiny fraction -- in the dozens or hundreds, out of those 1.3m staff, getting £120k+. What do you think the equivalents in Tesco earn? Or a big 4 accountancy firm? Or a pharma company? Or a tech company? Hint: the answer is shedloads more. E&Y in the UK has 400 partners (for 7,000 staff, so check out the ratio of management:employees there) -- they earn an average of £680k.

The problem in the public sector is that it is not keeping up with the private sector.

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(Written by Reg staff) Bronze badge

Re: 42,000 managers managing 1,300,000 employees

How many accountants at Ernst and Young are on the minimum wage?

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Too many

That sounds like an excellent argument for keeping the NHS in public hands to me.

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Anonymous Coward

Huh?

None. Like the NHS, E&Y will employ or contract in cleaners, mail room people etc on the minimum wage. But not sure quite what that's got do with the discussion here, which was about whether the NHS was over-managed?

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Unhappy

So many chiefs, so few Indians...

These managers are actually on the whole probably doing two things: !) applying for money, justifying grants, showing targets are being met, bullying doctors and nurses to fill in forms and 2) Clerical work. Getting rid of most of the 'managers' and replacing them with cheaper clerical staff (unfashionable as it is to call them that these days) would save costs and make things more efficient.

But then that would be too logical would it not? This whole egalitarian thing really is a farce, not everyone has to be a manager or a frontline staff and it's about time they started to slim down on the fatty cream...

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Anonymous Coward

Not much has changed, then.

A few years ago I worked in an NHS hospital lab. I went there after some years in industry. I didn't last 6 months, despite being far more expert in laboratory methods than most around me. Bad enough that most senior lab staff seemed to think actual work was beneath their station - the department head started at 10am, took 2 hours for lunch, and buggered off at 4pm. More junior staff regularly worked a dozen hours or more unpaid overtime a week. I reported to management that many lab tests were being severely compromised by pressure of work and lack of proper line management. I was told to shut my mouth or look for another job - in exactly those words. The extra training I was promised never ever materialised - a new excuse every week.

But the biggest problem was that I had never worked in a place where so many people thought they could tell me what to do. It might not have been so bad if they'd got together and made their minds what they wanted - but it was a constant battle between contrasting instructions, usually preceeded by "I don't care what --- told you!". In among all that, what I saw in the way of dodgy contracts, patient miscare and plain criminality would fill a book.

When - inevitably - I got sick of the 10 chiefs and 5 indians syndrome, not to mention management by bullying and lying - I left. I included in my resignation that I had never ever worked in a place where the words "tell me what to do and I'll do it" were regarded as insubordination.

That was a few years ago. Ex-colleagues still in the system tell me it's since got worse. I can't imagine how that might be humanly possible.

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Anonymous Coward

Partners are not managers

Partners are the owners and the operators of the business. They may employ a manager (most partnerships employ a manager, in the NHS partnerships of 2-10 GPs are unlikely to employ more than one) and they will employ reception and clerical staff and secretaries and cleaners and so on.

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Anonymous Coward

Forms, forms, forms,

I too work in a hospital, and I can attest that the amount of paperwork we get through is absolutely ridiculous.

A particular bugbear of mine is blood movements:

If I need to get blood for a patient I need to fill in 4 forms, all with the same information. I also have to put that same information into a computer which logs it on a server which happens to be in another hospital on the other side of the city, and if the private WAN had stopped working (again) I have to fill in another form with the same information again and detailing why I haven't used the computer. This even applies if I am getting blood for a patient who is bleeding profusely and needs blood *NOW*!

"Sorry, love, I've just got to fill this form in - don't die for the next 10 minutes, will you?"

I think the problems with paperwork are, however, made worse by the attitude towards IT. I don't know if it is the same for every trust but where I work people are not allowed to share file-space for security reasons - so if somebody wants a copy of a document then they have to get it e-mailed to them by somebody else. The result of this is that they get so many e-mails that their inbox is unmanageable so in order to make sense/keep track of it all it all gets printed out.

There is also an awful lot of "covering your own ass" going on, where information which is already automatically captured is also put onto a form just in case the computer fails and/or just in case the patient decides to sue the trust. The NHS has this "no blame culture" which basically means if you screw up... YOUR ON YOUR OWN!

And the computers do screw up a lot, and we're only allowed to use IE6, and it takes at least 20 minutes to log into a computer because the network is so damned slow, and users are locked down to using only one PC - if you want to read your email or print off one of the many forms elsewhere you have to ring up the IT department to get permission.

One of my favourite bits of IT management is that every time El Reg has an article about Facebook the NHS firewall blocks it: "Site blocked. Reason: social networking". Not only are we not allowed on Facebook (which I understand and agree with) but we're not allowed to know that Facebook even exists!

One of our endoscope stacks broke down once. I should explain that it has, as one of it's components, there is a colour printer which prints out little pictures to put in the patient notes. Anyhow, the printer stopped working - the engineer popped down to Argos and bought a cheap printer, brought it back and plugged it in. We were besides ourselves with envy - if any of us had needed a new printer it would have taken months of haggling to get permission from a senior manager, filling in forms and trying to get budget codes. I was seriously asked once if I could strip down and rebuild a laserjet printer because it would be easier than getting a new one!

Anonymous because... frankly, I don't want a P45.

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Big Brother

I agree with the paper issue but...

There are two problems from my perspective (which has to remain anonymous).

1. People have a nasty habit of suing hospital staff. Everything has to be on paper to keep the parastic lawyers off our backs (or the fear of them). One trust now has forms to fill in in case a lift fails, but also another of what to ask someone if they're trapped in the lift. Before common sense was used, an out of order notice etc. Now forms must be printed and used if something fails to prevent the lawyers getting us.

2. If something does go wrong, and a lowly minion had tried to report it up the chain, you print it off because an email has a magical habit of disapeering when public enquiries come round. And since it is usually the government targets that caused the management to cause the risk to life and health in the first place, the only back up for the front line (or even second line) staff is to keep it on paper.

3. Too many idiot users click on anything they send in the emails. Uptime can be notoriously fickle when you need it.

4. See three, but substitute the bit about emails to eveything else. Paper is used because we don't trust important stuff to the government's IT contractors or Siemens or anyone else...

So in summary, the forms are there to keep the managers off our backs. The managers are there because Central Command insists on their Orwllian demands for targets and everyone keeps in fear of the lawyers.

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re.42,000 managers managing 1,300,000 employees

It's closer to 12k employees across the UK & Ireland.

In addition the partners own the business, as pointed out above, and bear the risk if the business ever goes into court. They are, with literally one or two exceptions, actually facing clients day to day -not hiding in an office and hassling nurses cos they haven't dismantled and washed down every bed in the ward

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Sources

Here's mine:

http://www.ameritas.co.uk/default.html?frame=http%3A//www.ameritas.co.uk/clients/eandy.html

What's yours?

If you don't want to count partners as managers because they're the owners, you'll weaken your argument, not strengthen it. The directors / senior consultants / senior managers / managers etc who manage the associates / consultants / auditors who do the legwork, will be more numerous, not less. And the denominator will have reduced by the number of partners as well.

I notice that everyone is latching onto the E&Y example but ignoring the big corporates examples I mentioned as well.

There is a separate argument to be had about whether a partner at EY is, by virtue of being an owner, bearing (some) business risk (let's see how that goes with the LLP structure and Lehmans) and facing clients, doing a job that is truly worth 6 to 7 x what an NHS CE is paid.

My wife works for a big 4 and while there are some very good partners, she might laugh in your face at the hero-worship you are exhbiting for big 4 partners in general.

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Big Brother

Er ...

What's the bill in the USA?

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Grenade

Tell me about it

I have the dubious delight of a local hospice printing my phone number on their website as if it was their fax number due to a small typo

I hooked a fax machine up to it for a laugh - yes, a fax machine in this day and age, and waited for them to get it wrong

Their forms, are indeed shocking, it takes me hours to read the interesting patient notes they send me

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