Yesterday I joined in the Parliamentary discussion of an Urgent Question on pay talks and strikes in the NHS. There was was nothing new and nothing the two sides have regarded as particularly urgent in what was talked about. The Labour front bench was controlled in its demands, just wanting a resumption of talks but not backing the junior doctors’ demands for 35% and understanding that several of the Unions favour accepting the current offers made to NHS staff by the government. A few on the Labour left intervened to demand higher taxes to pay for bigger pay rises but were out of tune with their front bench and the government.

I asked about the role and work of the senior managers in the Trusts and NHS England. The Secretary of State confirmed that the junior doctors have raised a number of issues about rosters, work practices, technology and staff support for their roles. I asked what the managers were doing to improve the rosters, work packages and support for the doctors. I pointed out again that senior managers have considerable powers to change the ask of doctors, to reward good ones with promotions, salary increments and  revised gradings of jobs. Should more of these flexibilities be used to improve the mood of the workforce and to achieve more with the people the  NHS does employ?

I find it very strange that Ministers take all the burden of the pay negotiations with the staff. Senior managers rarely come onto the tv or radio to talk about the NHS though they claim considerable independence in running the service. When they do if asked about the strikes they always say it is a dispute between Ministers and Unions. Surely they must have strong  views on what is affordable, what is needed to recruit and retain, and what should happen going forward to make it easier for them to run a good service?

The establishment of NHS England was designed to distance Ministers from day to day management of the service and to leave most of the decisions in the hands of professional managers and w the clinicians they employ. So why when the service is  being damaged by strikes and when employee relations are so strained is there this silence from highly paid senior managers? Why will they only talk about trying to offset the worst impact of the strikes and not have ideas on how to end them? Why are we still waiting for the manpower plan, which should be a basic evergreen necessity in a service that relies so heavily on what employees do for patients?


  1. Peter Wood
    April 18, 2023

    Good Morning,

    Sir J, perhaps a better question is why isn’t the minister responsible asking senior NHS managers for their advice and recommendations? The money is his to approve, but the work is for the managers to arrange; surely they go hand-in-hand?

    1. Nottingham Lad Himself
      April 18, 2023

      Well, there would never have been an NHS at all without the Labour Party.

      The Tories are on a zealous mission to destroy all their good works too.

      1. graham1946
        April 19, 2023

        For once I agree. They have already done it to NHS dentistry. Most dentists are now private including my own who has been for many years, and I have been attending him and his predecessors even when I had a choice to go NHS. Now there is no choice. By the way, private dentistry is not expensive if you keep regular appointments and look after your teeth. I guess the annual bill for both myself and my wife to be not more than a couple of hundred quid, or a pint of beer a week. If you let them go, it will be expensive. I have all my own teeth at 77 years of age as does my wife at 75, so it does pay.

    2. PeteB
      April 18, 2023

      Another good question: When will the Government look at successful health services across the world and change the UK model to one that works?
      Plenty of examples where healthcare outcomes are much better than the UK, whilst spending per capita is the same or lower. Throwing money at the NHS will solve little.

      1. graham1946
        April 19, 2023

        The rest of the world did not have the Lansley re-organisation of 2012 which made things ten times worse. Before that it was better and much cheaper. Spending is the same now as the better ones, not per capita but by GDP. I expect per capita it is much less with 8 million more in the population in the last 20 years. They never do it per capita but always by the meaningless GDP.

    3. Peter
      April 18, 2023

      Cut out the middleman. The highly paid senior managers in the NHS just seem to be an unnecessary bureaucratic expense – but not vital to the running of an efficient service.

      1. graham1946
        April 19, 2023

        A result of 2012.

  2. Cuibono
    April 18, 2023

    This is all just part of the nightmare.
    It has been obvious for years that the NHS was going down the tubes.
    And now along with everything else it has finally crumbled.
    A little bit of conservative government might have helped?

    1. Nottingham Lad Himself
      April 18, 2023

      It’s been obvious since 2010, yes. Prior to that was its Golden Age.

    2. MFD
      April 18, 2023

      We need rid of the overpaid but incompetent management. They are the root of all NHS problems, the minister should stay at arms length and force them to manage both staff and perhaps a smaller budget.

  3. Ashley
    April 18, 2023

    If new Junior Doctors were given a 35% pay rise they would still struggle to have enough to live on. They start on £29K and often have £150K of student debt with £10K of interest on it. So just do the sums. Rent for a cheap room in London is now circa £1,000 PM studio flats about £1,500 PM.

    Two people at my son’s school had virtually the same top A level graded one did economic for three years the other medicine for six. The latter has twice the student debt and only starts work in the summer. The former has been working for 2+ years and is now on £105K (is similar for top university lawyers). The doctor starts on £29K (plus they have to pay further bills to the GMC, for stethoscopes etc. and for further exams and prof. body fees out of their salaries as they progress. They do surely (at least) need enough to actually live on!

    1. Ian wragg
      April 18, 2023

      They know full well the conditions and salaries when they embark on their careers.
      They also know that if they stick ar it they get a terrific pension which us in the private sector can only dream about.
      I have no time for their socialist inspired action.

      1. graham1946
        April 19, 2023

        Pensions don’t pay mortgages or rent when in you 20’s and 30’s. Being the lowest common denominator in the private sector is not a spectacular aim. If you don’t like your conditions, well you knew them when you embarked on your career.

    2. Sir Joe Soap
      April 18, 2023

      Yes it is crazy but there’s a different career profile for these occupations. I’ve no axe to grind but top lawyers in their 20s and 30s (at least used to) have a bed in the office for when they work 20 hour days. Their career progression is more risky and pensions aren’t gold-plated.
      Of course the deal for doctors should be to work for the state for 5 years or whatever and get the top slice of student debt relieved.
      But why not offer the doctors also up-front cash instead of a top dollar pension which they don’t need for 40 years? Answer in my comment below.

    3. Mike Wilson
      April 18, 2023

      They do surely (at least) need enough to actually live on!

      But so does everyone, not just doctors. A friend’s lad is a software developer. He has a partner who works and he also works for Deliveroo in the evenings and at weekends. All he does is work and they are still broke.

      And Mr. Redwood no doubt wants credit relaxed so we can get more of the fabled ‘growth’ so that house prices and rents can go even higher. The world is a madhouse for young people.

    4. Dave Andrews
      April 18, 2023

      £105k after 2 years is very rare. Even train drivers don’t get that much.

    5. Ian B
      April 18, 2023

      @Ashley – While junior Doctors pay has a lot to do with today’s situation, it isn’t the problem. The whole concept of the NHS as a global one size fits all service was bankrupt before it got going. As already intimated those that hold the day to day purse strings get paid extremely well, without qualification even for the job the are supposed to do – then they ultimately fail at the point of delivery. But the Conservative Government doesn’t care – the NHS is holier than thou and untouchable.

      This Conservative Government wants to make believe they are in charge, and will pontificate until the cows come home – but, will they themselves manage what they are paid to do?

    6. JoolsB
      April 18, 2023

      You’re spot on Ashley. My son after six intensive years of training at Cambridge now works in a busy London hospital. After tax, 9% student debt and £1,000 a month rent, compulsory membership fees such as BMA, buying his own equipment such as stethoscope etc., there’s not much left to show for the 70 hours of unsociable hours he works every week. Far more than it says on the rota and no they are not paid overtime. They are over stretched, underpaid and unappreciated and dumped on from all directions.
      Compare that to our mostly useless MPs, £100K a year if you include select committee work, no student debt for their mostly worthless degrees and taxpayer funded plush London apartments with heating and council tax thrown in. I know which ones I’d rather see my taxes go on.

      1. a-tracy
        April 19, 2023

        Jools you should check with your son he should be paid 30 hours overtime if he is doing 70 hours that’s how the contract is written, plus London weighting, plus enhanced pay nights and weekends, plus relocation bonus £10k, plus paid study leave. Why did he choose London for his placement and not somewhere where the salary goes further? Is it because the on-going training he is receiving in London is better?

        1. JoolsB
          April 19, 2023

          He should get overtime but he doesn’t. Apparently it’s frowned on if they try and claim it. As for the £10K relocation bonus, doesn’t exist. His F1 rota was 10 hour days but he actually ended up working much longer hours each day often starting at 7 and getting home at bedtime. Junior Doctors are well and truly put on by the NHS. He did try to claim all the hours of overtime he did and it was refused. He knows better than to try now. According to my GP, apparently they used to pay the first years rent of a Junior Doctor when he started but they certainly don’t do that any more.
          Being a Cambridge graduate, apparently 70% of Oxbridge graduates end up in London which is why it was his first choice. Hospitals are better and also being from rural Cornwall, the big city appealed. He loves living in London and sadly has decided that if he wants to carry on living there, he can’t do it on a Doctor’s salary which is why he intends to leave. He enjoys medicine but not working for the NHS so he is now going to leave medicine altogether. What a waste.

          1. a-tracy
            April 20, 2023

            Perhaps this is where doctors should start Jools claiming for their authorised overtime; does he work four days in seven in the hospital? I think it is dangerous for anyone to work in such a specialised, life-risking job for more than 12 hours per day, and it worries me that this is done.

            Can he backdate his application for relocation, or was his post more than one year?
            British Medical Association › Pay and contracts › Pay
            13 Mar 2023 — If you have to move home to further your junior doctor training or for the service, you may be eligible for relocation expenses.

    7. a-tracy
      April 18, 2023

      Rubbish, how do you think anyone else on graduate salaries manages it? Only English students have that much debt, yet Scottish junior doctors are all on strike; they don’t appreciate anything. It is a graduate tax of 9% on earnings; all three of my children pay it and pay it one from £16k plan 1; it is disgusting only the English pay it.

      You talk about London rent, yet you don’t give the FY1 junior salary from London with the London weighting, the £10k tax-free grant to relocate. Why not take an FY1 placement where the money goes a lot further, because of the health postcode lottery perhaps? I agree London and other southern cities are more expensive to live in perhaps it is the weighting that needs to change, and a nurse after a 3-year degree starting on £27,500 after the doctor has a further two years at uni doesn’t seem the right differential for those extra two years not earning sacrifice or are they earning, receiving grants?

      It’s all about differentials, if Labour gets in and gives their £15 ph nmw/nlw what will the doctor want then?

      1. JoolsB
        April 18, 2023

        When Scottish nurses went on strike they were offered 7% straight away by the Scots Government and Sunak had the brass neck to stand up in PMQs in answer to an SNP question and say that the Scots Government could only afford to give them that thanks to the extra 1.5 billion the U.K. Government had given them (courtesy of the English taxpayer on top of the 12 billion they already get via the skewed Barnett Formula). English NHS Doctors and nurses who incur higher student debt have not been offered 7%. The inept Barclay refuses to even discuss pay demands for Junior Doctors. Imagine how far the Barnett handouts could go to train and retain English NHS staff.
        It seems U.K. Governments of all colours have cash, English cash, to splash around on any country except England which is why England needs to toss out the anti English Con/Lab parties who treat us with such contempt and as nothing more than cash cows for the benefit of everywhere except England.

    8. a-tracy
      April 18, 2023

      Where are they working two years after undergraduate graduation on £105k? Are they just 23 years of age? What hours are they working for that amount? I know a lot of graduates, many with first-class degrees in stem subjects from top universities, and I would like to discuss this with them.

  4. David Peddy
    April 18, 2023

    In fact Sir John, you have answered your own question. The Trust Boards and ‘Middle Management’ of the NHS are largely useless.Only a few Trusts are competently led
    The majority are far more concerned with the social engineering of diversity, inclusivity ,equality and any other irrelevant -ersity that you care to think of . Period officers and other jobsworth from top to bottom.
    Risk and decision making avoidance are their primary concerns
    Massive over-manning as well

  5. DOM
    April 18, 2023

    Why is it lawful for State employees to take action to endanger the lives of their ‘clients’ while private sector employees acting in such a manner would be exposed to the full force of the criminal law? Is this merely an expression of POLITICAL POWER expressed by the Marxist union leaders who know they have gutless careerist Tory ministers by the balls?

    Let’s face it, if Tory ministers are able to abuse the taxpayer to pay off Marxist agitators in the public sector then they will.

    THEY’RE ALL PISSING INTO THE SAME POT and it’s the private sector and the civil population who has to pick up the cost in higher taxes and loss of life

  6. Bloke
    April 18, 2023

    Those who run the NHS are not managing.

  7. Mark B
    April 18, 2023

    Good morning.

    I find it very strange that Ministers take all the burden of the pay negotiations with the staff.


    Why . . . [then various questions] . . .

    The answer to the above is simple. For many, the NHS is the only game in town. Neither doctors or patients can go anywhere else thanks to a State monopoly.

    We’ve been here before.

  8. Sakara Gold
    April 18, 2023

    Your intervention on the dire situation in the NHS is welcome. The problem is actualy the excessive number of middle management and particularly the senior management structure.

    Only ~60% of NHS staff are clinically or technically qualified. The remainder are in administrative posts, many earning far more than the nurses, and senior management who earn far more than junior doctors or indeed, the consultants. The NHS could lose 150,000 middle managers and nobody, least of all the patients, would notice

    The NHS has never recovered from the pandemic and Hancock/Harding. The current SOS Heath Steve Barclay is not medicaly qualified. I would suggest that unless he and Sunak sort the pay structure and management problems PDQ, the public will vote for a party who can at the next election

    1. a-tracy
      April 19, 2023

      To be fair you don’t wanted skilled medical staff administrating do you? Administration posts and qualifications are far faster to obtain other than level 5 and computers do a lot of the heavy lifting now.
      The NHS has never recovered from Andrew Lansley’s reforms.

  9. John McDonald
    April 18, 2023

    “Professional managers” That’s one of the NHS’s big problems. It has caught the management virus which multiples out of control. The other big problem is the population explosion not helped by uncontrolled and illegal imigration.
    The concept of importing cheap labour rather than increasing skill levels and employing technology has depressed wage levels in all areas of work.
    Skilled workers do not need “managers” they can think for themselves but you have to pay them a bit more. But it is a lot less expensive in the long run and more efficient at getting the job done or providing a service.

  10. BOF
    April 18, 2023

    It is now becoming difficult, to put it mildly, to get necessary surgery. In early 2020 I needed a hip replacement but the waiting time was so long that I went private, then last year I had a cataract operation. Once again private. My wife is now booked for a shoulder operation, private. I am waiting for a minor operation on my hand but that can wait as the raids on our savings has made a large hole. Others we know have been forced to have treatment privately.

    Government should start putting hospitals back to private sector and give patients credits to decide for themselves how to spend. That would soon bring hospital budgets under control. Hospitals may even find they no longer need their diversity managers.

  11. Donna
    April 18, 2023

    I have an idea? Why don’t you ask Hunt …. you know, the man who was Sec of State for Health for 6+ years and left it incapable of dealing with a Low Consequence Infectious Disease with low mortality rates.

  12. Rhoddas
    April 18, 2023

    1. Nhs managers appear superfluous… why not remove them and use their huge salaries to fund an improved offer to those clinical staff still in dispute….
    2. Let ACAShelp determine the pay outcomes on a fairer basis.

    1. a-tracy
      April 19, 2023

      NHS Managers should come onto our tv news shows and newspapers and explain why they are important to the organisation’s running.
      You would think with top-ranking professionals who are managing the majority of high-grade graduates wouldn’t need so much top-down instruction from any none-medically trained managers.

  13. Charles Breese
    April 18, 2023

    I heard recently of a GP retiring in her early 50s. The cause was:

    – her workload used to comprise a mix of easy cases and challenging cases.
    – ‘management’ decided that resource would be more efficiently deployed if GPs dealt only with challenging cases and less qualified staff dealt with easy cases.
    – dealing only with challenging cases all day is so mentally demanding that she retired.
    I suspect that numerous decisions are regularly made across the NHS which superficially are logical but fail to take account of human behaviour and therefore result in unintended adverse consequences.
    Charles Breese

  14. Jude
    April 18, 2023

    The NHS is broken & the rot starts with the NHS Trusts board members. The audits of these trusts should be made public. The majority of Managers (similar to the young MPs) are straight from university. With little work experience let alone work competence. Hence why the NHS staff needs are not managed. Because there are too many managers who do not understand what NHS jobs entail & the challenges of those roles. Example: A consultant can have 7 managers that all require differing documentation. The one sure thing in life is give a person the title manager & they will create a process document trail. That will smother the task they are employed to manage!

  15. Narrow Shoulders
    April 18, 2023

    I am waiting for a hospital appointment and I have had appointments cancelled due to strike action.

    Will I get a refund of my tax that is going to pay for the monolith.

    The sooner it is dismantled and we move to a private system part-funded by tax rather than this bureaucratic quango the better.

    All medical outlets should be immediately moved to funding by procedure and not by existence. I am very happy for JUnior Doctors and nurses to be paid commission on their output.

  16. Sir Joe Soap
    April 18, 2023

    Could it be that the negotiators won’t swap top dollar pensions for cash now because they too have top dollar pensions which would be compromised? Get some real-life negotiators in the room on defined contribution pensions and let’s see how this is resolved.

  17. Berkshire Alan
    April 18, 2023

    Who is in charge of the managers and their recruitment. ?
    Clearly if the managers are not managing, why keep them on ?
    I will repeat what I have said for more than a decade, why do we make doctors and nurses pay fees to train.
    If the shortage is so bad, why not simply let suitable applicants train at no cost, in exchange for agreeing to guarantee to work for the NHS in/for 10 years after training, failure to work means the training fees are re-payable.
    All it would need is a simple legal contract.
    Do we actually have enough training spaces ?
    Do we have enough trainers ?
    Do we actually have the enough of the right buildings for training etc etc.?

  18. majorfrustration
    April 18, 2023

    Whilst 35% might well prove to be a try on surely its time to look at the ego tripping capital projects like HS2
    which seem to have more importance than looking after the publics health – when your ill you need help there and then with HS2 it might be ready in the 2030s. When is this Government going to look at the priorities of the voters?

  19. Sharon
    April 18, 2023

    Last year, I watched a five year old interview with two senior doctors. They were both very concerned that the administration choices in the NHS management were attempting to deliberately run down the NHS, to eventually privatise it – on the US model. They thought it was on its last legs then. More recently, another couple of doctors were being interviewed on GB News… they too thought it was being deliberately run down.

    If these four doctors are correct, that might explain the difficulty trying to get management to be questioned.

    I think is now an issue that needs to be more robustly handled by ministers.

    1. Sharon
      April 18, 2023

      According to my local Resident’s Association, with an update to one of our local hospitals being re-built, there are financial problems causing a delay. What the association says is as follows, “ According to a statement from the Department of Health and Social Care “We are developing a national approach to constructing new hospitals so schemes can be built more rapidly and ensure value for money and we continue to work closely with all trusts on their plans.” But trying to get agreement between the different hospital project teams about what the national approach should be is not unsurprisingly proving difficult.’’

      The usual central control causing problems and delays ( ignoring the financial issue for the minute.)

  20. Ian B
    April 18, 2023

    ‘I find it very strange that Ministers take all the burden of the pay negotiations with the staff’

    ‘I asked about the role and work of the senior managers in the Trusts and NHS England’

    As far as I can see the NHS gets given money from the taxpayer, the senior managers in the Trusts and NHS England then get to spend it any which way they want, and this Conservative Government with their refusal to manage hat on says ‘so what’ Obviously they see they can always steal a bit more form the taxpayer, as they have no choice.

    It is extremely odd that those that want the kudos of running the NHS and spending its money, have no say and nothing to do with the money they ultimately dish out in pay.

    Time to privatise the lot, to much messing around with a substandard mess. People are dying!

  21. Kayla Tomlinson
    April 18, 2023

    Clearly NHS England is a waste of money–overpaid bureaucracy and money being spent on on Diversity Managers rather than medical professionals to name the latest waste.

  22. Nigl
    April 18, 2023

    The answer is simple and you know it. HMG is the paymaster and politically Labour have you by the throat. So every time a problem occurs, votes are at risk, the MOS takes over, he cannot stay away.

    Put up senior NHS managers, more anti Tory rhetoric, unchallenged.

    You are paying the price for being too weak and still are, afraid to criticise NHS management which might have moved the narrative in your favour.

    You have zero leverage either politically or operationally.

    And re yesterday well done Peter for putting up a spirited defence of the EU yesterday. Obviously the Dutch view has nothing to do with the fact it has the EUs economic engine on its doorstep, happy to be bullied politically by a France/Germany axis and of course Germany’s ‘willingness’ to provide trillions to bankroll bankrupt countries to keep the project together.

  23. Christine
    April 18, 2023

    Why is the government encouraging people living and working abroad to buy back years of NI contributions? This can cost them as little as £3.15 a week. As soon as they are entitled to a retirement pension they and their partners are then entitled to an S1 which means the NHS has to pick up the bill for their medical costs. This is a blatant waste of taxpayers money and an added burden for the NHS. This also applies to all the families living abroad claiming DWP benefits.

    1. a-tracy
      April 19, 2023

      This should be banned immediately, Christine.

  24. AncientPopeye
    April 18, 2023

    Good for you Sir, wish you were my MP. Too true, the MsM never call the Trust Managers to task and the Unions use this as a blunt instrument to attack the Government.

  25. , George Brooks.
    April 18, 2023

    The pay demands on the public purse would reduce dramatically if the government gave Net Zero a rest and increased our production and made us self sufficient on electricity. Prices would fall back to pre-Ukraine and inflation would more than halve in the next 3 months.

    Your junior members need to understand the damage that is being done to our country and also avoid these so called ‘international treaties’ which reduce our remedial options as you so rightly stated very recently.

  26. Keith Jones
    April 18, 2023

    Personnel Departments were not considered “line” departments but Human Relations Departments are. Human Relations Departments set the rules for how managers relate to staff and staff to managers which leaves managers with little or no discretion and renders them managers in name only.

  27. Cuibono
    April 18, 2023

    Please, please JR MAKE whomsoever READ the WHO doc/agreement. PROPERLY!
    They even want to control OTC antimicrobials…hydrogen peroxide, antiseptics and the like.
    So you get a cut and can’t treat it!
    For years now we have had to endure the dire questionnaires from chemists’ assistants.
    Soon we will have no control over our health…doctors or not!

    And hasn’t the leader of the Junior Doctors gone on holiday?
    Alright for some eh?

  28. glen cullen
    April 18, 2023

    NHS (UK) one sector (including ambulance, dentists, chemists & GPs and the care sector), one employer, one pay scale, one management structure, one purchasing agency, one strategy one mission ….a bit like the organisational structure of our military

    1. a-tracy
      April 19, 2023

      glen, aren’t chemists, GPs and many dentists now mainly private and bill the NHS for their NHS services?
      I also thought our military was still different units.

      1. glen cullen
        April 19, 2023

        The military has the same command management structure throughout all its services …all using the same pay scale

  29. forthurst
    April 18, 2023

    A third of junior doctors are planning go abroad to work in the next twelve months. As we haemorrhage our home trained doctors we import their replacements from the the third world. Only a bunch of dimwitted Arts graduates (managers) could preside over such a appalling situation. People of low ability should not be in charge of people of high ability.

    The artificial squeeze on medical school places must be removed so that they train more people who have the necessary grades. In the meantime the government needs to step in, sack the senior mangers and increase the salaries of junior doctors to levels which are commensurate with the need for retention and the reward for doing a difficult and responsible job. We do not have enough doctors, particularly males who are available to work full time throughout their careers; this must be addressed as well by discriminating in favour of males, other things being equal.

    1. a-tracy
      April 19, 2023

      What sort of Country are we that provides top-notch training but doesn’t tie the trainees in as pilots are?
      I hope their student loan which is paid back on UK earnings is transferred to another type of loan at least so that it is recalled at a suitable rate pa depending on what their UK working colleagues are paying pa, they can appeal if they don’t earn that much, although we are told they earn more so should pay more.

  30. ChrisS
    April 18, 2023

    The problem is, as that everyone working in the NHS thinks that the service is so wonderful that the taxpayer just has to come up with whatever they demand. We have reached the limit. The public in general has at last realised that we are getting a second class service for first class money.

    Ministers are letting the management get away with blaming the government for the situation when the real problem lies with management failing to manage the service properly. In other words, they have the money, it’s up to them to deploy it in the most cost effective way possible. If they won’t do that, they should be replaced.

    It may be that the doctors deserve more money. If that is the case, the management needs to make sacrifices elsewhere to find it. Sacking all the Diversity managers would be a start.

  31. glen cullen
    April 18, 2023

    Remove the hundreds of NHS related quangos that don’t delivery a service to the public

  32. Bryan Harris
    April 18, 2023

    This article emphasises once more how much the NHS management is failing, despite their large salaries they do not take responsibility for anything.
    Isn’t it time HMG intervened and sacked those NHS top managers who are resistant to better working conditions for staff?

    Individual annual assessments have to be the way forward, but God know which direction NHS management is directed. They spend so much money and resources on being politically correct, it seems they don’t have enough creative energy left over to do their day job.

  33. a-tracy
    April 18, 2023

    Can the Health Minister sack underperforming ministers after going through a disciplinary procedure for not performing to the customer’s needs?

    We must continue paying our national insurance even though we have not effectively had half of our health service for a week, with threats of more to come as the nurses are sabre rattling again (I wonder if they want to keep this going until the local elections); what other organisation continues getting paid when they remove the service?

    I’ve had enough of it. Labour think everyone is blaming the Tory Ministry; they don’t. However, we do think Barclays needs to get a grip quickly and start giving the government position and shine a light on full payroll packages. We give a lot of little hidden perks that don’t seem to be counted or appreciated like the £10k tax-free resettlement after University into placement, what’s that worth £18k gross.

  34. Margaret Campbell-White
    April 18, 2023

    Well said. Perhaps some of the Managers should be sacked and their roles eliminated, then there would be more money for those at the coalface.

  35. Bert Young
    April 18, 2023

    For years the NHS has been managed badly . It is too large an organisation and needs to be broken down into more focused local operating units . Perhaps another problem has been the selection and leadership of the NHS management core ; it was always difficult to attract the best talent to the central roles resulting in confusion and disagreement down the lines .

  36. agricola
    April 18, 2023

    First apologies for longevity, but this is not a one liner subject.

    I come from the point that a service designed in 1947 for a population of about 45 million cannot be suitable fifty five years later for a population of 70 million. In that fifty five years our medical capability has changed beyond imagination, and with it the expectations of patients. Therefore there are many questions that need answering.
    1. Is a workforce comprising 47.5% with no medical training the right balance. Is the NHS over managed. Does the NHS have too many none jobs in make work positions such as diversity management. Would diversity be better lauded than managed.
    2. Why are we charging nurses and doctors vast sums for training when we are desperately short of them. Should the training be free against a contract to work in the NHS for ten years after graduation.
    3. Why, when we have academically suitable candidates, are we restricting the numbers we allow to train. Is this a medical profession retrictive practice. The downside is that we have to recruit fully qualified staff from overseas to the detriment of the countries they come from.
    4. Has nursing become overly academic. I can accept that you need a very high level of training if you work in an ICU and many other areas. However for what I would term nurse/orderly work involving hourly contact with in hospital patients, keeping them fed, comfortable and clean, I would question the need for a degree.
    5. Then there is how we fund the NHS. At present it is a money pit where political parties fight each other for virtue and the moral ground. We need to evaluate other national systems across Europe, Canada, Australia , New Zealand, and Japan and choose whatever works best. For sure our system of pretending it is free but charging heavily for medication, forcing dentistry, aural and optical services into the private sector while the rest comes out of taxation, produces a very third rate service for those who cannot afford it.
    6. Does the Purchasing organisation of the NHS provide value for money.
    7. Is there excessive wastage in the NHS.
    8. Could General Practitioners be organised to provide a more comprehensive service, perhaps on the path to being cottage hospitals, so diminishing the load on A&E.
    9. Integrate fully, hospital after care and end of life care, minimising bed blocking. Too much, including hospices and air ambulances is left to charity. It should be joined up.
    10. The present poor relation, Mental Health, needs to grow

    The NHS must cease being a political football. Parties must agree between them its future shape.
    Finally I would say that, in my experience, once you are in contact with our less than perfect NHS the medical service is excellent, compassionate, and caring. The problem for most is establishing contact.

  37. glen cullen
    April 18, 2023

    Maybe if this government repaired all the roads potholes there wouldn’t be as many cyclists needing the NHS due to slips, trips & falls, nor motorcyclists with broken bones and car drivers with whiplash …RTAs could be cut in half

  38. Stred
    April 18, 2023

    As usual, no debate about the signing up to the WHO treaty by which countries will be mandated to follow its orders when it decides that a new virus may be declared a risk and pandemic status. It can order mandatory vaccination even when rapidly produced with no long term information available. It mandates that 5% of national expenditure on health will be contributed to WHO coffers, in the case of the UK enough to fund half of GP practice. They have just agreed that mamber states enforce abortion up to birth. Its president is not medically qualified but an ex politician who covered outbreaks of cholera in Ethiopia, and was put in position by the Chinese Communists.

    1. a-tracy
      April 19, 2023

      Stred, interesting, do you know how much of our national expenditure on health is contributed to the WHO today?

  39. oldwulf
    April 18, 2023

    Taken from a speech by Tony Benn:

    “The NHS held a boat race against a Japanese crew and after Japan won by a mile, a working party found the winners had 18 people rowing and one steering while the NHS had eighteen steering and one rowing. So the NHS spent £5 million on consultants, forming a restructured crew of four assistant steering managers; three deputy managers and a director of steering services. The rower was given an incentive to row harder. They held another race and lost by two miles. So the NHS fired the rower for poor performance, sold the boat and used the proceeds to pay a bonus to the director of steering services.”

    Sounds about right.

    The NHS already receives more than enough of taxpayers money. It needs to learn to use that money wisely.

    1. Peter Gardner
      April 19, 2023

      I didn’t agree with Tony Benn’s socialism but he was a very affable man and good company. He was also passionately against joining the EEC because he knew it would transfer sovereignty to what became the EU which he understood, along with Enoch Powell (what an alignment of views!) was not and could not be democratic.
      What a great disappointment his son turned out to be. The Benn Act was uttery destructive and we have him and his Remainer supporters to thank for the awfulness of the WA/NIP even though it started with other Remainers, like Mrs May, Robbins, Barwell et al.

  40. glen cullen
    April 18, 2023

    Home Office – 17th April 2023
    Illegal Immigrants – 113
    Boats – 3
    Numbers using the NHS …hundred of thousands

  41. turboterrier
    April 18, 2023

    Sir John it might be a bit too harsh that all NHS Trusts are tarred with the same brush, but in light of all that’s going on that they are big and brave enough to hold an internal survey of every employee working for them asking the one basic question.
    British Gas South Eastern did it when the new Chairman Ralph Ellis decided that the new incentives to change the way they worked, all before Privatisation. It was totally anonymous but the results were very thought provoking and a lot of levels were very exposed. What it highlighted was there was many members of staff with very good ideas to change their and the companies progress. Wasn’t done with expensive consultants but by a small team(4) committed to Culture Change.
    Lots of people considered taking early retirement às the vision was totally outwith of their comfort zone. But a new brand of person coming in with new ideas, passion and belief took their places.
    One man with a vision and a small dedicated team motivated a lot of professional Auto Pilot employees to put their heads above the parapet and make things happen.
    Wasn’t a walk in the park but the momentum increased as others signed on . Best team I ever worked with.
    No extra money incentives but a firm belief in the vision of the Chairman.

    1. a-tracy
      April 19, 2023

      Excellent suggestion, but surely they are asked this question regularly anyway in their reviews. Government department do like their annual appraisal systems, they maybe just don’t listen or act.

  42. Brian Spratt
    April 18, 2023

    I often ask acquaintances who work in the health service if they know anything about Amanda Pritchard. I rarely find anyone wh has heard of her, but she is the Chief Executive of NHS England, has worked in the NHS for over 25 years and, I understand, is paid in excess of £300K, pa. It is quite amazing that she, and I guess, several cohorts of other NHS senior managers, are not held responsible for the current state of the NHS, the lack of solutions for strikes, and the abysmal reaction to the covid situation. Millions wasted on Nightingale hospitals which were never used. Money spent on diversity and inclusion officers instead of spending it on nurses and doctors. The senior management needs a clear out !

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