News, Culture & Society

It is nurses we need not more bosses says Dr Max Pemberton

Maybe I’ve missed something. Maybe I’ve misunderstood. All this time, I have been labouring under the belief that, in the NHS, there was a serious recruitment crisis.

There are 40,000 nursing posts unfilled. Two in three hospitals have a shortage of doctors, according to a survey last month by the British Medical Association.

We also need 12,000 extra GPs to meet demand and 3,500 midwives.

So, who is the NHS recruiting? Is it these staff — the ones who work on the coalface actually improving the lives of patients?

Nope. Instead, while clinical staff shortages grow, the number of NHS managers has soared. 

Figures published this week show a 7 per cent rise in the number of senior managers in one year alone, while the total number of managers is now 32,000 — a rise of almost 25 per cent in four years.

‘Maybe I’ve missed something. Maybe I’ve misunderstood. All this time, I have been labouring under the belief that, in the NHS, there was a serious recruitment crisis’

The sharpest rise was among senior managers, whose pay normally starts at £65,000 a year. This is sickening.

Don’t get me wrong: of course, the NHS needs managers. They are vital in ensuring the smooth running of services. 

But, in recent years, management has become a bloated mass, leaching money from frontline services to pay inflated salaries.

Why is a manager of a service worth three times more than a nurse, who is delivering the actual care?

Part of the reason managers have proliferated is that services are now required to collect vast amounts of data in order to show commissioners and senior NHS bods what they are doing.

This is wholly wrong and demonstrates the distorted priorities of the NHS, whereby filling out bar charts to show those higher up the food chain is deemed more important than actually helping patients.

A friend who works in a mental health service says there are now four managers in his department, yet just two clinical psychologists. 

'Figures published this week show a 7 per cent rise in the number of senior managers in one year alone, while the total number of managers is now 32,000 — a rise of almost 25 per cent in four years'

‘Figures published this week show a 7 per cent rise in the number of senior managers in one year alone, while the total number of managers is now 32,000 — a rise of almost 25 per cent in four years’

As a result, patients now have to wait about a year for therapy.

Underpinning much of this has been the internal market, whereby services are now in competition with each other to ‘win’ contracts.

Then, once ‘won’, managers have to harvest vast amounts of information to demonstrate they are delivering what was promised, ready for when the contract comes up for renewal.

And the spiralling cost of this bureaucracy has no discernible benefit to patients. 

A recent study from the Organisation for Economic Co-operation and Development (OECD) suggests that around one-fifth of spending on health in the UK makes no or minimal contribution to improved health outcomes.

Police must not turn blind eye to cannabis use 

Cannabis ruins lives. This is not opinion, this is hard, scientific fact. 

Yet it has become unfashionable to say this in public for fear of being branded out-of-touch or a killjoy.

But there’s no joy in watching, as I have, someone descend into madness because of skunk (a highly potent form of cannabis). There’s no joy for their families.

And the problem is only going to get worse. Research this week showed that nearly all of the cannabis on Britain’s streets is super-strength skunk — which is dreadful news, since the strength of cannabis is closely related to the risks it poses to mental health.

Particularly frustrating are the smug, ageing, liberal hippies who lived through the Sixties and Seventies and claim that, because they’re still here, it must be fine — failing to realise that not only did plenty of people not make it through unscathed, but also that the cannabis today is almost entirely different from what it was 15 years ago, let alone 50.

Yet, as the dangers this drug poses to mental health increase, the police are taking an increasingly relaxed view of it. It is now normal to see it being smoked openly on the streets, because users know that the law is never going to be enforced.

This enrages me when I’ve spent hours of my life trying to pick up the pieces of lives ruined by cannabis.

I know that policing is incredibly tough and, with limited resources, decisions about which crimes to prioritise have to be made.

But turning a blind eye has effectively decriminalised cannabis on the streets.

The police should be enforcing the law, not making it. If there are to be changes to the law, it must be done properly, in Parliament, with experts from both sides putting their case and the evidence.

Decriminalising is the worst possible option. Because even if we were to make it legal, the type of cannabis being sold should be monitored, with the level of potency kept in check. This would be better than allowing this drift.

I’m not saying that legalising cannabis is the answer, just that this current fudge — where it remains illegal and the police look away — helps no one.   

I think there’s an element of Parkinson’s law here — that work expands in order to fill the amount of time available. As the number of managers increases, so the bureaucracy increases to justify their jobs. Put a manager in a room with a clipboard and they will find work to do.

And much of this involves those at the coalface — nurses and doctors — filling out yet more forms, which the manager can then collate.

Research from the NHS Confederation shows that clinical staff spend up to ten hours a week collecting or checking data — more than a quarter of their average week — and that more than one-third of the work was neither useful nor relevant to patient care. It is estimated that collecting this data alone costs the NHS £500 million.

And many of the managers can’t even manage properly, as evidenced by the astronomical spending on management consultants — external people paid to come in and restructure and improve a service.

It is estimated that every NHS trust spends £1.2 million a year on them.

Why? We have managers already and, if they’re unable to evaluate and restructure their services, then they have no business being employed.

My solution is simple. For every service, there can be one manager. Just one. This is exactly what it’s like in the private sector. This single manager will have to prioritise what data they collect; they’ll have to be lean and precise in their work.

Reducing managers in this way will see many jobs go, but they can be redeployed to the frontline.

For the absurdity is that many managers are former clinical staff — nurses, occupational therapists, social workers and so on.

Many were lured in to management positions by the inflated salaries, but this will stop.

They will go back on the wards and in the community, working with patients and using the skills they learned as managers to improve the quality of services.

It’s high time we reminded those in the upper echelons of the NHS that the Health Service exists for one thing and one thing only: the patients. Anything else is a waste. 

Why I’m so upbeat about my patients 

When it comes to eating disorders, there’s no single treatment that’s superior to any other. 

Often, it’s a combination of approaches that works best — and, typically, these come from the patient.

This came to mind as I read a new book by Laura Freeman, a writer and editor formerly of this parish. 

The Reading Cure: How Books Restored My Appetite charts her recovery from anorexia and explains how she rediscovered how to enjoy food — and life — through literature.

A friend who saw me with the book was surprised when I said it was about the author getting better from her anorexia.

‘But I didn’t think people could recover from that?’ he asked.

For me, this touches upon a much wider issue relating to mental illness.

People often ask if I find working in this field depressing because no one gets better.

In fact, most people do recover. Compare this to other areas of medicine, with many conditions chronic and deteriorating over time. 

Yet you never hear anyone say to a cardiologist: ‘Oh, how depressing, all those people with heart failure,’ do you?

What makes my work so rewarding is the knowledge that so many of those you meet will, in fact, get better, even if it seems unimaginable to them at the time. It is a field full of hope. 

Well done to Dame Sally Davies, the Chief Medical Officer, for speaking out this week about her experience of incontinence after childbirth.

I have been a critic of Dame Sally in the past, but she should be applauded for highlighting an issue that affects so many women, but which is cloaked in shame and embarrassment, with many suffering in silence. 

That the most senior doctor in this country has spoken about incontinence will mean so much to them.