Dont disagree. In days gone by consultants were more akin to teams of barristers operating as individual specialist professional practitioners working as individuals but within a chambers style organisation providing admin support with trainees supporting on an individual 1-to-1 basis and dependant upon their patronage. Nursing on the other hand was more like a military model with rank, determined by different coloured uniforms, being all important and this rigidly defined role, responsibilities, etc. However times have changed dramatically since professional management structures, systems, accountabilities, etc were introduced into the NHS. The problem is that we have had this clash of cultures and apart from specialist functional areas like procurement, finance, HR, IT, etc we have invested very little in developing clinicians to become senior managers within the NHS and as a result we have this mismatch of the old and the new cultures. In cases like Letby the old style of 'lets us manage this ourselves within the professions' failed drastically and it seems the professional managers ie the CEO, failed to see and address this. It is often easier for CEO to let the Medical Director of Clinical Team to manage poor performance of consultants given it is a minefield, unfortunately in this case doing nothing and not listening to the guys on the ground was an unmitigated disaster!C69 wrote: Sat Aug 19, 2023 6:55 pmOn the whole I agree and know a few Medical Directors who are or have been great Clinicians and have respect from their Peersdpedin wrote: Sat Aug 19, 2023 6:44 pmI think when folk talk about NHS management they forget/don't realise that many are or have been senior clinicians of one sort or another. In the Letby case it looked like the Medical and Nurse Directors were the ones who blocked any action. Any CEO or legal rep worth their salt would look to them to provide expert advice about taking action against a clinician as it is part of their professional responsibilities to provide this advice to managers. I wouldn't think any CEO would ignore the professional advice of their senior Clinical Directors, that would be suicide.Blackmac wrote: Sat Aug 19, 2023 12:13 pm
My wife and a number of her nursing colleagues are currently involved in a complaint against a consultant anaesthetist in their hospital who they have seen being physically abusive to anaesthetised patients and also bullying and abusive to nursing staff. They are up against an absolute brick wall, no one at the hospital is interested and the nursing unions are beyond pathetic.
It is often very difficult to get issues raised about doctors, as the profession they close rank and prefer to deal with the individuals themselves through their professional routes. When I had to go in for a knee op my GP, who was a friend, asked me who I wanted to be referred to (in the days when this was an option) I asked does it matter and he raised his eyebrows and told me to ask my doctor mates who they would allow to operate on them. I did and got a list of good guys/bad guys! I know one surgeon who when a trainee would often tell his consultant he would close up after surgery but then often had to redo the surgery to correct their mistakes. Poor surgeons might find they are given simpler case mix on their lists, are given senior trainees to 'assist', are asked to assist other surgeons in surgery rather than operate alone, are asked to do more non-clinical work, etc rather than be confronted with their poor performance. Quite often early retirement is offered rather than being asked to stop clinical work. Whist the vast majority of doctors are hard working and dedicated professionals there are like in every walk of life a few fucked up bastards!
This is very different for Nursing staff in Chief Nurse positions.
I know of no Nursing staff in this situation who have any series clinical kudos or reputation.
The Chief Nurse of an organisation usually surrounds themselves with yes men and often the surround themselves with people they have history with and being in their friends and colleagues from previous organisations.
The culture in the NHS is getting no better and I am glad I decided to not go down the Senior Manager route about 10 years ago
The NHS is a behemothan organisation that has been run into the ground systematically and deliberately.
I can't wait to retire, hopefully next year I will start slowly decreasing my hours.
However I am not sure other models work better - the US with their processes and litigious environment creates many more problems and also fails to identify and deal with dodgy clinicians.
