Cloning Val and Ursula
click to enlarge"Organisational Structures in the Belfast Trust"
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Another email arrives, this time from an Irish nurse, currently working in Belfast.
Dear Dr Crippen
I work for the new Belfast Health and Social Care Trust, which is the recently merged trust covering the whole of Belfast, and all facets of both healthcare and social services.
I couldn't help but laugh at the latest structure chart that has just been sent out (attached).
We are now approaching the same number of directors/co-directors/associate directors as we have nursing staff in the trust - it's getting beyond a joke and just another example of where UK healthcare is going wrong.
We even have a Director of 'Patient Experience'...what on earth?!?!
I worked for a while as an occupational health adviser for a large high street retailer, which is far bigger than the Belfast Trust. We made do with 8 directors.
How times change!
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Valerie Jackson cloneHow times change indeed. Take a look at the first flow chart. The Co-Director RHT reports to the Co-Director BCH who reports to the Co-Director Education who reports to Olive, the Co-Director Standards, Governance & Performance who reports to the Senior Manager Service, Planning and Development who reports to Valerie Jackson, Director of Nursing and Patient experience.
Ursula makes the tea.
click to enlargeAnd what, pray, IS a Director of Patient Experience? Dr Crippen would be grateful for suggestions.
Valerie Jackson cloneBut our Val is a busy girl. In her spare time, she is also Director of Older People, Medicine and Surgery and sits on top of another ponderous hierarchy.
Ursula still makes the tea.
click to enlargeI have only excerpted two charts from the document. There are many more. Those interested in self-flagellation may wish to download the whole “Organisational Structures in the Belfast Trust” document from here.
Val and Ursula clones work in an NHS Trust close to you.
Those who do download the main document may find it confusing. Help is at hand. There is a longer publication, entitled "Freedom of Information Act Publication Scheme" in which all is explained. Do not worry if you do not know what a "Publication Scheme" is; the first part of the "Pulication Scheme" includes a chapter on "What is a Publication Scheme."
This splendid fifty-one page document is available here.
Labels: administration, clones, waste
26 Comments:
Dear Dr Crippen
Why start a competition for the best (?) NHS management tile under NuLabour? A contribution from Planet Hounslow PCT in West London who have a "Director of Quality and Healthcare Transformation"
Small fleas have smaller fleas upon their backs to bite 'em, smaller fleas have smaller fleas and so on ad infinitum!
Unfortunately the salaries are not small.
The NI NHS also has a large number of Purchasing Managers and Purchasing Directors all over the province. With 'Manager' and 'Director'after your title, the salary rises alarmingly. They all do the same job though even in the days of the computer!
I found out today that the new personal assistants in the Belfast Trust are getting assistants of their own - like you say, fleas on fleas!
Doctor Crippen,
A Director of Patient Experience is a very expensively trained and skilled nurse who spends her time reporting how much patience a patient needs before he/she becomes a patient, while of course avoiding being a nurse! Clearly a vital role, provided you can find someone patient enough!
With 'Manager' and 'Director'after your title, the salary rises alarmingly I can't speak for the Belfast trust, but the usual reason to give people new titles is in lieu of payrises. If you call them "senior" something" or "something manager" you don't have to pay them so much to stop them leaving. Anyhow that's how it is often in the private sector. Strange but true.
Of course you sometimes get runaway title inflation. There are zillions of people called director and vice president in financial services. Someone will have to invent a new title eventually.
Well actually at least it is a move in the right direction here in NI as at least we have decreased from 26 or 27 Trusts to 7 (I think those figures are right) and managerial jobs are going. The Royal (RVH) and the City (BCH) were two large, competing Trusts and I suppose it ws inevitable that jobs had to be divided between the two camps and titles were created to smooth ruffled egos, but it used to be worse.
Once in our practice we decided to give ourselves hospital style titles so I became the Director of Children's Services (I do the Baby Clinic) and Director of Estate Services (I put the bin out every Thursday and keep a few spare bulbs in my press), we ran out of bodies long before we ran out of titles
There seem to be a huge number of Ass Directors in these organograms. Perhaps this is to direct people to get up off them?
Oh we are being so royally fucked.
Dear NI GP
You said "and managerial jobs are going. The Royal (RVH) and th ...."
Eh!!! check out the recently merged Down Lisburn + Ulster & Ards now called the South Eastern Trust.
Several of the Directors of DL Trust failed to get positions when they re-applied for their own jobs at the merged trust. You would think that would be the end of them. Not so ........they are alive and well, working in the same offices, drawing the same £££'s, keeping the same secretarys, pulling the same perks..........but nowhere do they appear on any organisation charts.
And the best bit
You cant see them for love nor money
And they are not accountable either
John
I can't see how to send you stuff by e-mail. How do I do that?
Personally I sleep better knowing these people are out there
how Kafka knew...
Hey buddy, did you know you were named #15 on the Times list of best business blogs (!):
http://business.timesonline.co.uk/tol/business/industry_sectors/media/article1923706.ece
Woo Hoo!
John
I can't see how to send you stuff by e-mail. How do I do that?
By Gasman, at Friday, June 15, 2007 9:19:00 PM
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click on drjohncrippen above, and you go to the "profile" where you will find the email address
John
At what point does the weight become so great that we sink? How long have we got before anarchy arrives to clean out the dross and everyone else in its wake.
No matter what job one is in the same shit seems to be happening. Zillions of drones sucking on the tit while obstructing the workers.
Maybe blogs like your's John will be part of what brings change before total chaos arrives.
I salute you and your efforts
How do you do full time gp work and this blog? Do you sleep?
anaru
http://kiwidocblog.blogspot.com/
How did that weird photo of me arrive on my post?
Did that fix it
"skeletal services": priceless.
Yes... priceless.
Of course, when I showed this to the other half, who is a battle-hardened mid-level Trust doctor, she just said "Oh yes, that's pretty standard stuff."
Was interested to try and work out how many levels of admin droid this meant there were between (e.g.) a nurse and the Chief Exec. I tried to figure it out from the chart... but it made my head hurt and even Co-Codamol (see Dr C's column above) didn't help.
Contrary to my lifelong prejudice, I have to say the University where I work seems actually to have streamlined the management a bit. I count only four or perhaps five steps from a lowly Lab Techperson to the University Chief Exec / Vice Chancellor:
Lab techperson
-(possibly Chief Technician)
- Tech Uber-supervisor
- Head of Faculty Admin
- Dean of Faculty
- Chief Exec / Vice Chancellor (or at least someone in his/her office)
[For info, this is in a Univ with almost exactly half the number of staff and half the annual turnover of the NHS Trust in question.]
..Although I will admit there are a number of centralised "Offices for XYZ" whose precise purposes we Droids in the Trenches of Education are not privy to.
Meanwhile, every second thing I hear from my friends in the Private Sector is on about "stripping out" unnecessary tiers of Middle Management. But I guess they can't do this in the NHS or there wouldn't be enough MidLevelManagerApparatchiks for
all the grand-plus-a-day Management Consultants to "shadow".
You are right aging academic - in the private sector they try to remove unnecessary mangement, both on cost and efficiency grounds. A rule of thumb is that no manager should have more than 5 direct reports. On this basis an institution with 7 levels of management would have a population of 5 to power of 7 ie 78000+. The 7 levels on the 'Patient Experience' chart! 5 more on the Older people chart and all in one hospital! The trust's website lists 12 executive directors, including Valerie Jackson! Could it be that some are surplus to requirements?
I don't have any remit, or desire, to defend the Belfast Trust, but it might help put things in perspective if readers understood that this new Trust is the largest in the UK and among the largest healthcare organisations in Europe. Five former Trusts have been combined into this one Trust, which is responsible for both acute and community services in its catchment area.
Under the Review of Public Administration, the number of Trusts in Northern Ireland has been reduced from 19 to 6. The purpose of the exercise has been to reduce administrative duplication, though only time will tell if this objective is delivered.
In fairness to Valerie Jackson, a cursory glance at the "belfastbonkers.jpg" diagram will show that the Director for Nursing and Patient Experience post is vacant, so she's evidently covering that post as well as her own.
Re Anonymous 10.26 today -
When the duplication was removed, how many of the managers involved became, and were made, redundant?
Does the new trust have figures for redundancy payments in the past year or so?
My guess is they should be alarmingly high, but I doubt there have been many redundancies. Parkinson's Law and the Peter Principle are likely to have taken over and the info in the piece certainly seems to confirm it.
I'm with Anon 1.59 here. I'll
believe the "streamlining" of administrative staff when I see it.
My experience of living through a merger or two in Higher Education has been that it is older staff in the front-line posts (teaching / research in Univs) who tend to accept voluntary severance, often to take part-time jobs elsewhere. The administrators cling on like limpets and have to be found jobs in the merged system.
At an earlier stage many yrs ago I was involved in a merging of five large Departments, each with a manager type. The five chief managers met up, brainstormed at length and finally decided that the new "unified structure" would require splitting managerial responsibilities into - guess how many? - five "briefs", each requiring a highly experienced manager. Kerrching - no redundancies and enhanced salaries and pensions all round.
*sigh*
I suppose we should have been grateful they didn't proliferate, as opposed to simply differentiating and undergoing a bit of hypertrophy.
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