By background, I’m still a registered nurse, but I’ve been in NHS management longer than I was at the bedside and while I was an operational manager for many years, I’m now working on a project deemed critical to the service in my part of the country and unlikely to be called back to the front line. That said, I still do a stint on call for the acute hospitals in my board and get some insight of what life is like at the sharp end from some of those experiences.
Burning through essential staff groups
I happened to be on call as our hospitals were formulating their response to Covid-19. At that point, we were still in “contain”. Some activities, mainly non cancer, non-urgent scheduled surgery, such as orthopaedic operations were being cancelled to make space and allow us to cohort suspected Covid-19 patients in specific wards, preferably where we had a fair number of single rooms to enable isolation. At that stage, staff who’d been exposed to confirmed cases were self-isolating. That didn’t last long as we were burning through essential staff groups, such as Senior Trainee doctors and Advanced Nurse Practitioners. Advice was revised that they work unless they develop symptoms. While cancellation of elective surgery and prospective A&E attendees were beginning to create capacity not usually seen in the system, we’d run out of beds in the Covid isolation wards, and would be involved in creating even more capacity/interim solutions in the earlier hours of various mornings.
As I said, I’m on a project, so while I work pretty regular hours and have the time to plan and complete tasks. That is not the lot of the operational manager, or the nurse managers who oversee patient care. In setting these areas up, they were stepping up gears from already frantic work schedules and putting in even more hours. One hospital director told me they’d put 60 hours in by Thursday and had hit a wall…
Hospital managers are invaluable
It is a common public misconception that somehow hospital managers, particularly non clinical ones are surplus to requirements. That misconception can also exist on the shop floor with domestic staff, porters, staff nurses, nurse practitioners wondering what they’re there for, but those that come into direct contact – Charge Nurses, Consultants, Clinical Managers – recognise they are invaluable. They take away a number of tasks, concerns, challenges and smooth things that clinical colleagues don’t have time for and don’t want to deal with. Among the hardest of all those gigs is the lot of the operational manager. There are always more tasks than time to complete and performance to deliver with scarce resource while identifying savings to reinvest in services and care.
A Chief Executive told a group of operational managers, while I was still one, laughing, that, “Senior managers are like hamsters, you have one for a couple of years, then you get a new one…”. Then they immediately implemented a new sequence of organisational changes and wondered why their managers could not influence those they managed…
It isn’t until you get off that hamster wheel, you realise how consumed you were by it, how much of your life it ate up and how many experiences in family life passed you completely by. When you find yourself with the time to plan and refine and execute again, how utterly hellish it was and how you never want to go back to it, regardless of ambition and capability and skill and pay. A colleague recently retired from such a senior operational role and told me they don’t miss it and won’t go back to it.
The NHS Sharp End
So while they aren’t at the very tip of the sharp end, NHS managers are very close to it. They’re in those jobs, like most in health care, because they chose to be, to help people and make a difference. However, few if any in healthcare signed up knowing the additional risk they are now carrying in treating people with a virus that is killing some of the young, fit and well in their ranks as well as people with more obvious risks.
There are also many working like care workers, essential shops, supply chains, home delivery other parts of the emergency services now facing a hazard they have never anticipated. Nonetheless, no matter the risk assessments and mitigation, they are putting themselves at risk in continuing to provide things other people need. Many of those were considered “non-essential workers” just a few short weeks ago.
Those volunteering in these times deserve a different layer of respect altogether.
Those fronting the NHS response to Covid-19 are predicting it may be like this for a long time yet and that as it rolls across the UK, hospitals are going to get busier and busier. The way we can protect the health of those delivering care and all those (managers, porters, domestics, catering and on and on) is to follow the government’s advice.
Stay home. Protect the NHS. Save lives. It may be your own life you save.
*Glen C. spoke to me anonymously due to press policy of NHS hospital employers.