Category Archives: NHS managers

Standards “Going into reverse”….There is no button to push… we need tens of thousands of staff

Chris Smyth reports in the Times on the reality of the staff shortages, which are worsening as those who failed to move on to pastures new fail to manage the brutal workload. “100,000 job vacancies as  NHS pushed to limit” in the Times 22nd of Feb 2018. Stories of leaderless dysfunctional consultant teams spread over wide regions, of GPs who take sabbaticals being shocked that even after a break they cannot cope, and resulting early retirements are legion. There are only politicians to blame, as the administrators are only doing their behest. There is a risk of anger, walkouts, burnouts, and serious mistakes through a collusion of denial and disengagement. Exit interviews conducted by an outside and independent HR department are now an essential and emergency need.

Image result for work walkout cartoon


About 100,000 NHS posts are vacant and hospital deficits are twice as high as planned even after a winter bailout, according to official figures.

A rapid financial deterioration means that hospitals have overspent by £1.3 billion so far this financial year while waiting times have not improved.

Patient numbers continue to rise, with 5.6 million A&E visits in the three months to December, a quarter of a million more than in the same period the previous year.

Despite efforts to improve links with social care, patients spent almost half a million nights stuck in hospital over the quarter.

One in 11 NHS posts cannot be filled amid a shortage of doctors and nurses. In London, one in seven nursing posts is empty, rising to almost a quarter in the ambulance service. Overall 35,000 posts for nurses are vacant and 9,500 for doctors.

Janet Davies, chief executive of the Royal College of Nursing, said: “All the evidence shows that standards of patient care rise and fall as nurse numbers do. That was the lesson from Mid Staffordshire and we cannot afford to forget it.”

Nigel Edwards, chief executive of the Nuffield Trust think tank, said that the “dangerous” shortage of nurses was more worrying than worsening NHS finances.

“Shortages of nurses damage patient care and make working life harder for those who remain, potentially driving them away too,” he said. “We can bring back more money onstream if the will is there, but there is no button to push which will suddenly bring us tens of thousands of qualified extra staff.”

Hospitals warned that they were being “pushed to the limit” by rising patient numbers. “Having one in eleven posts vacant makes it much more difficult to provide high-quality care,” Saffron Cordery, of the lobby group NHS Providers, said. “There is an increasing feeling among frontline trust leaders of ‘We cannot carry on like this’.

carry on like this’.“The NHS has shown extraordinary resilience in sustaining performance in the midst of an unprecedented financial squeeze. We have managed to keep the show on the road. But the warning signs are now clear and in plain sight. The time to act is now.”

Officials pinned the blame for worsening finances on a minority of hospitals that were overspending by far more than planned. However, Richard Murray, director of policy for the King’s Fund, the independent health charity, said this “raises serious questions about how reasonable the financial targets were in the first place . . . these are not pressures that have sprung up in the last few months and [they] show no sign of abating.”

Ian Dalton, chief executive of NHS Improvement, the financial regulator that published the figures, said: “More people than ever before are going to emergency departments up and down the country at a time when providers are already having to tighten their belts. It would be unrealistic to assume the demand, which has been building for a number of years, is going to reverse.”





Good on you Mr Gavin Tait. Tell it as it is… and I bet you never got an exit interview.

The importance of a “utilitarian” approach in the restructuring for improved standards cannot be overstated. The debate in West Wales, although driven by financial constraints, should place it’s remedy on higher standards.  The planned 5 sites for 2.5 million people, in 2014, and not implemented, is too many – one site may be enough. Orthopaedic operations are the most common, give the most life-years quality gain, and are prone to infection if the conditions are less than perfect. There are short term temptations to try and make do, and to ignore the experts appointed to help us.

SURGICAL SERVICES – A letter in the Times 29th Jan 2018
Sir, I have recently retired from the National Health Service and have spent almost 20 years trying to have elective and acute surgical services geographically separated in my health trust. I support Alan Mackay (letter, Jan 25) and advise Eleanor Walsh (letter, Jan 27) that it is usually the public and politicians who are resistant. Any suggestion that orthopaedic surgery leaves an acute site is viewed in the public eye as a threat to A&E, and is resisted even with street protests.

Historically, elective orthopaedic surgery was always on dedicated sites until they were closed in the 1980s as they were considered to be unsafe. Waiting lists were never disrupted.

Surgeons who are prevented for months each winter from operating as the beds are taken by acute medicine become deskilled and bored, and trainees get little experience. The sooner we return to past arrangements the better.
Gavin R Tait

(Retired consultant orthopaedic surgeon)

As it gets worse, YOU are going to have to wait longer and longer – or pay up. A “grim reality”..

The evidence basis of all practice(s) needs to be challenged – continuously. There are perverse Incentives in private systems, but why do the UK health services still overtreat?

NHS rationing: hip-replacement patients needlessly suffering in pain on operation waiting lists

Orthopaedic waiting lists: time for more, and equal access to, non-urgent centres

South Wales NHS: Plan to centralise services on five sites

Whilst Nurses leave, “Extra funding to help NHS used on short-term fixes”, report finds. Conspiracy theorists may be right..

Image result for hip replacement cartoon

When a crisis is the predictable outcome of poor policy making. It will take 10 years to begin to recover, and 20 years to recover completely from the politicians’ cowardice.

Perhaps the politicians (who go privately) think we the people deserve this. The falling standards, lengthening waits and lack of social safety net are now becoming evident. NHSreality started warning over 5 years ago, and even then it was 5 years too late….. It will take 10 years to begin to recover, and 20 years to recover completely from the politicians’ cowardice. … & The captains will NOT go down with the ship…

Image result for no safety net cartoon

Mary McCartney in the BMJ opines: When a crisis is the predictable outcome of poor policy making (BMJ 2018;360:k90 )

When is a crisis not a crisis? The “crisis” may be felt differently in the UK’s four NHSs, but these services are being pushed beyond reasonable capacity. I’ve little doubt that the coping mechanisms—corridor care, ambulance stacking, and a month’s worth of cancelled operations and outpatient appointments—are harmful. And these will contribute to burnout, sick leave, resignation, early retirement, and the cycle of even more rota gaps.

This is not a sudden explosive “crisis” but the predictable, and predicted, result of multifactorial choices over long periods that have made a mockery of evidence based decision making. This is winter: it’s a foreseeable annual event.

Yes, the NHS needs more money. But that money’s wasted if it’s spent on initiatives that don’t work and are driven by party politics, not patients. And it’s been spent on such initiatives repeatedly and avoidably. England has had the internal market and vast monetary waste from administering the legal framework,1 such that Virgin sued the NHS in 2017 in a dispute over tendering.2 This money should have been spent on direct patient care.

In Scotland a quarter of delayed discharges have been due to a lack of residential care beds.3 England has 43% fewer general and acute hospital beds than 30 years ago and fewer beds per head of population than any comparable country.4 People can’t get into hospital, but neither can they safely leave.

In 2013, management consultancies were telling us that technology would save us,5 when it couldn’t; and the government said that telehealth could save the NHS £1.2bn a year,6 before a randomised controlled trial found that it wasn’t cost effective.7 This was all money that could have paid for beds, hospital nursing, and community care.

Austerity has meant English councils cutting adult social care by 11% in real terms.8 The privatised, opaque process of carrying out medical assessments of eligibility for benefits has had a “substantial disadvantage” for the people it should have helped,9 while being associated with worsening mental health.10 This is avoidable harm done to patients and picked up by primary care, all while the provider turns a profit.

The origins of the current winter “crisis” have their roots in multiple places, all accumulating harm. Yet several campaigns aim to change behaviour by advising alternatives to visiting a hospital or GP.

These campaigns are untested and may not work—but they may harm. Patients, induced into guilt about “taking up resources,” may delay consultations and incur avoidable, expensive complications. Shifting problems we’ve failed to tackle onto the shoulders of ill people is unfair. This is a systemic problem that needs systemic change. If we can’t get the essentials of the NHS right we’re failing everyone, including the staff.

We’ve had our fill of short termism and party political policy making. We need to plan for the long term, seek cross party agreements, prioritise the basics, and have an “evidence desk” using expertise and systematic reviews, over which we can debate policy, disallow conflicts of interest, and stop wasteful nonsense in its tracks.

GP out-of-hours services struggle to fill shifts amid “intense” winter pressure –  2018; 360 doi: (Published 08 January 2018)   (BMJ 2018;360:k97 )

Providers of out-of-hours GP services are struggling to fill gaps in their rotas in the face of “intense” pressure this winter, despite a £10m (€11.2m; $13.6m) cash injection to help cover indemnity fees that was intended to ensure full coverage.1

Simon Abrams, chair of Urgent Health UK, a federation of social enterprises that provide out-of-hours GP services, told The BMJ, “My colleagues generally have found it more difficult this year to recruit doctors to shifts. Pressure on health services has been intense this winter, especially over the bank holidays.”

Abrams believed that previous extra funding from government for winter pressure, such as the £335m announced in November,2 had been too focused on hospitals. “In the wider strategy, there hasn’t been that recognition of …

Image result for no safety net cartoon


Doctors are recommending patients pay for non urgent operations… Inequality rules..

Alexandra Thompson reports for The Mail 4th December 2018: Doctors are recommending patients pay for non urgent operations…

Alzheimer Research reported 1st December 2018: NHS rationing reports are red flag for dementia treatment

Chris Smyth reports in The Times 4th December 2018: NHS ready to rule out more ‘poor‑value’ treatments (see below) This well written article highlights the health divide, and the risk of civil unrest.  The distraction of Brexit is starving the nation of other debates that are badly needed, and of new ideas to solve the unequal and unfair society that has led to the Brexit vote.

NHS reports on the crisis in care of the elderly.

If you have a relative in a care-home this’ll interest you and if you don’t it should…  

Which? the consumer magazine people, have been busy researching.  Results published last week, that didn’t hit the headlines.  Given the system-wide difficulties with care of the elderly, this news should have pushed Brexit, Trump and all the other malarkey, off the front pages. Here’s a flavour: 

“More than half of care-home places in some parts of England are in facilities rated as ‘inadequate’ or requiring improvement” 

The report, based on the CQC’s own data, is a horrifying read.  In 45 local authority areas, a third or more, care places are in poor quality care-homes.

The situation is so bad that even newly planned and approved hospitals, such as in Basingstoke, cannot go ahead.  Planned £336m hospital for north Hampshire scrapped –

Chris Smyth reports in The Times 4th December 2018: NHS ready to rule out more ‘poor‑value’ treatments (see below)


he NHS could end shoulder surgery, hormone tests and other procedures which have been listed among poor-value treatments by health chiefs.

It is claimed rationing could save billions of pounds a year. Routine use of “low-value” medicines such as costly painkillers and homeopathy have already been stopped.

Senior doctors say that the plans would be justified if they avoid tighter rationing of more valuable treatment but warned against overzealous restrictions that could leave some patients languishing without care. Simon Stevens, the head of NHS England, is under pressure to find more savings as he steps up a public feud with ministers over funding. He argues that a £2.8 billion boost over three years promised in Philip Hammond’s budget is too little to do everything the government asks of the NHS.

At a board meeting last week, NHS England said that waiting lists for routine surgery would rise to protect cancer, mental health and GP care. Restrictions on the routine use of ineffective, unsafe or overpriced medicines were approved, as well as a crackdown on prescriptions for drugs that are available over the counter. The local health groups which began this work say that they want to go further and have started to pull together evidence on a much broader spread of treatments.

“There are a range of interventions that we shouldn’t be doing because they don’t work,” Julie Wood, chief executive of NHS Clinical Commissioners, which represents the groups in charge of buying care locally, told The Times. “We are now starting a piece of work to bring that all together and we hope there will be significant savings. We’re talking with NHS England about this on behalf of our members — we need to do it and it’s the right thing to do.”

The National Institute for Health and Care Excellence (Nice) has more than 1,000 treatments on its “do not do” list and Ms Wood plans to scour this for expensive procedures that could be cut.

Nice estimates that at least £129 million a year could be saved by following this list. For example £17 million could be saved by carrying out CT scans on more people with chest pain, avoiding the need for other more expensive interventions and tests.

The Academy of Medical Royal Colleges, which represents professional standards bodies for 220,000 doctors, has previously estimated that about £2 billion a year is wasted on useless medicines, operations and tests. Ms Wood also plans to review the academy’s recommendations.

Last month a Lancet study found that common shoulder surgery carried out 21,000 times a year was no better than a placebo. Other research found that costly robot surgery was little better than conventional keyhole methods.

Rachel Power, chief executive of the Patients Association, said that the rationing work could not be done behind closed doors. “The people best placed to say what has value to patients are patients . . . If it’s done badly, patients will lose out and there will be zero accountability for it.”

Poverty in the UK: a guide to facts and figures.

Definitions of Poverty and Social Exclusion

Tim Shipman reports in The Times 3rd December: Alan Milburn quits as Social Mobility commissioners achieve ‘zero’ and in the Mail: Alan Milburn quits, says no hope of fair Britain | Daily Mail Online



Disgraceful post-code differentials in the care of children. We are losing our humanity because we fail to address the rationing issue..

We are facing disgraceful post-code differentials in the care of children. We are losing our humanity because we fail to address the rationing issue..

Emma Forde for the BBC News 12th November 2017: ‘I’m dealing with life-threatening situations – but I’m not a clinician, I’m a mum’

Hayley Smallman’s 15-year-old daughter Holly has a series of complex, life-limiting health conditions.

Her cerebral palsy, chronic lung disease and epilepsy mean she needs 24-hour care at their home in Liverpool.

It is estimated there are 40,000 children like Holly living with life-limiting and life-threatening conditions in England alone.

Many of them need palliative care round-the-clock, which is largely provided at home by their families but with the support of community children’s nurses and community paediatricians.

‘Alone and scared’

Hayley says: “I have a community matron and a community physio. They work Monday to Friday, 9am till 5pm. They are great.”

But when it comes to out-of-hours and weekends, Hayley says she is left without any support…..

On the same day: ‘Postcode lottery’ for dying children’s care, report finds

Families of dying children lack support because of a “postcode lottery” in palliative care services, according to a report.

The Institute for Policy Research says 49,000 children have life-limiting or life-threatening conditions in the UK.

The report says Scotland is “leading the way” in ensuring the right care is available to all, but the rest of the UK must follow suit.

The government says it is committed to tackling end of life care variations.

The IPR, based at the University of Bath, blamed a “piecemeal” approach to polices around palliative care and helping the bereaved for a wide difference in services across the UK – notably for children.

According to children’s charity Together for Short Lives – which contributed to the report – seriously ill children are “being forgotten or ignored” by nearly one in ten clinical commissioning groups (CCGs) in England as important services are not being made available.

Only 73% of CCGs provide palliative children’s nursing out of hours and at weekends, meaning children have to go into hospital rather than be treated in the community, the report found…..

…James Cooper, public affairs and policy manager at the charity, said: “The way in which children’s palliative care in the UK is planned and funded represents a postcode lottery.

“The current policy and funding environment has failed to adequately acknowledge the needs of these children, their families, or those that work to support them.”

He said families of children with life-limiting conditions have to co-ordinate a “vast array of professionals and agencies” for the care their children rely on.

“While a number of positive policy initiatives are being developed by the UK’s governments and other agencies, more work is needed to make sure that they bring about more joined-up plans, assessments and services with children and families at their centre,” he added.

The IPR report praised work in Scotland where the government is investing £30m following a pledge to provide palliative care for all who need it by 2021, “regardless of age, gender, diagnosis, social group or location.”

But it criticised the rest of the UK for being “ill-prepared” for the ageing population, and left with “disjointed policies” for people of all ages.

The report’s lead author, Dr Kate Woodthorpe, said: “For too long we have been complacent about death’s social and economic consequences, and our policy responses.

Government can no longer ignore the many, many challenges outlined in this brief.”

Other issues highlighted in the report

  • Only one in six employers have policies in place for employees providing palliative care for someone with a terminal illness
  • Growing funeral poverty – 45,000 people annually seek help from the state to meet the cost
  • A lack of burial space and concerns regarding crematoria capacity
  • One of the lowest rates of organ donation in Europe, while more than one in ten people die in the UK before they get the transplant they need
  • Nearly two-thirds of the UK population do not have a will

The report said the example of the devolution of powers and resources to Scotland offered a framework to tailor services to local populations and allow best practices to be shared.

“National and regional devolution is showing early indications that innovation and modernisation is possible, and Scotland is arguably leading the way with ambitious targets and re-organisation of key policy areas,” added Dr Woodthorpe.

“It is up to the rest of the country as to whether they wait to see how well Scotland fairs, or whether they use this as an opportunity to review, consolidate and improve how they support dying, death and bereavement.”

Scotland’s Health Secretary Shona Robison, said it was “extremely heartening” to be recognised by the report, adding: “It is a tribute to the compassion, commitment and dedication of those working across our health and social care services.

“To achieve our aim it is essential we create the right conditions nationally to support local communities in their planning and delivery of those services and support – to help ensure that the unique characteristics of each individual and family are met.”

The Department of Health said it had made a commitment to address variations within end of life care, including investing £11 million from NHS England into funding for the Children’s Hospice Grant.

A spokeswoman said: “We want all children and their families to receive high quality, compassionate and tailored care at the end of their life, regardless of where they live. That’s why we have committed to improving care in all settings.”

Update 12th November – And I forgot to mention child and adolescent mental health. A letter from an exasperated mother in the Sunday Times reads:

Psychiatry crisis takes toll on young anorexics

The woeful provision for young people with eating disorders led to my daughter being transferred in March to Edinburgh — even though we live in Hampshire (“Crisis in child psychiatry as vacancies soar”, News, last week).

It is totally unsustainable and she cannot build a life outside while she receives care. In early summer she was ready to move on but beds and/or funding were not available, so she has relapsed and lost hope.

This happens to patients time and again; hence the cyclical nature of anorexia. As a mother, I feel I am fighting on all fronts every day to get the right treatment for my daughter — with her condition and her daily or future care — while also dealing with grief and sadness for all that has been lost for our daughter and family, and the fears over what lies ahead for her.

There is a desperate need for more inpatient beds and a variety of treatment settings community, acute or inpatient and step-down) in which there is a greater range of therapy options to enable all the complexities of the illness to be addressed. One size does not fit all.

Incentives to train more psychiatrists, mental health nurses and support workers, plus a specialist eating disorders pathway for therapists, are essential.
Jemma Perkins, Andover


Stroke patients in Wales ‘could die’ because thrombectomy not available Acute shortage in NHS of specialist doctors who undertake life-saving treatment means hospitals cannot provide it

The WHO will be reporting on the gross overall outcome comparators of different health systems and the next time they do, it will not be on the British “National Health System” but on the 4 Principalities in charge of their own health budgets. The long term rationing of medical school places, and the generalised under-capacity, mean that post code rationing is reality for a common and serious illness. More will follow. It’s going to get worse because none of the profession would have started from here. The BMA has been asking for more medical school places for years…. and only now are applications rising – we have to wait 10 years or more for most of the new entrants to be useful.

Image result for stroke cartoon

Dennis Campbell in the Guardian reports 1st October 2017: Stroke patients in Wales ‘could die’ because thrombectomy not available Acute shortage in NHS of specialist doctors who undertake life-saving treatment means hospitals cannot provide it

Stroke patients in Wales are being denied a life-saving pioneering treatment after the surgical team providing it had to be mothballed because of an acute NHS shortage of the specialist doctors who undertake the procedure.

Internal NHS emails obtained by the Guardian reveal that health service bosses in Wales are pleading with hospitals in England to perform mechanical thrombectomy on their patients to save them from disability and death.

And they show one senior doctor warning Welsh NHS officials that they have “not got a grip on the situation” and deserved to be “the laughing stock of the international neurovascular community”.

Doctors who specialise in stroke care are warning that the inability of the NHS in south Wales to offer patients what they say is a “game-changing” operation illustrates a chronic UK-wide lack of consultant interventional neuroradiologists (INRs).

They perform both thrombectomy and a similar emergency procedure, called endovascular coiling, on patients deemed at imminent risk of suffering a stroke.

However, there are just 70 consultant neuroradiologists working in the NHS across the four home countries – barely half the number the Royal College of Radiologists says is needed to cope with the rising demand for mechanical thrombectomy in particular.

That shortage means a number of hospitals are unable to provide the operation themselves and must send patients elsewhere.

University Hospitals Coventry and Warwickshire NHS Trust, which is struggling to fill several vacancies for INRs, has been sending stroke patients who need coiling 50 miles north to Royal Stoke University Hospital since January and sends mechanical thrombectomy cases 20 miles away to the Queen Elizabeth hospital in Birmingham.

The Stoke hospital, which in 2009 became the first in the NHS to offer mechanical thrombectomy on a 24/7 basis, has also been treating patients from six hospitals in the east and west Midlands, and north Wales, since 2010.

Patients from Middlesbrough who need emergency stroke treatment travel the 47 miles to Newcastle to have it rather than the town’s James Cook hospital, which cannot recruit enough INRs to offer its own local population that service.

Glasgow has also had recent problems offering mechanical thrombectomy to its citizens, some of whom have instead gone the 50 miles to Edinburgh for treatment.

The problems underline the NHS’s deepening staffing crisis, which hospital bosses claim is now a bigger issue day to day than lack of money. They also threaten NHS England’s ambitious plans to hugely increase the number of patients who undergo thrombectomy as part of its plan to reduce avoidable mortality.

During a thrombectomy doctors remove a blood clot from someone’s brain using a stent. That gives patients a much better chance of walking out of hospital unaided and disability-free rather than ending up with significant paralysis, or dying. Evidence suggests it is more effective for some stroke patients with a blood clot than solely undergoing thrombolysis – receiving clot-busting drugs – which is the traditional treatment.

Cardiff and Vale University Health Board launched Wales’s first clot-retrieval service, covering the bulk of the country’s 3 million population, last August. However, it had to stop functioning in May this year when one of the three doctors providing it retired, another got a new job and the third went on sick leave, and no replacements could be found.

Stroke specialists warn that patients from south Wales could die because they can no longer have a thrombectomy. Efforts by senior NHS officials in Wales to persuade hospitals in England to perform the procedure on patients from south Wales have so far failed to lead to any formal cross-border care agreements.

The NHS in Wales estimates that 500 people a year from the country would benefit from undergoing thrombectomy. Yet hospitals in England have made clear that they already have too many cases of their own, and too few beds and staff, to help on more than an occasional ad hoc basis.

In a testy email to Welsh NHS officials last month about the disappearance of the Cardiff service, Crispin Wigfield, the North Bristol NHS Trust’s stroke lead, told them: “At the risk of being blunt most frontline clinicians think that you have not got a grip on the situation and if it wasn’t so serious Wales would be the laughing stock of the international neurovascular community.”
His hospital at the time had no spare intensive care beds to be able to accommodate stroke sufferers from Wales, he told them.
In another email Dr David Rosser, the medical director of the Birmingham trust, told Welsh NHS officials that “we are, sadly, unable to support this [request for a cross-border thrombectomy] service as we do not have the capacity [to take extra patients].” He declined Welsh colleagues’ offer to pay for the opening of extra beds, explaining that his hospital was already “opening every bed we can get staff for”.
Doctors in south Wales can only seek help from a few English hospitals because doctors have ideally between four and six hours in which to perform a thrombectomy or the chances of a patient receiving real benefit fall significantly.
Twenty stroke patients from Wales have undergone coiling since May in hospitals in Birmingham, Bristol, Oxford, Plymouth and Southampton. The Cardiff service has recruited one new INR, but does not expect to resume offering thrombectomy for some time.

Terrifyingly, according to the World Health Organisation definition the UK no longer has a NHS

Image result for stroke cartoon

Record numbers apply for Oxbridge and medicine



Golden goodbyes for NHS managers soar to £39m

Its quite surprising that managers who will not get jobs outside the health service (except in health providers) are so “valued”. The doctors who move into management are considered to have “moved to the dark side”, as their colleagues appreciate that the philosophy is unsustainable and the hoops they are asked to jump through are mostly pointless. This applies in both Hospital and GP land. As referrals are “blocked” more taxpayers will have to go private…

Image result for health manager cartoon

Nadeem Badshah in the Times 16th September 2017 reports: Golden goodbyes for NHS managers soar to £39m

Spending on golden goodbyes and voluntary redundancy deals has risen eight-fold in a year at the Department of Health, according to official figures.
A parliamentary answer reveals that more than 700 staff left the department in 2016/17 due to restructuring and cost-cutting programmes.
The figures, which cover the DoH and its agencies, showed that £39 million was spent in total, compared with £5 million the previous year.
Across the whole of the NHS, including the DoH, £153 million was spent on redundancies and “exits”, up from £141 million the year before.
Philip Dunne, the health minister, said that “voluntary exits” of DoH staff accounted for £31 million in a parliamentary answer published this week.

An additional £1.4 million was spent on compulsory redundancies, the Health Service Journal reported.

The remaining £6.6 million is thought to have been spent on voluntary redundancies at agencies including Public Health England and the Medicines and Healthcare Products Regulatory Agency. Ministers were criticised in March after revealing that 340 civil servants were to be recruited, despite the mass redundancies, largely to respond to Brexit.

Almost £2 billion had already been spent on NHS redundancies since 2010.

Official statistics released earlier this year showed that in the past three years more than 1,000 civil servants and senior NHS officials were awarded exit payments of more than £100,000, with 165 receiving at least £200,000.

Separate figures disclosed that more than 600 NHS quango bosses are now on six-figure salaries, with a doubling in the number earning more than the prime minister in just three years.

In 2010 the Conservatives pledged to reduce spending on NHS bureaucracy. A reorganisation of the health service reduced administrative costs, but has resulted in almost £2 billion being spent on redundancies.

The DoH said: “The department undertook a redesign and subsequent restructure to make sure it is best placed to meet current and future health and social care challenges. Redundancy and other departure costs were paid in accordance with the provisions of the civil service compensation scheme.”

Carolyn Wickware in Pulse 15th September reports: GPs told to refrain from referring as hospital declares early-season black alert

NHS managers still growing as GP posts fall

HSJ implies Managers and Directors are now at odds with Politicians over rationing..

It’s falling apart, and it’s going to get worse… for everyone except the top managers and politicians.

GPs (Commissioning Groups in England) spend vast sums on temporary managers – no its not happening in Scotland or Wales

NHS middle managers too comfortable to take top jobs “Kafkaesque regulation and rising patient expectations mean that managers and doctors opt for an easier life in less demanding roles”… political courage is needed.

Whistleblowing in the NHS – The need to regulate non-clinical hospital managers

Perverse behaviours by managers lead to covert and unfair systems for us all. Patients ‘bumped from cancer test waiting lists’

Trying to defuse some of the invective against NHS managers.