{"id":296520,"date":"2025-07-27T18:27:14","date_gmt":"2025-07-27T18:27:14","guid":{"rendered":"https:\/\/www.europesays.com\/uk\/296520\/"},"modified":"2025-07-27T18:27:14","modified_gmt":"2025-07-27T18:27:14","slug":"why-nhs-wales-needs-more-managers-not-less","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/uk\/296520\/","title":{"rendered":"Why NHS Wales needs more managers, not less"},"content":{"rendered":"

\"\"Photo Jeff Moore\/PA Wire<\/p>\n

Professor Russell Deacon<\/strong><\/p>\n

To anyone who works in or interacts with the NHS in Wales \u2013 be it for themselves, a friend, or a relative\u2014it\u2019s clear that when the system works, it can be a truly extraordinary institution. It saves lives, offers comfort, and provides care in times of great need. But when it doesn\u2019t work, the experience can be frustrating, disjointed, and exhausting.<\/p>\n

The NHS in Wales often suffers from what economists call \u201cdiseconomies of scale\u201d \u2013 an organisation so vast and cumbersome that its own size becomes the very thing that slows down the compassionate, efficient care at its core. Bigger is very often not better with respect to the patients who often have no choice but to use the service!<\/p>\n

Let me put it another way.<\/p>\n

Imagine if all supermarkets in Wales, except Waitrose, were merged into one giant Tesco. Now imagine this new Tesco placed most of its stock in massive hypermarkets with 200 aisles, where the products were largely free \u2013 but with a much narrower selection than before, when there were many different supermarkets. In each aisle, shelf-stackers were responsible only for their own section, rarely communicating with other aisles.<\/p>\n

In each aisle they tell you what you can have, when you can have it, or that if items are out of stock you would be placed on a waiting list but with no idea how long the wait would be. At the same time sometimes you couldn\u2019t move from one aisle to the next because staff were on staggered (or simultaneous) breaks. Each aisle had a supervisor governed by a lengthy rulebook, which could lead to inconsistencies in stock and its availability. The store had a general manager, but they were far too busy to manage each aisle effectively. Staff often outnumbered customers, but at many times seemed more focussed on their products than the needs of the people using them.<\/p>\n

This, to me, is a fitting metaphor for how the NHS currently operates in Wales. Tesco represents the NHS; Waitrose is the private sector \u2013 offering similar or better products (sometimes by the same staff working extra hours), but at a price most Tesco shoppers couldn\u2019t afford. This seems to be the operational model the NHS in Wales has chosen.<\/p>\n

<\/a><\/p>\n

Business logic<\/strong><\/p>\n

We\u2019re told that \u201cthe NHS isn\u2019t a business\u201d and that it can\u2019t run like one. But that doesn\u2019t mean it should reject basic business logic: effective management, streamlined operations, and accountability.<\/p>\n

Right now, we all pay for a product we can\u2019t always access that easily or at all. If this were a commercial enterprise making its customers wait years for a product, we\u2019d go elsewhere. But with a near-monopoly and limited private alternatives, most of us are stuck with the \u2018Bigger the Better\u2019 model of service provision.<\/p>\n

From my own experience \u2013 and more recently in picking up an elderly friend from hospital \u2013 the system is clearly not working as it should. After five hours in the ward waiting, no doctor was available to explain the patient\u2019s diagnosis or recovery plan, so we were discharged without one.<\/p>\n

Though he was told he could be discharged at 1pm, we were informed when I arrived it would take another 2\u20133 hours for pharmacy to issue his medication. Meanwhile, my local GP surgery in Caerphilly can process a prescription in two minutes. I was told the delay was due to \u201cvolume\u201d and \u201cmultiple checks\u201d. But why can\u2019t prescriptions that are issued every day be pre-packed based on data? It left me thinking why must the worst practices in the NHS persist when better ones exist within the same system? Would not each ward having an effective manager ensure that this situation did not occur?<\/p>\n

<\/a><\/p>\n

Improvements\u00a0<\/strong><\/p>\n

Not all NHS patient improvements require vast sums of money. Many come down to changing attitude, communication, and remembering that patients and their families aren\u2019t fluent in NHS jargon. We need transparency, compassion, and some common sense when dealing with people.<\/p>\n

From what I have seen and noted, what patients need from the NHS in Wales are:<\/p>\n

1. Clear timelines \u2013 If there\u2019s a wait of hours to be seen when entering the system, let people return closer to the time for their scan or check-up. If they are already on the ward, don\u2019t say \u2018a doctor will see you some time\u2019, say between 11-12 or around that time. The patient can relax and stop looking at every medical person who passes wondering if that is the doctor.<\/p>\n

2. Uniform clarity \u2013 Related to point 1 \u2013 a wall chart explaining staff roles by uniform colour would help us know who does what.<\/p>\n

3. Patient confidentiality \u2013 Don\u2019t discuss medical details publicly on the ward when in your group consultations; both the patients and everyone visiting can hear and see you do this and it does little for patient confidentiality.<\/p>\n

4. Diagnosis clarity \u2013 Explain the condition and recovery plan clearly, in writing, with patient, family and GP. .<\/p>\n

5. Medication guidance \u2013 What does it do? What are the side effects? When will it help? Please tell us.<\/p>\n

6. Respect for older patients \u2013 Speak to them directly, not just their relatives over their heads.<\/p>\n

7. Joined-up care \u2013 How does hospital treatment link with GPs and community services? Why can\u2019t those discharged be provided with a GP follow up appointment time within 48-72 hours to plan their recovery?<\/p>\n

8. Break coordination \u2013 Why not stagger breaks to avoid bottlenecks, such as X-ray taking a break 30 minutes different from the department that is sending them there?<\/p>\n

9. Post-discharge support \u2013 Provide real contact points if problems arise and advice, not dead-end phone lines. The private health system does this already.<\/p>\n

Inconsistency<\/strong><\/p>\n

Some NHS staff and institutions undoubtedly do much of this. But many do not \u2013 and the system allows that inconsistency to persist. For patients, especially the elderly or vulnerable, a hospital visit can be physically and emotionally draining. When you observe staff clustered like sheep on a field, it\u2019s hard not to wonder, where are the shepherds?<\/p>\n

Contrary to popular belief, the NHS doesn\u2019t have too many managers \u2013 it has too few effective ones. What it needs are competent, compassionate managers who can shepherd the service toward its founding principles: to care, to cure, and to do so with dignity.<\/p>\n

We all want the NHS to succeed. But unless it changes how it\u2019s managed, we risk allowing this titanic service, like the ship of the same name, to continue sinking into troubled waters.<\/p>\n

Professor Russell Deacon is a visiting Professor in Welsh History and Politics at the University of South Wales but writes here in a personal capacity.\u00a0<\/p>\n

Support our Nation today<\/p>\n

For the price of a cup of coffee<\/strong> a month you can help us create an
\n independent, not-for-profit, national news service for the people of Wales, by
\n the people of Wales.<\/strong>\n <\/p>\n","protected":false},"excerpt":{"rendered":"Photo Jeff Moore\/PA Wire Professor Russell Deacon To anyone who works in or interacts with the NHS in…\n","protected":false},"author":2,"featured_media":296521,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5010],"tags":[748,4884,16,15,1764],"class_list":{"0":"post-296520","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-wales","8":"tag-britain","9":"tag-great-britain","10":"tag-uk","11":"tag-united-kingdom","12":"tag-wales"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@uk\/114926613784495498","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/296520","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/comments?post=296520"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/296520\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media\/296521"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media?parent=296520"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/categories?post=296520"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/tags?post=296520"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}