Letters: Managers are the lifeblood that keeps the NHS running

Whenever I attended an NHS hospital as a patient, on arrival there are signs, which someone has put in place, to direct me to the appropriate entrance. I pass through the functioning automatic doors and step into an area where clearly the heating, lighting and ventilation are all in order. Cleaners have been busy, the corridors and waiting areas hours before my arrival. I follow signs to Reception where the person behind the desk, and there always is someone there, knows that I am coming and knows where to send me to meet a “patient-facing person”. In the examination room the medical specialist is also expecting me, with all the relevant information about why I am there and in addition my historical medical data. When he or she wants to examine me on a bed there is an endless supply of hygienic paper sheets for me to lie on. The doctor puts on rubber gloves out of a box which is always there and never runs out. And so on and so on with ever increasing complexity as the medical intervention becomes more serious. If I have to stay overnight the background organisation becomes greatly more involved. The preparations required for even routine surgery can be quite staggering.

None of these things happen just by chance. There must be people making sure that everything is working – these people are managers.

We take for granted that our contacts with the basic unit of the NHS, General Practice, run smoothly and that when we go afterwards to the pharmacist that he or she will have the required medicine ready to collect. As in a hospital it all depends on good organisation and team work.

The NHS depends utterly on team work. Sack most people who do not directly face patients, as your correspondent demands, and the whole system collapses.

Consider the situation for your correspondent who worked as a professor in the United States and whose thoughtless letter prompted this response.

What would happen if he were to work in a university which had sacked most staff who did not deal directly with students? I expect he would have been annoyed turn up to present a lecture and find the door to the lecture theatre was locked, or if it was open the half the lights were not working, or the air conditioning had failed.

It may well be that the NHS needs re-organisation but let it be done with some understanding of how the it all works and how its different aspects are integrated.

Hugh Boyd,

65 Antonine Road, Bearsden.

I TAKE a quite different view than that of John Black. The NHS in Scotland has made (cash-releasing) savings annually for more than 20 years. Invariably, health boards increase the percentage savings target for non-clinical services and reduce it for the patient-facing clinical teams. However, currently, my own board has a policy of delaying the filling of all vacancies as they arise – a random and dispiriting attempt to balance the books in-year.

As a primary care clinician, I cannot do without a clerical team and manager support – skilled individuals who know the local NHS and many patients. I depend on consultants’ secretaries to assist patients and navigate a complex organisation. I need others to book clinics, to inform me of waiting times and HR professionals to deal with employment problems, aberrant behaviour and provide organisational development for teams. These are not empires, they are loyal public servants striving to improve quality, safety and efficiency of services.

I struggle to support the case for funding in the NHS of drugs for ovarian cancer which extend life for a very few months when we have major social care needs, poorly remunerated care assistants and a deep need to provide care and end of life care in the community. Such care meets the urgent requirement to ease delayed discharge numbers and the concomitant pressure on emergency departments unable to move patients from cubicles to wards.

Philip Gaskell,

General Practitioner,

Woodlands Lodge, Buchanan Castle Estate, Drymen.

I WAS puzzled by the letter from John Black. To remind him, Scotland's National Health Service and social care are being integrated and locally devised plans for delivery of services are being delivered by locality planning groups which include members of the public.

I live on an island and our team of hard-working GPs hold surgeries, work out of hours and cover the community hospital working alongside nurses, allied health professionals, social care staff, administrative staff and linking to mainland hospital staff. We also provide training placements for medical students. Is Professor Black really suggesting the doctors should act as receptionists, do their own administration tasks, order drugs, take minutes, and book transport arrangements for patients travelling for treatment on the mainland? As a patient who is a member of a Locality Planning Group, I would think this was a waste of resources and time.

Does he think that the consultants who visit from the mainland arrange all their own appointments, arrange their own travel and accommodation ? If I have to visit a hospital in Glasgow I would not expect my consultant or nurse to check my travel arrangements home, book a wheelchair and make sure this was done safely and compassionately. I do accept that everyone involved in delivering health and social care might be able to make some more savings through the locality planning groups, although everyone is already working hard to be more efficient without losing sight of the needs of patients.

If Prof Black thinks managers, accountants, cleaning staff and catering staff never see patients then he has never been to a health and care forum meeting or worked in a community hospital. He must live in a very different world from my reality.

Ann Humphreys,

11 Keills, Port Askaig, Islay.

EMERITUS Professor John Black claims that one-third of the NHS Scotland budget is spent on administration, or “paper pushers who never see a patient” as he disparagingly terms them. Perhaps the good professor, who calls for “the lot” to be sacked, would care to tell us where he gets his absurd statistics.

Dr Jim Macgregor,

Lawhill Cottage, Dollar.