(We distribute a shorter version of this article in our hospital magazine Vital Signs no.5)
A lot of necessary work in the hospital is hidden. Be honest, how often have you contacted the IT department because you forgot your log-in details? Working together is essential, but they don’t make it easy for us.
As workers we manage to cooperate and keep society running through our combined labour, despite all the hurdles that this system puts in our way: the self-interest of individual departments and corporations; the outsourcing and high levels of fluctuation of staff; the precarious and militarized global supply-chains; the irrational hierarchy and bureaucracy; the unpredictable movements of markets and the arbitrary and abstract goal of turning our labour into money, rather than a better life for all. These hurdles create a lot of unnecessary work and frustration that we could do away with.
This experience of cooperation against all odds is the basis on which to rethink about an alternative society and the struggle for it. We have to turn our cooperation into real relations of solidarity – between hospital workers and workers who supply us with material, between inpatient care workers on the phone and the IT worker on the other end of the line. In a new society that is not limited by petty profit and power interests we can re-organise our cooperation consciously, for a better life for all.
At Southmead hospital we have a lot of admin staff. In 2025, out of a total of 10,238 workers, 2,486 were categorised as ‘Administration and estates’. That’s over 600 workers more than those working as ‘Healthcare assistants and other support staff’.
What are all these admin workers doing? How much of their work is related to coordinating patient care, how much to running the hospital? How much admin work is only done, because the market and the state forces us to deal with money transactions, legal back-and-forth or other bureaucratic bullshit?
We spoke to an admin worker in another NHS about their job. The first part describes the daily tasks and relationships, a future second part deals with the problem of outsourcing and the trouble as a union rep.
We will continue these interviews – if you want to share your experiences, please get in touch!
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I work in a radiology department as an appointment facilitator. There are two aspects to the job. Firstly, we arrange radiology appointments with patients. So radiology appointments include ultrasound, CT scans, X-rays, MRI scans. The MRI scans are done by a private company, which creates issues.
We receive referrals either internally from hospital doctors asking for scans to be carried out, or we would get requests from GP’s asking for scans to be arranged for patients. There’s also a private hospital that sends referrals to us – and all their referrals are treated as urgent, they get priority.
The referrals will be scored. You have a two week rule, when the clinician believes that the patient might have cancer. In this case we have to book that appointment within seven days. A lot of the time we can book appointments within seven days. Sometimes we cannot. The next level of priority is urgent, for example, if the GP thinks the patient is in a lot of pain. We will try to book within four weeks of receiving the referral. The others we have to book within six weeks.
There are various bottlenecks that cause delays of scans. We had a bottleneck with CT scans. One of our C scanners was out of action for seven months, we were 25% down on CT scanning. Management has been very quiet about this, but I think it could have led to deaths.
We handle phone calls from patients who want to book scans. We also actively ring patients to arrange appointments. We don’t just send out appointments without speaking with the patient. One admin worker would be dealing with the stream of work for ultrasound, another one with CT scans or bone density scans.
We’re over quite a wide geographical area. Depending on where the patient lives, some of the places can be awkward for the patient to get to, if they don’t have a car or they don’t have a family member or friend that can take them to the hospital. They then may have to rely on public transport, depending on how mobile the patient is.
Sometimes doctors do explain to the patient why they’ve actually referred them for an appointment, but sometimes they don’t. This is absolutely bizarre. Sometimes we do not know if the patient has had a face to face conversation with the GP. Now, some of our referrals are quite intimate. It could be like a trans vaginal scan, for instance, which is an internal scan. Some women may not want an internal scan, or they may want the scan done by a female radiologist or radiographer. So that leaves it up to us to explain what the procedure is, explain what the doctor maybe hasn’t said.
It also creates a difficult situation for us when it comes to cancer scans. Going back to those two week referrals, we can’t say your doctor thinks you have cancer. We can only say that the doctor wants you to be checked out as soon as possible. Sometimes, patients don’t want the scan done or they don’t think it is important. If the doctor hasn’t told the patient the reason for the scan, then that leaves us to find ways to bring across the urgency of the scan, while being restricted with what we can and can’t say. We are sort of trapped.
Apart from doing the job on the phone there are between 4 and 5 people working at our reception desks, booking patients in. That’s a different aspect to the job. We rotate between phone and desk. We book patients in, directing them to the clinics. We deal with patients that have come in late, because if they’re more than ten minutes late, they may not be seen. So we then have to speak to the relevant co-workers, like senior healthcare assistants, who might be able to slot them in. That requires a lot of improvisation, you have to know who to talk to. I would go down and speak with the CT technicians directly: “Can we get this patient booked in?”.
Then you have to ask a patient medical questions, depending on what the scan is. Some CT scans have a contrast dye and iodine dye. If you scan the chest upwards, the patients shouldn’t have eaten for two hours beforehand. If it’s from the abdomen and below, they should have eaten for four hours. We might then have a conversation with the technician saying: “Well, they’ve had a couple of biscuits and a cup of tea or coffee – is that still okay?”. Or when it comes to steroid injections. For that procedure we would have to talk the patients through the precautions that they need to be aware of. So they can’t have the steroid injection within two weeks of having had any vaccinations, because the steroid injection will completely invalidate the vaccination. You can’t have it within one week from when you took an airplane. You can’t drive home yourself, after the injection. You can’t be on certain medication, if they are, we have to talk to the clinician. We have to keep all that in mind.
We also have to have a spreadsheet with all doctors and radiologists on it, telling us what kind of procedures each individual clinician can do. We have to bear that in mind when booking in patients – not every radiologist will do all scans. Sometimes, when things are overstretched, patients end up in the wrong clinics.
We also prescribe medication, as Band 3 admin workers! When people have a colorectal they have to go on a soft diet 24 hours before the scan and take a certain medication called [name]. We talk the patient through this and send out the medication by post – we have to make sure it reaches them in time before the scan.
Each case has got quite a lot of different factors, it’s not that straightforward. There are potentials to automate some of the phone work, but then AI would perhaps not get the nuances or would be able to improvise, e.g. when a patient doesn’t speak English well. AI is already looking at scans, but that may be more straight-forward.
The main issue that prevents us from doing our job is the restricted budget. A restricted budget causes other problems which prevent us from doing our job properly, for example a lack of desks, not the right chairs or monitors. Very basic things. The lack of money filters through. For example, not all clinicians can or want to do bone density scans. So often we don’t have enough staff to do scans, because they also cut all bank shifts. Clinics reduce their opening times, which increases the waiting list. If elderly people don’t get their bone density scan, that might result in delayed treatment and possible fractures.
When there is a lack of porters, it is us admin staff who push patients in wheelchairs out to the taxi stand or guide them there. But then the transport has been outsourced to a private company paying minimum wages, and sometimes there are long waiting times. Then we have to arrange a sandwich or a cup of tea for the patient. Sometimes patients wait four hours in a chair, which can cause pressure sores. At the site where I’m working we have volunteers and they can help if we’re a bit stuck. This raises a whole other issue about how the NHS is using unpaid workers to do the work.
The lack of staff can cause problems when it comes to coordination between different departments. For example, elderly patients get discharged, although on their file it says that they are still supposed to have an ultrasound scan. Then family members might have to bring that patient in again, and are upset. A lack of investment means that our data platforms are not integrated. The radiology department uses a different system from other departments, which could mean that a warning note in the online form, for example that a patient uses a wheelchair, might not be passed on electronically to others.
Other issues are caused by outsourcing, for example our MRI scans are done through a private company within the hospital…
