skeletal-debate

Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.

Aneurin Bevin

The ability to provide safe, cost effective health and social care, across the National Health Service (NHS) England, and other recognised agencies, is continually being driven further into an abyss.  Contribution to this situation is seen through numerous factors: the change in societal expectations of what treatments should be available on the NHS; the historic failing of successive governments to create mechanisms within general taxation, and additional charging to facilitate the continuing demands on these services; poor leadership by the Department of Health-a direct result of short-termism and political ideology-cascading down to hospital management teams.  The private funding initiative (PFI) projects that have been demonstrated have a phenomenally catastrophic impact on patient care.  Outsourcing of services to the private sector which are integral to patient care, for example portering, and domestic services.  And more recently a drive, initiated through a shared myopia of government, and hospital managers, to blindly follow a culture of “more for less”, to name but a few.

Making savings ad infinitum with the objective of maintaining the same standards, is detrimental to an organisations ability to be efficient and sustainable.  Savings are a tool used by accountants to achieve short-term gains.  Whilst “Lean” working is a viable proposition in health care “lean” is not anorexic.  The long term effects of short term savings are to drive down standards, to force errors through the cutting of corners, and to cost the organisation dearly in the future.  “Speculate, you can’t accumulate, if you don’t”: true leaders in the NHS will see the value in this proverbial saying.

Hospitals are finding themselves in such financial dire straits, that with no apparent means of raising capital for investment, in the very basic infrastructure to make them viable propositions, under any  other circumstance they would be bankrupt.  It is possible to put a plug in the bath, even if it is a round(ish) plug in a square hole; and to at least turn the flow of the, money, taps down so they are running at a steady flow and not gushing.  But this requires long term policies, more freedom from government control, and leadership: not crisis managers.

It is time for hospitals to look at becoming shrewd financial investors; to speculate wisely.  If £25million in the red, to continue saving will only drive debt.  Speculate and invest to drive productivity over the long term, bringing the debt down.  If it is a system allegedly good enough for the government to implement, then why not Hospitals?

Following the passing of a much respected work colleague, the atmosphere in work was, as could only be expected, subdued.

Mark was an amazingly uplifting character. Despite suffering renal failure, and under going a successful transplant, Mark remained positive and inspirational. One had but to think of him, during personal times of crisis, to realise there was nothing to complain about.

Even when Mark was diagnosed with terminal cancer, his spirit never waived. It was the cancer that beat him in the end.

He has left a wonderful wife and two exceptional boys. And many a sad colleague.

Rest in peace dear friend. 

Managers do not inspire doctors or clinical staff but good leaders do. NHS needs good clinical leaders.

Dr Umesh Prabhu

It is true, managers do not inspire doctors or clinical staff; it is also true that the NHS needs good leaders. 

However, even good leaders will fail to inspire the diversity of professional groups within healthcare, even though they share common objectives. Professionals, who with their own opinion toward hierarchical importance within the organisation, are but a barrier to progress.

Recognition needs to be given to the real and present danger within health care. One [danger] so great that the power it wealds will lead to the conclusion of the self fulfilling prophecy, based on the negative implications, of a failing NHS. This danger to healthcare, and leadership within healthcare, is the short-termism afforded to financial savings imposed by accountants, on the behest of others.

What is required, is for NHS Trust boards to be represented by members of all parties with intrinsic and extrinsic vested interested in the provision of healthcare, each with parity of voice. 

NHS Trusts must be empowered to raise funds: but not held captive by the shackles seen imposed through Private Funding Initiatives (PFI); to facilitate long-term investment. There is real truth in the addage, “speculate to accumulate”.

NHS Foundation Trust Hospitals are in a position whereby they no longer have the facility, ability, to progress.

I have been married twenty-one years; I have two teenage daughters, and I am fifty years of age this year.

I wish to spend my fiftieth birthday in a log cabin, by a lake full of trout, with fishing tackle and a boat; with enough food essential’s to last a week. No Internet, nor TV, but a few good books. And did I mention on my own? Well yes on my own. 

If this makes me selfish, well so be it. Because I won’t enjoy my fiftieth any other way.

However, as I live in the UK this isn’t going to happen as I’d like.

So I guess I won’t enjoy it.

The role of an agency has historically been to provide a source of labour to bridge short term vacancies, through sickness or maternity leave etc., within permanent establishment numbers.  Naturally, due to the nature of the short notice required to fill these vacancies, the cost to the Hospital, and the remuneration to the agency staff, is higher than a basic payment.  However, more so now-a-days, agency staff are found to be in post, in the same hospital, for years, enjoying higher rates of pay than their permanent colleagues; having to add here with less security and benefits.  But is this their fault; that agency staff can find themselves in such a position?  The answer is a resounding no.

There are reasons as to why agency staff, from all professions, find themselves in long term posts.  These reasons have remained unchanged over the years and include, but are not limited to:

  • High turn over of permanent staff – either out of health care completely, or on to the agency; tempted by the flexibility brought about through agency work.
  • Stagnation in the employment market – unless there are substantial benefits to moving, most staff remain at the same place of employment for considerable periods of time.
  • Inability to recruit experienced staff into permanent positions
  • Develop good working rapport with department – flexibility

On the 23rd November 2015 Monitor and the NHS Trust Development Authority (TDA) introduced price caps relating to the total amount Trusts can pay per hour, across all professional groups of agency staff.  The reason being that due to the existing pressures on health care budgets managing agency costs could allegedly save considerable sums.

Jeremy Hunt had indicated that such an action could save approximately £1 billion over a three year period.  A secondary, less publicised objective of the price caps being the eventual forced migration of agency staff  back in to permanent posts within the health service.

Introducing capping of the gross amount payable to an agency provider, thus in effect capping the remuneration of agency staff, at a time of year when people are at their most vulnerable, is a deliberate crass act by Jeremy Hunt.  Obviously a sanction timed with deliberate intention; reducing the potential risk of rebellion by the agency staff, withdrawing their labour.  Moreover, the timing of such an act would appear to be a deliberate attack on Junior Doctors in retaliation to their planned industrial action.

For clarity, the how and why of capping:

4. How have the proposed price caps been calculated?
4.1 The caps would determine the maximum total hourly rate trusts can pay an agency for an agency worker.  The cap would apply to the total charge and therefore would include:
 worker pay
 worker holiday pay
 employer national insurance
 employer pension contribution
 administration fee/agency charge
 any other fixed or variable fees or payments to the worker or agency or bank (e.g. travel, accommodation, finder’s fee, bonuses)

http://bit.ly/1LS1Nvo

1.10 The price caps are intended to support trusts when they procure from agencies and to encourage staff to return to permanent and bank working.  They should enable trusts to manage their workforce in a more sustainable way, reduce reliance and expenditure on agency staffing, raise quality and improve the working environment for their staff.

The effect of the capping for Band 5 and Band 6 on maximum AfC rate, most typical of Nursing and Operating Department Practitioners (ODP) can be seen here (on page 17).  An agency shift rate calculator can be found here.

This is not the first time there has been an attempt to address the high cost of agency expenditure, with the introduction of NHS Professionals.  An agency provider, owned by Government.  Professing to be the primary provider of healthcare professionals in the country, NHS Professionals does not appear to achieve the objective of having a positive impact on overall agency expenditure.

The continuing use of agency staff will inevitably remain a thorn in the side of NHS expenditure, as safe and effective health care provision is a catch twenty-two situation. The provision safe and effective health care is man power dependent.  If the provision of health care has to be pared-down to a minimal work-force in order to save money, to re-invest in other area’s, then the money saved will never reach those other areas: it will be needed to pay for mistakes made.  Invest in a work-force and whilst it will cost more to get the provision of health care right the first time, the savings made in the future will be rewarding and significant.

Effective work-force planning in health care, as with education is compounded by the lack of fluidity within the professions.  It is difficult to plan ahead for recruitment and retention in these areas and therefore there is, and will continue to be, a need for agency staff. And the capping of agency rates, to draw staff away from agencies into permanent positions is not the resolve.  It will only serve to move experienced health care professionals away from the NHS.

Dear Mr Hunt

Let us not beat about the bush.

Your attempt to save the National Health Service (NHS) £1 billion over three years, by way of capping agency spending bills, to re-invest in frontline patient care, is nothing but bravado in the face of a public who knows no better; and intimidation of hard working professionals who have to tread daily through sludge of government induced bureaucracy in order to deliver high levels of patient care.  To implement this aggressive policy at a time of year when individuals are at their most vulnerable clearly demonstrates the disdain this government has toward public sector workers.

Jeremy, the ignorance to the true potential of damage to health care demonstrated through your action is incomprehensible.  It is evident that there is already considerable loss of income across the NHS through the inability of hospitals to meet, in a timely manner, contracts with commissioning trusts.  On-the-day cancellations attributable in part to the inability of NHS hospitals to staff substantive vacancies with permanent staff; and a reluctance to employ short term agency staff, compound loss of income with the addition of  fines imposed by the commissioning trusts for failing to meet standards.  The perceived cost to prevent the cancellations, through the employment of short term agency, is an additional expenditure of small significance in the grand scheme of overall patient experience and outcome.

It must be asked Jeremy whether National Health Service Professionals (NHSP) ltd, an agency for healthcare professions set up by the Secretary of State for Health Alan Milburn in 2001; which was still owned in whole (all though not centrally funded) by the Secretary of State for Health in 2011, is included in your harsh opinion of, “agencies ripping off the NHS“?  In the very own words of NHSP:

We typically recruit more than 1,000 flexible workers every month, making NHS Professionals the largest recruiter in the NHS. http://www.nhsprofessionals.nhs.uk/nhsp/Pages/default.aspx

Is NHSP Ltd going to flourish through your anti-competitive attack on the private companies supplying agency staff?

Based purely on empirical data there is sufficient, substantive, evidence to be able to be explicit in saying the ratio of permanent staff (doctors, nurses, Operating Department Practitioners (ODP)) in post, on any one day, is far greater than that of agency.

Jeremy, if you are serious about making substantive savings in the NHS, remove the barriers of the internal market implemented by Thatcher post the Griffith Report.  Healthcare in silo’s creates financial waste.  Put some meat back on the carcass of a health care system made too lean by the blind followings of an inappropriate management system.

Regards

Richard

 

141f3438758a52b854f3e2219e2c8f1bFollowing the atrocities of Friday 13th November, witnessed on the streets of Paris, during which, through coordinated suicide attacks and shootings, one hundred and twenty-nine innocent victims lost their lives, there has been a collective outcry on social media to “Pray for Paris”.  Praying will not bring back loved ones: will not lead to justice, what justice is there to be had?  However praying may very well be the only path to solace people know to take.

There have been two particular comments which have appeared on social media, that have stood out for me, which  could have much further reaching influence; and which can direct us toward the path to peace.

The first, “When the power of love is greater than the love of power, the world will know peace.”  Whilst there is religion, countries will know no peace.  Religion is the politicisation of  faith and with politics the love of power will always prevail.  Rabbi Jonathan Sacks, Baron Sacks, makes a suggestion in his book, “Not in Gods Name: confronting religious violence”, that the God of Abraham was a God without faith: that Judaism, Christianity and Islam compartmentalized faith through interpretations of the word of God by man.  Compartmentalization creates a “them and us” situation, that in turn leads to the power struggles, the dehumanization of the believers of one faith by others, and the violence allegedly perpetrated in the name of God.  Lose religion, keep faith in humanity, nurture peace.  God is faith in humanity: not religion.

The second has come from the Dialama,

“We cannot solve this problem only through prayers,” the spiritual leader said. “I am a Buddhist and I believe in praying. But humans have created this problem, and now we are asking God to solve it. It is illogical. God would say, solve it yourself because you created it in the first place.” http://www.rawstory.com/2015/11/dalai-lama-stop-praying-for-paris-humans-created-this-problem-and-humans-must-solve-it/

We can solve it, we must stand side by side in solidarity and say, “NO MORE!”

We need strength to have that faith in our neighbour as he has in us.