He was telling me about an interesting staff-side scenario that he recently faced.

Following the implementation of TCS (where some ‘community based’ services from the local PCT have recently transferred to the acute Trust next door) his Trust decided to re-organise some of their patient pathways.   In one area,  two related services operated out of buildings next door to each other.  It was felt that in order to improve  patient experience and the quality of service provision it would be better if two  services were co-located in the same building.

It sounds simple, doesn’t it?  In terms of human resources implications there was:

a) no impact on pay

b) no impact on the hours of work

c) no impact on the type of work they would be asked to do

d) the employee’s would not incur any additional travel costs as they would still be operating out of the same site.

The benefits were numerous.  There would be greater communication, more opportunities to work as part of a larger team, and hopefully increased staff engagement.

So Andy embarked on a consultation.  The staff saw the benefits and all voluntarily agreed to the move (to the next building).  An implementation date was fixed and plans progressed.

The plan was neat. It was simple and effective.  Until the local staff side representatives found out.  They informed the staff that in effect they were being consulted on a “Variation to Contract”.  Staff were informed by their trade union representatives that in effect they were being dismissed and re-engaged again.

As a result, the staff became anxious, worried  and started to challenge the move.  They didn’t want to be dismissed.

Andy spend the next couple of weeks engaged in a series of meetings and conversations.  He spoke to the staff about  what the contractual implications were and in particular the difference between voluntary agreement to the variation and serving notice on the proposed variation.

As a result, a simple HR process turned into an HR nightmare.  Andy, to his credit, was patient and focussed on the end result.  The move still took place to schedule, but it wasn’t without stress and anxiety on behalf of all staff and managers.  I think the only people who won in this case was the trade union representatives.

It doesn’ t have to be like this. But too often it is.

This afternoon, I can’t remember any of the science behind her recommendations, but all I know is that I’m to abstain from all caffeine (coffee and diet coke feature a lot in my diet), eat more nuts and seeds, go wholemeal, eat a little less red meat and a little more white meat.

In my case, it doesn’t really matter how much of the science  I do or don’t remember, I’m clear about what my actions are.  But is this always the case with employees who are going through some kind of formal procedure?

I’ve been supporting two friends recently as they have been under threat of dismissal (one for gross misconduct, the other due to redundancy).  It’s been interesting being on the other side of the fence, seeing how hard it is for an employee to navigate the formal procedures we use in HR.

In the redundancy situation there were so many different options for my friend that it just confused the issue.  My cynical mind thinks that the organisation used my friend’s confusion to their benefit, trying to persuade her to take a voluntary severance (VS) over what appeared to be a clear case (to me) of compulsory redundancy.  Obviously, the VS package was the cheaper option for the organisation.  The more questions my friend asked (following our conversations), the more information she received. Even for me, it felt like wading through treacle at times.

In the other case, the employee hadn’t realised what the allegations were that had been made against her when she was suspended.  Having reviewed the documentation she received, they did inform her – but she just hadn’t heard or understood.  Despite being supported by her union, she was given very little information on what was happening to her, what the next steps were, and how she could best prepare.

When I’m talking to employees I try to give them the full picture , including the worse case scenario.  If employees are going through organisastional change, I tell them from the start of the process that it might end in redundancy.   I inform witnesses in disciplinary investigations that their interview notes or statements might end up being public documents should the case get to an Employment Tribunal.  I think it’s important, so that employees can prepare themselves and make the right decisions based on the long-term view.

But how much do employee’s really take on board when we bombard them with this information at a difficult and stressful time in their employment?  Whilst we might follow-up any conversation in writing, do employees really read the finer details?  How much more should an employer do once it’s met its legal implications?

There is the argument that employees have their trade union representative who can support them in such instances.  However, in my experience, the quality and experience of the union support is variable.  There are some great union reps, and others who I feel miss the point and confuse the issues – and it’s the employee that suffers.

Another approach is to keep on re-iterating the key information to the employee(s) concerned.  I could be wrong, but I’ve never heard of an employee tribunal being lost due to an employee being given too much information.

In the centre of all this is the need to consider each employee as an individual.  Each employee reacts to their situation differently.  In cases of gross misconduct, some staff show remorse whilst other don’t when faced with similar scenarios.  The threat of redundancy can be a positive or negative experience for employees -depending on their personal circumstances.

What I have learnt over the years is that it is impossible to pre-judge an employee’s reaction to redundancy or other dismissal situations.  I’ve also observed that employee’s will tell us when they’ve “got it” and will keep on asking questions when they haven’t.

And if an employee is still asking questions…….. the organisation hasn’t yet given them enough information.

So, instead this guest post was provided by Erin Palmer – a writer and editor with Bisk Education. Erin works with the online programs for prestigious universities such as Villanova University. Erin can be reached on Twitter @Erin_E_Palmer.

With much of the public sector facing spending cuts, alternatives need to be explored to remain productive and efficient while staying under the bottom line. Once such tool, video conferencing, is changing the way we do business by reducing travel and training-related expenses. Instead of dealing with mileage reimbursement and hotel bills, video conferencing helps to efficiently use time and energy within a lower budget.

One of the most popular video conferencing services being used is Skype. The software application provides a lot of services including free phone calls to landlines, but its video conferencing feature has grown in popularity. As is with any new endeavor, there are some tips to follow that will make your first (or next) meeting run a little smoother.

Make your environment distraction-free

With so many gadgets and devices floating around your workspace, something is bound to make a noise, light up or pull your attention away from the meeting. Remember that the other individuals participating in the meeting can see you. Remove clutter from your desk, make sure unnecessary electronics are turned off and keep people from coming into the office while conferencing. Be respectful of other’s time.

Dress appropriately

Don’t forget to look professional. Just because you’re not meeting in person doesn’t mean you aren’t making an impression. Dress as if you were actually going into a face-to-face meeting and make sure to do a spot check before you go live. Having a ketchup stain on your shirt or being dressed in pajamas is not appropriate.

Choose the right meeting time

Give careful consideration to the time you schedule the meeting. Too early or too late in the day both have their downfalls (both lend to less interaction from the group as they wake up or are winding down). If you’re working across different time zones, remember to account for the time difference and try to accommodate everyone.

Create specific parameters for the meeting duration

Letting everyone know how long a meeting is going to last will help keep everyone focused and moving forward on the meeting objectives. Be clear on a start time and sign in early, especially if you are running the show. It’s okay if the meeting runs a little long, but don’t keep everyone on if you’re only having a discussion with one individual.

Prepare materials and add contacts beforehand

Being organized before the meeting is very important. Have key statistics or data nearby that you can reference when needed. It is a waste of everyone’s time if you are trying to search for an important number or file while everyone is waiting on you. Moreover, sending an outline or other specific data to attendees beforehand will help to keep the meeting on point. This allows the other participates to generate questions beforehand and makes it easier to get lively participation.

Equally important is getting contact information, ideally before the meeting starts. Include alternative phone numbers should there be a problem with Skype or the connection. Being able to quickly reach other participants in the event of a problem will help salvage meetings and relationships.

Make sure that your speakers/microphones are in working order

It is vital to make sure everything you need for the video conference is working before it starts. Test everything with someone at the office so you know everything sounds and looks good. If you’ll be video conferencing on a regular basis, consider upgrading your microphone, getting a better camera, or buying a headset.

Listen intently

Remember that you’re on camera, so you should be paying close attention and listening to everything happening in the meeting. Be aware of your facial expressions and always be engaged. You’re on camera, so some physical cues like nodding and smiling will let the others know that you’re listening.

Skype and other video conferencing programs can really help the public sector cut down on costs without sacrificing productivity. Using proper meeting etiquette will help make video conferences just as effective and successful as in-house meetings.

These interview tips were provided by Villanova University’s online HR programs. Villanova offers human resources courses in addition to a Master’s Degree in Human Resources that is available 100% online. For more information please visit http://www.VillanovaU.com.

It took me a while to work out why my gut feelings were telling me that there was something wrong with this correspondence.  And then I realised what it was:  The HR Manager referred to the Doctor and his colleagues by their first names through-out the email exchange, even though they were discussing a serious matter.

Whilst this may not appear to be inappropriate or disrespectful during most email exchanges, in the NHS there is an unwritten ettiquette in how you converse with a Consultant.

Firstly, you make sure that you get the title right.  Never call a Mr a Dr and vice versa.  There’s a simple rule to follow:  Surgeons and O&G consultants (Obstetric and Gynaecology) are Mr.  The rest are Drs.

Secondly, never refer to the Doctor by their first name at the start of a conversation.  Even if they call you and say “Hi, this is Bob”.  You respond “Hello Dr Leonard”.

Out of curiosity, I spoke with the HR Manager in question and asked him why he was so informal.  He replied that he believed that he was as equal as the consultant and therefore all communication should on first name terms.

Whether we like it or not, there is a hierarchy in the NHS.  And the Doctors are higher up in that hierarchy than an HR professional.  And there are many reasons for this, but the two main ones are as follows:

a) to qualify as a doctor and sustain a credible career takes a lot more hard work than becoming an HR Manager.

b) Doctors move around hospitals during their training years.  But when they get appointed as a consultant, they usually stay at that hospital for the rest of their career, unless something significant happens.  They see Chief Execs, Managers, and HR Professionals come and go.  The only other long serving employee is usually their medical secretary (which in itself will deserve another blog post).  Their view and perspective is on the long-term and therefore this influences how they manage their relationships.

It’s not hard to address someone formally at the start of the conversation. It sets the tone.  By showing respect I believe that I am taking one small step towards building good, credible relationships with Consultants.

So I think my HR Manager is wrong.  We aren’t equal and I think it’s delusional to think that we are.

Naturally, the end of any year is a time to reflect on what you’ve achieved and setting new goals and targets for the New Year.  I’m never very good at setting New Year Resolutions, and usually they are not determined until the  second or third week of January.  I need time for my thoughts to mature before I make the commitment to my resolutions.

December also marks the anniversary for my business.  This last year has been interesting and more successful than previous years.  In brief, it’s been about working hard for shorter periods of time, taking more holidays,  repeat business and diversification.

That last point is particularly important:  in June time I received an unexpected phone call from a Twitter pal.  This phone call has had a significant impact on my business and has enabled me to increase the diversity of my work and type of client I work with beyond any planned goals or targets I would have set at the beginning of last year.

Which has led me to think about the content of this blog. Because whilst the NHS still remains a key client of mine, they are not my only clients. I have also had a number of ex-colleagues  who still work in or with the NHS contact me over the Christmas holidays talking about my blog. Ttheir comments are valued and remind me that there aren’t any other NHS HR bloggers doing what I do: giving the perspective of what it’s like from an operational aspect.

After much deliberation I have decided that will continue to write this blog, as there is still so many quirky little NHS – stories worth sharing.

1.In an average District General Hospital (DGH) they will undertake about 2,000 outpatient appointments per day and 180 elective operations.

2. On an average week day, a DGH will admit about 80 patients through A&E.  On the weekend this will drop to 65.

Based on the above, the staffing levels are determined and bed moves are managed.  The Trust will run its operations tightly.  Any  significant increase in A&E attendances & admissions will be felt across the Trust.  Naturally, weekends have lower staffing levels because of the lower number of potential admissions.   On top of this, every Trust has sophisticated admission prediction tools, and they will increase / decrease elective activity in response to these predictions.   But like the weather, these predictions are sometimes wrong.

Turning to elective operations, the theatre list will be determined by the consultant who is recommending the surgery.   Each surgeon has different views on how their patients should be treated, and consultants do not “swop” or operate on another consultant’s patient except in exceptional circumstances.  The list is drawn up by specialty.  Eg a respiratory consultant will operate on all patients with lung conditions, including those with Cancer.

The same applies for outpatient appointments.  The key difference with outpatient appointments is that a patient may present with a persistent breathing issue [for example] and in the course of the appointment the potential diagnosis of cancer may present.

There were two strike exemptions on November 30th: one was emergencies, the other was cancer.  But as you can see above, it is incredibly difficult to pull out and determine who is a cancer patient on any given day without considerable effort.

Some Trusts treated November 30th November as a Bank Holiday.  Whilst it might be a sensible approach, I’m not sure how they pulled that off. Not withstanding the fact that it was [otherwise] a normal working day in terms of predicted admissions, but also the fact that usually, with planned cancellations, six week’s notice needs to be given.   Six weeks is deemed as the appropriate length of time to arrange cover / re-arrange appointments in a way that is not disruptive to the Trust.

Since the legislation states that strikers do not need to notify their employer before the day that they intend to go on strike, many Trusts had no idea of the true extent of the disruption.  They faced two choices:

1. Continue as normal, assess the situation at 8am on the day, and cancel as appropriate

2. Make cancellations at short-notice.  However, the Trust may find itself in a position where many staff arrive for work, only to find that there is no work to do.

The  impact on patients should not forgotten.  The exemptions were around cancer or emergencies.  But what abut the patient who’s been suffering for years with their leg?  Their routine operation scheduled for the 30th November is going to change their life.  And then it’s cancelled.  Or the patient who didn’t know she had cancer, until she attended an  outpatient appointment and through discussions with her doctor the diagnosis is made?

Other Trusts took the brave [but in my view the only] option to continue as normal.   What was not seen on Wednesday was the considerable work that was done behind the scenes by managers in Trusts to ensure that the hospital continued to run on November 30th.  The same managers who are in the unions that were out to strike.  And this work continues, as Trusts attempt to recover from the Day of Action.  As I said, maximum disruption.

Jordan’s a clever kid, but he just didn’t enjoy school.  After being expelled from 3 schools, his father home schooled him and he achieved 5 GCSEs grade A or A*.

Jordan then went to college.  He didn’t like it, so he dropped out.

Just after he turned 17 he decided he didn’t like living at home any more.  With the help of social services he moved to new accommodation.

Enjoying his new found freedom, he decided to go back to College.  He enrolled in 4 AS subjects and sat the exams the following summer.     He even enrolled for the second year at College but a couple of months ago decided that it wasn’t working out for him.

Instead, Jordan got himself a job.  It’s not permanent job, but the owner of a local restaurant employs Jordan on an ad hoc basis to be a runner and general dogsbody.  The relationship suits Jordan. He works fairly regularly, but isn’t tied to regular hours.

The thing that Jordan is most proud of is the fact that he’s managed to negotiate a good rate of pay of his work.  At £5 per hour, he’s earning almost twice what most of his fellow co-workers are earning.  Needless to say, this work is “cash in hand”.

Jordan is classified as unemployed.  But he’s happy with his lot.  He’s got his freedom, a bit of cash.  Right now he doesn’t really aspire for anything else in his life.

8 months ago she was successful in being offered a place on an Apprenticeship scheme in an HR department in an NHS Trust.

Emily had a bright outlook on life and took a positive approach to her work. She quickly learnt the role and worked well with her team members. Everybody liked her and she was doing a great job.

In 4 months time, when her apprenticeship ended, the Trust was going to offer her a job in their HR team. In 4 months time she would have some vocational qualifications under her belt.

But Emily decided she didn’t want to work in HR. She wanted to be a Maternity Healthcare Support Worker (MHSW).

So her boss – the HR manager – arranged for her to shadow a Maternity Healthcare worker (MHSW) for a week, instead of coming to work in the HR Department.

The idea was that when a job came up in the next couple of weeks for a MHSW, Emily would be in a great position to be successful in obtaining that role.

On the first day of her shadowing she didn’t turn up. She’d changed her mind over the weekend and didn’t want to be a MHSW.

In fact, she had decided she didn’t want to be an Apprentice at all anymore.

So, her boss – the HR manager – called her to a meeting. She even asked Emily to bring her mum.

They sat and talked about Emily leaving the Apprenticeship Scheme. Emily liked her work, liked the team, but she would not change her mind. She didn’t want to work in HR, she didn’t want to be a MHSW…..and she didn’t know what she wanted to do. All she knew that she did not want to continue on the Apprenticeship scheme. She wasn’t bothered about getting the qualifications. She wasn’t bothered about the almost guaranteed job at the end of it all. In four months time.

Her boss called the Education Provider, who also called a meeting with Emily. But they were unable to change her mind.

So now, Emily is at home. Unemployed. And a statistic.

To give you some background, my father-in-law dedicated his life to academia.  He invested in his pension scheme and a few years ago retired at the age of 60.  To say he is enjoying his retirement is an understatement.  He bought a boat, stripped it down and built it back up again.  In the summer, when he isn’t holidaying in Greece for a month, he goes sailing.  In winter, he works on the boat.  He regularly hosts and enjoys cooking fabulous food for his friends.  Needless to say, my father-in-law and his wife have a great social life.

But my argument round that dinner table was that I believed that when I wake up every morning, I am doing exactly what I want to do now.  I’ve worked hard to build my career and now I work as a freelance consultant.  This means that not only do I get to choose what projects I get to work on, I also get to choose how and when I want to take time off work to pursue other activities (like spending the summer in Spain with my kids).

Presently I’m working on 5 projects.  Each one is very different to the next and are interesting and challenging.  I’m not saying that these projects aren’t without frustrations, because they are.  But for me, the frustrations and how I overcome them are part of the learning experience.

A few days later I was participating in a very difficult meeting with some  trade union officials.  I sat there and thought  “I don’t want to be here”.  And with my father-in-laws words from the previous weekend echoing in my mind, I began to think “Why am I here? I don’t need to be here, I could do something else much more enjoyable.”

I must admit I came out of that meeting with a look on my face like “a bag of spanners”.  Two hours after the trade union meeting had finished I was briefing the Director of Operations and the Director of Finance on how the meeting had gone.  I concluded my debrief with some strategic advice – both short and long term as to how they should manage the situation which turned into a very productive debate of the issue.     It was this meeting which turned what potentially was a disastrous day into a good one.

That evening I was listening to a programme on Radio 4 about planning financially for retirement when I had the sudden realisation that I had 30 years of work ahead of me.  At first I felt shock (I don’t know how I’d miscalculated it, but I previously believed I only had 2o years of work ahead of me!) But then a bubble of excitement grew from the pit of my stomach.

I consider myself to be experienced in practicising my profession and I am able to earn a good living as a freelance consultant.  I realised that 30 years would give more experience, more opportunities to learn and hone my craft, to get better at what I love doing.  I was excited about the potential of my future.  

It may be interesting in 30 years for someone to draw attention to this post and ask “Was it all that?”   But to be honest, the answer doesn’t really matter.  I’m enjoying the here and now.



I often forget how much or how little the general public know about how the NHS works.  It’s perhaps because I’ve worked in and alongside the NHS for so long that it’s wonderful, strange and bizarre ways are almost second nature to me.

For example, I’m used to the fact that the monthly timesheets which are manually completed and sent to payroll have a different name in each Trust.  And yes, unless a Trust is very progressive  -  or has been working with the excellent  @Vincelammas – and have fully implemented the costly Electronic Staff Record and thereby using it to its full potential, the monthly timesheets are still completed manually costing millions of pounds in employing payroll staff to input each timesheet, audit it etc etc.  But I digress.

One Trust I have recently started working with has an interesting deadline culture. Every conversation ends with

“What deadline would you like [me] to work to?”.

I like this approach, and deadlines are strictly adhered to.  But it’s unique – and that’s why it has a struck a chord with me.

Although I like to think that I’m consistent in how I practice my profession,  I realised the other day that the way I approach issues depends on the local culture of an NHS Trust.

The HRD of one Trust called me as an issue had arisen regarding a particular topic.  He knew I had knowledge of the subject and would be able to give some sound advice.  I helped prepare a response which used evidence from NHS Employer documents, emails and minutes of meetings.  It was factual and contained timescales.  The HRD was happy with the proposed response and kept me in the loop as the internal discussions continued and the issue was successfully resolved.

Afterwards I sat and reflected – if another HRD from a different Trust I know well had called me with the same question, my response would have been very different.  In this second Trust the politics are subtle. My response would be designed around  managing the audience and focusing on the outcomes  rather than look at the detail.  A different approach, but appropriate for a successful resolution for that Trust.

So it isn’t easy, despite central control and guidance, to ensure that there is consistency in approach across the country, across every NHS provider.  The challenge is to find way to work with the nuances of each different culture when trying to embed a nation-wide initiative.   It also explains why some initiatives or innovative ways of working work in some areas, but not in others.

I think that’s why I enjoy working with the NHS – the local culture is a challenge and brings added complexity to the projects I work on.  Who would want easy or simple?