The impact of #N30: a day of action

Maximum disruption.  That’s the purpose of going on strike.    You will  have read the global figures on the impact of the Strike Action on November 30th but I felt it was important to write about the local impact.  Let’s begin with some basics

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.

Learning From French Industrial Relations

I was at an event with a client last night celebrating the success of a major project that I have been involved in over the last few months.   I normally don’t like such events as they are usually attended by an “interesting” array of individuals turn up to drink the wine & fill themselves up on canapes.  I much prefer impromptu, informal celebrations.  

But I decided to attend as I am really proud of the work that we’ve achieved together to make this project a success.  And as predicted, although I have been heavily invovlved in the project, I only knew about 15% of the people in the room.

As I was gathering a plate-full of canapes a man turned to talk to me:

“And what brings you here?”

Although I groaned inwardly, I embraced the moment:   that simple question lead to an interesting conversation.  

The man was a partner from one of the consulting companies I have working with.   He had not been involved in the project, but he was aware of some of the challenges I had faced on the project – particularly in relation to the trade unions and staff engagement.

He shared with me the experiences that he’d had working in France:   the trade unions have a particular ritual that accompanies any major change, including mergers or TUPE-type scenarios. 

The staff KIDNAP the boss for 3 weeks and lock him in his / her office. 

It’s all part of the peacock-display as they protest their objections to the proposed plans.  And after the 3 weeks, it’s business as usual and the changes are made regardless.

Apparently, it’s such a common occurence that some management consultancies are now recommending that this 3 week interruption is actually factored into the road-map.

Which leads me to think:  with the current challenges facing the NHS accompanied by the increasing amount of union unrest, we could find ourselves in a similar position.   In a pragmatic move, should NHS Trust start factoring into their PRINCE2 gant charts time-delays caused by collective grievances, ballots and industrial action?

I don’t think that I’ll be advising any of my clients this particular to factor this into their planning just yet, but it’s worth thinking about (just in case).

PS – I’m not sure if it’s a true story or not, but thought it was one worth telling.

An autumn of discontent?

This week I’ve noticed an interesting development.  Or perhaps, once I’ve been looking out for it, I’ve noticed the following:

It started with the announcement that UNISON were going to take on the Government as they claim that there hasn’t been the appropriate consultation with the public over the recent White Paper.   I think this is a brave and interesting move, and I will be watching developments unfold as they happen.   Whatever happens will have long-term consequences both within and outside the NHS.

Along with this expression of discontent at a national level, I’ve learnt of a number of local disputes.  The GMB are balloting their members over the transfer of a contract with their patient transport service at a Trust in South London.

I’m also aware of UNITE also talking to members about taking similar action at two other Trusts south of the river.

Is this the sign of things to come?  In my 12 years with the NHS, I’ve always experienced good staff side relationships, working through differences in a pragmatic way.   As the pressure increases with significant cost savings and radical service changes on the agenda, will we see an increase in union action?  Are we entering an autumn of discontent?