Remind me, what’s the purpose of this?

Some weeks ago I published a post on the draft Equality Delivery System (EDS).   In brief, the EDS is a  a new framework that Trusts will use to measure how well they have embraced and embedded equality and diversity.  It was due to go out for consultation in November, but I have recently been informed that it’s postphoned until the New Year, although no reason has been given for this.  Pilot sites will start working towards their EDS in April 2011, with full-roll out in 2012.

The current framework of the EDS has been designed by individuals working either in PCTs or SHAs.  In my view the framework, as it stands in draft format, is not transferable to acute or mental health Trusts.    And this an issue, because we know that SHAs and PCTs aren’t going to exist in the very near future, so what is the point?     I understand that this is a question that is being discussed behind closed doors at some trade unions and professional bodies, who (reassuringly) share my views. For us, the consultation will be crucial, as it will be our only opportunity to significantly influence this initiative.

As I began to think through the implications of the EDS in conjuction with the White Paper, I recalled the following:  an ex-colleague of mine, who is now a leading figure in Equality & Diversity in the NHS, recently went on record saying a recent survey had established that c.34,000 GPs have a poor record in terms of their attitude towards diversity.  Unfortunately, he wasn’t around last week when I called to see where this figure came from.

It’s well documented that there is a genuine worry about the commissioning capability and capacity of the new GP consortia.  And there is quiet concern within the Equality & Diversity community about that the capability & capacity of GP consortias to run organisations who believe in equality and the concept of being “effortlessly inclusive”.  And to be clear, this isn’t just a workforce issue, but applies to patient services too.  (Ironically the White Paper is about reducing health inequalities). 

Am I taking it too far by thinking that the EDS has been designed to ensure that the GP consortia embrace and embed equality & diversity?  I think so, we’re not that visionary in the NHS.

Sometimes I feel that the NHS is like a tanker that has invested so much in trying to drive an initiative forward that it can’t change direction mid-course.    The EDS is such an iniative.   I heard a great quote recently when I was talking about the EDS with a leading Equality & Diversity specialist.  She described it as a “piece of furniture”: It sits in the corner of the room, but it looks out of place and nobody wants to use it.  That is exactly the opposite of what we should be striving for.

The NHS Temperature Test

It’s been a few weeks since the White Paper was published. There was nothing in it that was a surprise to those of us working in the NHS and reading the trade journals. I recently reflected upon my conversations following its publication and as a result, I decided to do a totally unscientific survey on how staff in the NHS were currently feeling about job security.

My methodology? The NHS is a glorious institution: if you don’t work in the NHS, you know a family member or friend who does. It is through these loose social networks that I have been undertaking my research. I have traveled to the South Coast, to the heart of Berkshire, 100 miles north of the M25 and of course, central London.  I have also undertaken a literature search by keeping an eye on what’s being said in the Health Service Journal (who have run articles about redundancy every week for the last 3 weeks).

My conclusion is that staff are falling into four  key themes:

  1. Many staff are already working in an organisation that is facing significant financial pressure, and where major organisational change was already on the agenda.  Those staff working in acute Trusts mainly fall under this category
  2. Staff with significant service are taking the pragmatic approach that at least they have a substantial redundancy package to fall back upon.  The HSJ has run an article every week for the last 3 weeks preparing managers for this.
  3. Senior staff within PCTs (both clinicians and managers) recognise their value and the fact that many of the new GP consortia will require their skills.  They see the long-term position of job stability, just with a change of employer.
  4. Junior staff are showing higher levels of anxiety, as they are less clear about the future plans and how it relates to them.  This is understandable

There is one particular anecdote from my survey that I wish to share which highlights some of the above points:  Jane (fictional name) is the Head of Pharmacy in a PCT.  Since university she has worked her way up through the hospital system.  When she reached a glass ceiling, she moved into her local PCT.  In the last three years she has saved the PCT millions in reducing the drugs budget and she knows there is potential for more.  But with the White Paper she won’t be given the chance to see this through.

Jane has achieved her savings through working with the GPs.  She knows the different personalities, and how some are more progressive and forward-thinking than others.   Because of this first-hand experience, she knows how difficult it’s going to be to drive efficiencies into the drug budget for her patch when it’s devolved to the different GP consortiums.

The GPs need her expertise, and so Jane knows she’ll get a new a job working in one of the consortia.  She also has great belief in her abilities.  And in the back of her mind, Jane is aware that if it all goes wrong she has 15 years service and that equates to a substantial redundancy package.

Today, Jane continues to work hard, and like all NHS employees, as she wakes up every day knowing that she wants to deliver the best possible healthcare she can for her patients.

There is anger and fear about the proposals, but’s the subject of a different post in the future.

Thoughts on NHS Restructure – Part 1

After a brief hiatus, I felt that my first post this week should be about restructure – it’s the topic that everyone has been talking about non-stop since the publication of the White Paper.  From Executives to the Healthcare Assistants to the external suppliers.

Many Trusts are now also feeling the impact of the recession.  Reality has finally hit the NHS, whereas it affected the general population some time ago.

Last week, I was chatting with a Full Time Officer from a professional body.  I found myself completely agreeing with their position:  after years of working to establish levels of staffing that will provide a minimum of safe, clinical care, Trusts are now looking to reduce staffing levels as they need to to save money .   All the hard work over the last 5 – 8 years looks like it’s going to be washed away.

I reflected upon the time I was working as  a Director in a PCT when we were faced with a significant financial savings plan.  My full-time officer-colleague was working in the same patch at the time.  However, as none of her members were represented in my organisation, our paths did not cross.  But she remembers the pain.  We made radical cut-backs in staffing and overhauled how we delivered clinical care.

My managers at the time kept telling me that their service re-design was based on best practice and current research.  The front-line staff strongly disagreed, their biggest issue was with the heightened levels of risk they were required to work with on a regular basis.

For my part, I steered the organisation through a reduction of the workforce by one third (400 staff) with only one Employment Tribunal claim (the manager refused to take sound HR advice).

My Full-time officer – colleague was surprised to hear that there weren’t more ET claims.  My response:  we technically got it right from an employment law point of view – but it doesn’t mean we made the right clinical decisions.

And so back to the issue in hand:  There’s no doubt that we are entering a period that will see a series of radical cutbacks in the workforce.  The good Trusts will do so in accordance with the legislation.

But that’s not my point (or that of my full-time officer-colleague).  The point is that patients are the centre of our business.  We have to make cuts, there’s no disagreement about this.  But if the balance between cost savings and clinical care tips in the wrong direction, it is the patient that suffers.