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.


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