Thoughts on NHS Restructure – Part 2

Restructure.  That’s the reality of the NHS at at present.  This is my second post about restructure within the NHS,  and highlights another issue that I regularly see when working with different NHS Trusts around the country.

When the finance guys look at the numbers and decide that there needs to be a plan to bring the balance sheet back into the black, the gut reaction is often to take a percentage cut from each division – 10%, 12%, 25% (sound familiar?).

But there are two reasons why this isn’t the best approach:

1. To enable effective organisational change that generates cost savings, resources need to be ploughed into the organisation.  In otherwords, Trusts need to “spend to save”.    In some services it is as simple as making an invest need to be able to realise any potential income generation.

Turning to HR:  By asking a HR Department to cut back on 25% of it’s employee relations team when it’s just about to embark on a major redundancy programme is just madness.

During any major downsizing – it’s all on hands-on-deck if you’re in HR.  There are numerous meetings, letters, calculations and other transactional tasks that need to be taken.  And that’s not even considering the transformational elements that should be part of the mix.

Trying to do this within limit resources means that the organisation is more likely to encounter problems down-stream. Problems that cost.  Either at Employment Tribunals or that fact that the organisational change wasn’t properly thought through and doesn’t work.

2. A flat cut across departments encourages silo working.    Organisations should consider what cost efficiencies can be gained by redesigning a workforce that cuts across the organisation.  Such as moving from a service that is  decentralised to a centralised approach.

When departments seek to achieve a percentage target, the organisation does not give itself the time and space to consider what greater, and perhaps more appropriate savings could be made within the system  as a whole.

There is often a pressing need to identify how money is going to be saved, yesterday.  Decisions are made under pressure, and the impact is that there are lost opportunities.

All the above is easy for me to say, as I’ve already learnt from my mistakes.   However, I am (un)fortunate enough to have already lived through this fight before in the last five years.  Not many of my colleagues have.

Significant savings require a radical, yet carefully planned and thoroughly considered  organisational change plan.  I know that I’m not stating anything new here.   I just felt it had to be said again.


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.