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.


Are ice-breakers naff?

At the start of any training event, it’s likely that the participants will have to engage in an ice-breaker. Many of us (me included) dread it: we don’t want to be embarrassed or made to stand out of the crowd by saying or doing something stupid.

With this in mind, when I’m designing training courses or small workshops, I think long and hard about how to ease the participants into the session.

Last year I read Nancy Kline’s Time to Think, which had a profound impact on me. Subsequently I wrote a book review, which you can read the book review here or here (HSJ).

The reason I only gave Nancy’s book four stars is that, whilst I liked what she was saying  (enough to put some of it into practice) I didn’t truly believe in the magic that she was describing.

Nancy starts every meeting by asking the attendees to do two things:  
a) state one thing that they did last week which made them feel proud of themselves.


b) turning to the person on the left, to say one thing that you really respect them for.

Everybody gets to speak twice before the meeting has even begun.  For the first 10 minutes, every comment made is a positive one. The impact?  There is a dynamic shift in the room. Everybody feels relaxed, upbeat, positive and willing to contribute.

Last week I was working with a team that has had some difficult few years, has just recently has turned the corner and is on the road to recovery.  We started with this ice-breaker, and by the time we finished there wasn’t a dry eye in the house.  Not  because they were sad, but because of the overwhelming emotions they were feeling. They all liked each other already, just nobody had expressed it before. And they liked what they heard.

It was magical. Just like Nancy said it would be.

Going back to the start, I believe that on the whole ice-breakers are naff.  Why do trainers and facilitators like to torture us by making participants behave like animals – literally?  And what purpose do these particular interventions serve?

From my point of view, there’s no reason why we can’t strive to find respectful and effective ice-breakers like the one I’ve described above.    Those trainers who don’t just let our industry down.