News and Comment from Roy Lilley


See what he’s made of…

It looks like No18 will be visiting B&Q this weekend, to buy a shovel.

He needs to dig his way out of a very deep hole.  In fairness, it is not a hole, entirely of his own making.  A couple of feet of it are a legacy hole… a sink hole opened up.

Only a week or so ago he was announcing his undying love for the NHS, how badly managers treat staff and how he was on their side and would stand by them.. 

‘… as Health and Social Care Secretary, I promise… I will do everything I can to defend you and champion all the hard working staff who make our NHS what it is today.”

Well, I guess we will find out next week.

The pay rise for Agenda for Change people has gone horribly wrong.  There is no way to proceed with the offer as it stands.  That’s the legacy hole.  The extra digging will be required to extricate No18 from his ‘championing the staff‘ hole.

As I wrote yesterday, the offer everyone voted on turns out to be entirely different to the offer that will hit pay packets.

I dealt with some of the issues and there are links to the detail.  It seems it might be even worse than I thought.  I’m left asking the question; were people deliberately misled?  

The bones are; the information on the detail of the offer, circulated, promoted and used as the basis for conferences, workshops and staff briefings does not appear to match what is on offer now.  

Some staff are worse off.

The information supplied to staff came from employers and unions.  Where did they get it from?  It looks very likely, NHS Employers.

NHS Employers briefing material was on its website and has since been changed.  The RCN briefing was changed right after the ballot.

On the other hand the RCM claim to have been right all along…  

Just where is the font of knowledge on the detail?  Who was the source?  It can only have been the DH?

I’m assuming; 

The DH sign-off the deal.  The details agreed with NHSEmployers who create briefings for HR departments and unions.  Everyone goes to town briefing everyone.  It’s a big job as there is a ballot in the offing.

Before the ballot takes place unions study the deal and advise their members on what they think they should do for the best.  With the exception of the GMB, the unions said, go for it.

It is inconceivable the Unions would have recommended the deal as it is now.

It is highly improbable that NHSEmployers would have briefed a deal that they knew was different.   They would have realised all hell would break lose and guess what… it has.

None of these organisations has anything to gain by misleading staff, about to ballot on the deal…

All fingers point to the DH.  The Tinkerman had everything to gain by settling the deal.  The last time he handled a staffing issue, the junior doctors went on strike!

Conspiracy, dishonesty, clumsy, carelessness, confusion, honest mistake.  Who knows.  What we do know, thousands of staff were made an offer, they voted to accept it and what they have now is not what they were promised.

How to fix it?

  • The DH should withdraw the offer.
  • An independent authority, maybe a university, commissioned to produce an independent evaluation of exactly what is on offer.
  • The results put to the staff who should be able to re-ballot.

There is nothing to lose by a brief pause, six weeks tops.  People have waited years for this raise.  The important thing is to get it right. 

Even more important is this… to proceed with the deal as it is will sour staff relations for years to come.  

Already HR departments are getting hammered by angry staff.  

Trust between unions, struggling to attract new members and very hacked-off existing members will take years to repair.

Already a vote of no confidence in the RCN is mooted, even though they have apologised.  The other Unions will be unable to keep their guilty looking silence for much longer.

Faith in NHSEmployers is evaporating and the spotlight is on the DH.

You cannot trumpet a pay rise for people and ignore them when they blow the whistle on being worse off.  There is only one person who can fix this.  

Let’s see what he’s made of.

Have a good weekend.

Some explaining to do…

Here’s a question for you; when is a pay rise not a pay rise?

The answer… much more difficult than you’d think.

Since 2010, when the government, as part of its response to the world banking crisis, slammed the breaks on public expenditure, NHS staff were subject to a pay cap, the result of austerity and the need to balance the nation’s books.

Then, amongst great fanfare, the cap was lifted.  The increase was discussed, example salaries were posted on websites by employers and unions.  It was complicated.  Unions asked their members to vote on the proposals.

There was a cockamamy threat to cut annual leave if nurses didn’t accept the deal.  Impossible to do as it involves contracts of employment.  But, the unions fell for it.

I had doubts and said so… but unions, apart from the GMB, who expressed reservations, recommended their members accept it.

They did and we are where we are.

Since then, the three year deal has dropped out of the headlines.  Now, it looks as though people could be in for a bit of a shock.  The published pay rates don’t seem to be the same as the rates published before the votes on the deal were cast.

There is a further muddle over the cost of living increase and the increment.  They will be paid on two different dates.  

We all thought the whole increase would be back dated to the start of the financial year in April?  

It turns out only the cost of living increase will be and the annual increment will be paid on the anniversary of when people started working in the NHS.

It is claimed, some staff could be thousands out of pocket.

The web-site Open Democracy report; 

‘But both Unison and NHS Employers have today made clear …members of staff would be paid only £25,934 from the 1 April. That’s only around a quarter of their promised 2018 increase on basic pay (around £400 rather than around £1400 – a difference of nearly £100 a month in this typical example).’

A lot of you have written to me to point out another important issue; the uplift in pension contributions will take more money than the pay-rise compensates for.

Here’s a sample of what people are saying on Twitter; 

  • Only one in ten of RCN members voted for the pay rise.
  • [It’s alleged] the RCN information provided to its members was not accurate.
  • Why is the RCN telling us a different story about what the pay deal actually means in terms of this month’s pay packet, than NHS Employers (and other unions) are saying? It’s £100 per month different for the average nurse!
  • If your increment is near the end of the year you could spend eleven and a half months on a pay point lower than what was suggested.
  • [It’s alleged] NHS Employers original poster, on their web-site, explaining the rise, was misleading and has since been removed. [As far as I can tell this is the old link and this is the new.  Beware it may be changed by the time you get to it!]
  • The pay rise did not factor-in the impact of increased pension contributions that have the impact of reducing pay, despite the increase.
  • Add in the impact of an increase in NI and many will be worse off.
  • I moved up a pay-band in April, £150 a month down due to pension increase.  The pay-rise will take me back to where I was.
  • 2015 pensions scheme rules; ‘those earning less than £11K pay the same 9.3% personal contribution rate as those on £47k.’
  • Most employees are required to put 3% of their pay into pensions and this will arise to 5% next April so people will have less take home pay despite the increase.
  • The pay rise can tip you into the higher band for pension contributions.

I have no idea how much, or many, or none of these comments are accurate.  In my experience of you hear the same thing from three sources… it’s probably right.

What is clear is how unclear the pay-rise and its impact is!  

If there is a case for rerunning the Brexit referendum vote, because people were fed bum information, there may well be a reason to have another vote on the nurses pay rise!

Knowing what we know now, I wonder how many would have voted yes?  

It looks to me; the unions and employers have a lot in common with Boris Johnson… they have some explaining to do.


Post Script; Since writing this it has come to light the RCN leader, Janet Davis, is to send a personal apology to all members ‘over the pay dismay’.

This is a courageous and right thing to do, well done.

Now we are left with the simple fact this ballot and all the others, should be re-run.  I doubt there will be many nurses willing to accept the deal now its full implications have come to light.

Post, Post-Scrip:  There is more on the apology here and it looks like a vote of no confidence in the RCN is brewing.

How many more times…

Time to be honest.  I have a question.  You may answer it to yourself, or whisper to a close friend.  I’m not setting out to embarrass you.

Here’s the question, quietly…  

Have you read No18’s speech?  

If you are interested in management it’s a must.  

If you are interested in technology, you should.  

If you sell IT stuff to the NHS and you don’t, you’re dangerously potty.  

Buried in the middle of the love letter is a threat.  It starts innocently enough….

‘I want to drive [that] culture change.’

Well, let’s get that management howler out of the way…

It’s naive and quaintly, unworldly.  You don’t ‘drive’ culture.  It’s an oxymoron, or at least muddles up a verb with an adjective.  ‘Driving’ culture is just the kind of culture we don’t want.

You can only cultivate culture…

You can only change the climate and hope culture takes care of itself.

We bring our own eco-structure to work, our attitude, experience and training.  Collectively, that changes the climate that creates the right conditions for culture to develop.

Trusts are in recoverable debt.  Without damaging services and cutting back, all the efficiency gains in the world won’t balance the books.  

Presently, the ‘culture’ is for NHSI to get tough, shove people around, the CQC turn up, looking for trouble and another good person loses their job… the board collapses.

That’s the culture.  It’ll be interesting to see how No18 ‘drives’ that.

The next passage in the speech is fascinating.  Just 56 words and throws a whizz-bang into the technology tent.

‘… I want to work with everyone across… NHS and social care system… to embrace the next generation of technology.

We will work with suppliers who want to embrace this change.

And I’m crystal clear that suppliers who drag their feet or threaten to stand in the way, won’t be suppliers for long.’

What does he mean; ‘Won’t be suppliers for long‘?  

Who is he talking about.  The implication; there are suppliers who are standing in the way of progress.  Does he intend to tear up contacts?  How will he do that?  With threats like that, it will be a brave supplier who will want to ‘engage’, to use a jargonoid.

This threat can only be aimed at proprietary systems.  Which of them are unwilling to embrace interoperability.  Who will name names?

We know who the big NHS suppliers are.  Who is No18 aiming at.

We also know interoperability is poor and with Social Care and care homes… worse.  As new systems emerge and Apps are developed and added to the compost of computing, we risk creating a new, electronic Tower of Babel.

It’s not for the want of trying.  Back in September 2015, in Newcastle, the big brains of NHS informatics and stuff went to a summer school and emerged with ‘The Newcastle Declaration’.  Five key points about interoperability.  It was a very important document.  

Alas, we know the road to better healthcare is paved with good intentions and the Declaration turned out to be just another paving slab, walked across and forgotten.

A year later, they had another go and then the techUK Health and Social Care Interoperability Charter was added to the mix.  You need to have a look and see for yourself, these are eminently sensible documents, produced in good faith, by people who ‘get it’.

So what’s happened?

Well, we still have;

  • Primary care systems that won’t talk to secondary care systems
  • Secondary care systems that can’t talk to primary care
  • Community care systems that can’t talk to secondary care 
  • Secondary care systems that can’t talk to community care
  • Social care systems that don’t talk to anyone 
  • … and care homes that are mostly in the dark about everything.

Whose fault is it?  It’s our fault.  We buy stuff that is ring fenced and can only be used with the supplier’s other stuff, or costs a fortune to knit into a wider system… we perpetuate the problem.

Two simple rules; 

  1. Don’t buy stuff that won’ t talk to all the other stuff…
  2. Re-read rule one.

Procurement, framework agreements, common sense… how many more times!


No18 has made a speech.   Probably, you didn’t know.  He made it in West Suffolk, about the same time as the Prime Minister was speaking on Brexit, in Ulster.   

From the geography and the timing, I’m guessing the DH+ press office didn’t want too many people to know. 

You can read it here but if you’re in a hurry I’ll tell you… 

You didn’t miss much.  A re-run of the traditional ‘clinicians and managers must be friends’ and ‘doctors are better managers than managers’.  The usual about about culture and three priorities; workforce, technology and prevention.   

We know…  

We can’t get enough qualified people working with us in the foreseeable and the ones we have are pressured, stressed and asked to do the impossible.

We have too much ‘technology’.  Gung-ho geeks are piling-in with stuff and ideas, creating a compost of computerised chaos.  We have nothing like a strategy.  Just a lot of digital egos prancing on conference platforms.  It’s impossible to know what good looks like.

Prevention.  I’m not sure if No18 wants to prevent admissions or prevent people getting sick. 

His ‘to-do-list’ has been around for as long as I can remember. 

The solutions look simple…

Workforce; figure out what work you want to do, how you want it done.  Train enough people to do it.  Look after them, make it interesting, rewarding and fun… and they’ll keep doing it.

Technology; decide what you want technology to do, find where they’ve  got stuff doing it well, copy it, buy it for everyone, plug it in… get on.

Prevention; show kids how to turn ingredients into a meal.  Decide what you want people to eat and tax the rest out of the market.  Prevent admissions; create vertically integrated systems, with population based, capitated budgets.  Watch the admissions tumble. 

Simples… not really.   

Workforce planning has been woeful, wards are dangerously under staffed and there is no real prospect of resolving this, inside ten years.  

Technology is a confusing strategy-free-zone and no one has any real idea what the end-game looks like and procurement encourages delays, racks up costs and defies interoperability.  

Prevention; the devil has all the best food and the money is in all the wrong places. 

What to do? 

No18 has announced another consultation on workforce issues.  Groan…

No one ever tells minister the truth… what it won’t conclude, is what it should conclude;  

…the root cause of all the difficulties… we don’t have enough people to do the job within the constrains of targets and finance.  Ministers are frightened of criticism and so frighten people doing the job, to death.  The CQC terrorises Boards.  NHSI terrifies senior executives who, in turn put the pressure on middle managers, who put the fear of god into the front-line.  It all starts in No18’s office. 

Helping people to do better, rather than helping them to get over a nervous break-down, might be a start. 

Technology doesn’t need clever ideas, it needs some clear ideas, otherwise any new cash will be squandered.  

We need ubiquitous wifi, an interoperable-digital-first-contact policy and system-wide access to records… not more Apps and gismos.  

We need central procurement and the courage to shout ‘stop’.

Seek out what’s working, now

Tweak it if necessary

Order it, for everyone

Plug it in and use it.

Prevention.  This is toughest.  Any policy extending beyond the life of a Parliament, or a minister, is too long and most of the quick-wins have been done.

International comparisons on PH success are poor and difficult.  In the end PH is about changing behaviour, in the end it’s the law that changes behaviour, so for the beginning of the end; governments have to have the courage to take on the vested interests that are ruining the environment and screwing up the kids.

Admission prevention; vertical integration and strategic care organisations. 

This was an Amazon Prime speech; repeat order, delivered by lunch time. 


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Reproduced at by kind permission of Roy Lilley.