This Weeks News


Can we agree to that…


There are a lot of rules about having difficult conversations.  Here are some ideas that might give you a soft landing…

  • Make sure you have all the facts, stay calm.  
  • Talk eye to eye, not one standing and one sitting
  • Do it in person, in private, not over the phone.  
  • Dump the blame game.  
  • Avoid the words ‘always’ and ‘never’ and ‘everything’.
  • Listen more than you speak and approach the conversation with an open mind.  
  • Don’t finish before you’re finished; have a time-out if you need it but don’t leave unfinished business.  

Try and end with;  ‘Can we agree, that….’


With these ideas in mind, there is a difficult ‘something‘ that needs to be said.


‘Some Boards are doing things that makes them rotten employers.  A form of corporate bullying and bullying as this, latests, from Roger Kline tells us, has no place in the NHS.’


Three examples…


Public Health staff left, marooned in local authority employment.  


Mostly, they didn’t want to leave the NHS but were bullied out and TUPEd… now stuck in a career cul-de-sac where the NHS won’t fund the recent pay rise and neither will LAs.  Many have already faced cuts to income or terms, to create parity of grading with LA staff on lower rates.


Next; VAT-fiddle companies. 


No one has written to me saying how pleased they are to be bullied out of a career in the NHS.  They have said; they joined the NHS because they wanted a career in the NHS not a job in a spiv-company.


In Bolton ex-NHS, TUPEd people went on strike to get the national pay rise when the VAT-fiddle company argued they weren’t entitled.  The staff won.   


Since 2015 TUPE is not worth a light. (Item 6)


Under TUPE 2014, an incoming contractor, although bound by the terms of any collective agreement in effect before TUPE takes place, will not be bound by any changes to that collective agreement negotiated after the transfer date where the incoming contractor is not a participant in the negotiating process.


… no pay increments, Unions castrated.


Finally, NHS staff parking charges.  


People need to get to work, shifts mean cars, cars mean car parks.  Car parks aren’t cheap; maintenance, security, lighting, insurance and… PFI profits.


According to NHS Digital,  NHS staff paid nearly £70million, in 2017/18, to park.   A newly-qualified nurse earns £94.20 per day… one was fined £140 when the permit fell off the dashboard.  Insidious bullying – want a job… that’s the deal.


There is a callousness that has crept into employment.  


The gig economy, zero-hours contracts, workplace rules on comfort breaks… a contagion spreading to the NHS; shipping people around the system to avoid VAT, dodging long-overdue increments, exacerbating a lost ten years in wage growth.  Sky-high parking charges. 


All signs of a bad employer.


What makes a good employer?


Create a feeling of being part of an organisation, a member of a team, having a shared purpose.


The better an organisation communicates the better they will do.  Keeping colleagues up-to-date with developments, looking for ideas and feedback.


Showing people they can progress within the company.  Even McDonald’s have their university!  


Companies that are good at people are good at quality, it translates into people having a have pride in what they do, and it shows. 


Flat organisations really work; decisions get made faster by the people who know what’s what.  


Visibility of leaders and managers.  Tesco’s expect to find their managers on the shop floor.


What does that mean for the NHS?  A difficult conversation…


There is a global shortage of people willing to work in the care sector and the problem is already on our doorstep.  We have to do better.


We have to say three things and mean them;

  1. We think the people we work with are partners in our aim of better, safer care.  
  2. We will train them, listen to them, help them with their problems and share in their success.  
  3. We will create the time and space for them to be the best they can be and we will be honest with them. 

Can we agree that?


Passing the parcel…

How do you know winter is on its way?


The clocks go back.  Tesco has Xmas crackers by the door.  You don’t have to worry about what to wear… everything goes with black.


Two thrushes which breed in Scandinavia, Redwings and Fieldfares are arriving, having flown the 500 miles across the North Sea.  


Pumpkin Spiced Lattes are on offer at Starbucks.


Oh, and a sure sign of winter is when Captain Mainwaring and the gloomy Dad’s Army Team, from NHS Providers get busy telling us; this will be the worst winter since god invented wooly-socks. 


Are they right?  Who knows?  The flu-jab might save us… if it’s the right one.  If it’s not, it won’t. 


On the BBC Today Programme, yesterday the Providers spokesperson advised the public to avoid A&E and ring NHS111, talk to a pharmacist or go to the GP.


I’m not sure that is a fat lot of help.


According to the Nuff’s analysis, the proportion of callers being dispatched from NHS 111 to emergency services over the last three years has risen with a particular rise in the share of people who are passed to ambulances.  


The largest number of callers are sent to primary care.


The report says;


In its first years [NHS111], 18% to 19% of people were dispatched to ambulances or emergency departments: that has now risen to 20-22%. This means around 20,000 more people a month are sent to emergency services…


The reasons are multifactorial and variable depending on geography and presumably demographics.


The upshot seems to me, NHS111 is doing a great job sending people to places they would probably end up going to, anyway.  Mostly callers are sent to primary care and we all know they are stuffed to the gunnels.


Going to the pharmacy? 


Most high street pharmacists cannot prescribe and are not trained to diagnose.  What can we expect from the pharmacy?  Except in the most minor of ailments, they can only distribute demand.  Most of it goes to the GP.


All roads lead to the GP and it looks like a bumpy road.  Last year’s MORI survey is horrible reading;


Patients are finding it much harder to get through to the surgery, patients unable to make an appointment, patients reporting a positive experience of making an appointment is falling.


The proportion of patients giving their GP positive ratings for spending enough time with them, is declining, increasing dissatisfaction with out-of-hours services.  The percentage of patients reporting an overall positive experience of their surgery… steadily falling.


Practices aren’t stupid… they are busy!


Is it any wonder we all end up in A&E?  We go because it’s open, we can get there and even if we wait we can have the Five Gets;

  • Get in
  • Get diagnosed
  • Get treated
  • Get out
  • Get on with our lives. 

Hospitals I visit do better with discharge planning when there is a real live social services person working on the ward, with their own computer and coffee mug.


Magic Morecambe Bay do it and so does the Royal, in Liverpool but it is more rare than routine.


Trusts who’ve been sensible and spent time and money training care home staff to do the basics, instead of dialling 999, do better but it is not often you see it.


Segmenting flow, efficient triage, taking all the glitches out of the system… all helps.  Ask ECIST.


Other than that?  We can’t reverse the global shortage of nurses and can’t buy a box of doctors from Amazon Prime.  


What we can do is up-scale and train every HCA, AHP and porter to work at the top of their game.  Double the number of prescribers.  Only a handful of Trusts do that.


Remember most delays to discharge are down to NHS Trusts, not social care.  58 per cent in 2016/17.


Maybe NHS Providers might look a little closer to home for solutions before they start passing the parcel.


Say it…

The runes don’t look good.  Until recently I’d expected we’d get a deal of some sort.


Apart from the fact all my contacts on the mainland of Europe think we’re barmy and they hate immigration and costs and bureaucracy as much as we do, they need a deal because they want to keep flogging their stuff to us.


We’re heading for the two great standbys of British gymkhanas, fetes and county shows… waffle and fudge.  


We have a government with no majority, an opposition with no guts and the EU; Macron losing traction, Merkel finished and are terrified that Italy with a junk-bond economy, Greece and perhaps Spain will follow us out… if it looks easy.


There is no answer to Mrs May’s Rubic Cube.  If there was, we’d have it by now.


The Maymite should say;


 ‘There is no solution to this puzzle that will accommodate everyone so let me try and fix this, best I can.  If I can’t, I’ll tell you.  In the meantime, everyone, shut up.’


The people know there is no sensible solution and have taken to the streets of London, in their thousands, to say so.


Managing the impossible is never possible.  If there is an answer, it is to say… there is no answer.  


There is no better case study than the NHS.  Because we didn’t say a collective ‘no’, soon enough and loud enough, we ended up with Lansley’s reforms, that still, to this day, create impediments in service delivery.


We seem to forget, the NHS is owned by the taxpayer and run by people who pay taxes.  We have a voice.


We know Charter standards in the NHS cannot be met; not enough people, not enough money.  


Targets have largely been abandoned but not before regulators and inspectors have ruined the careers of good people who have done their best, destroyed morale and trashed the expectations of patients.  


All because people are not able to say, no.


Not being able to say no, ruins productivity.  We see it, plain as a blue light in the NHS.  Focusing on delivering impossible targets and ruinous inspection has wasted millions that might have been better spent on looking after people.


New initiatives, daft ideas, political policies, visions, heaped on the heap of stuff we already know we can’t do, is bonker’s management.  


Focusing on what you can do, can deliver is sensible, mature and rare.  Doing what you can do, better… is much better.


There is an expectation that NHS problems will be somehow fixed by Apps and technology.  


I have news, they won’t.  They will add to the cacophony and with no prospect of interoperability, add to the workload instead of redefining it and redistributing it.


Visions, wishes and fairy dust are not enough.


The pace of IT development and the ease of adoption needs careful curation.  


The NHS is unprepared for what is to come and without organised, targeted procurement and a clear understanding of what we want to achieve, we will create an impossible future. 


We have to say no to this tide of technology or we will be swamped by it.   

Creating a place where people want to put their names to something they are proud of, starts with the art of the possible, not the nightmare of the impossible.


‘No’, is a moment of clarity, avoids exploitation and defines the boundaries.


Mature management must accept they have a responsibility to say no.  In public services there is a tension…  


Politicians, in pursuit of  making a name, exploit public services to develop their careers and foibles.  No18 is keen on tech, so we get tech.  No17 ‘did’ safety, No19 might have a thing about bunions… so bunions it would be.  


Managers of public services want to be cooperative but not trash the place in the doing.


Saying yes to other people’s priorities doesn’t make a bad priority right.  Productive time is crowded out, frustration tempts us to make the wrong decisions and there is no opportunity to say ‘yes’ to the really important things.


Saying no creates the time and space to focus on getting the basics right and we are a long way from getting the basics right.


There is no weakness in saying no.  


The weakness is hearing a no and not recognising the good sense and courage it takes to say it.


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Reproduced at by kind permission of Roy Lilley.