This Weeks Roundup of News and Comments by Roy Lilley

primary_care_training_flowers

Not begun…

Let’s get to it.  I only have 700 words.  I don’t want to fritter any.

Why is the NHS so bad at workforce planning?  

We have a mission critical workforce.  One of the most highly educated and skilled groups on the planet and what we don’t have in qualifications, we have in vocation, guts and perspiration.

Yet, we have more gaps than a witch’s grin.  There could be 115,000 vacancies by 2027.  

The boss of HEE told a recent conference;

 ‘… the workforce needs to grow between 3% to 5% a year’.  

If he means 4% he should say so.  My guess is it’ll be closer to 7%.  It doesn’t matter really, he says his current growth projections won’t deliver a three to five per cent increase, anyway.

So that’s that.

His solution seems to rely, mainly, on retaining staff.  Leavers have cost the Service 16,000 vacancies.  An extra 5,000 leaving, compared to 2012.  

He’s announced a ten year plan… ten years!  Will we never learn… gimmestrenght!

Aside from all the vocation, commitment, perspiration, compassion, love and dedication, which I am not, for once, belittling, or downplaying, or dismissing, the fact is; for a lot of people, working in the NHS has become a rotten job.  A grind. 

We can only thank our lucky stars the job is done, so well, by the ones that stay.

Earlier this year I was in Australia.  They’ve had so many applications from English doctors, they are fully staffed, their points system has closed the doors.

First job; make working in the NHS the go-to, happy-place to be developed, cherished, valued and looked after.  We’ll never look after patients if we don’t look after staff. 

Why are we so bad at workforce planning?  

Two words, political interference… recognised by Andrew Lansley who created the arms-length HEE.  

However, before they got their feet under the table the coalition government cut the HEE budget, there was a junior doctor’s strike, Brexit and the end of the Bursary.  They had a poor hand but they’ve played it badly.  Are they waving or drowning?

Trusts have nowhere near enough control over their workforce.  The regulatory pressures on them mean it’s easier to balance their books if they leave vacancies unfilled and skeleton staff on the wards.  

The absence of legally enforceable, national, safe-staffing levels is a co-conspirator in sloppy planning.

Trusts have never driven home the point that adequate levels of well trained staff are mission critical to the success of safe care and a lot cheaper than fighting quality battles and complaints. 

Trusts don’t own the workforce plan, it’s handed down.  Ward sisters are who we should be asking.  Practice managers.

The CQC have made it worse by blaming Trusts for bad management when bad workforce planning is the culprit.  They should have turned their fire on Whitehall. 

If we recruit a doctor today, how many members of staff will be required to support them at the end of their training? 

For a surgeon, how many physiotherapists?  How many theatre porters?  For every geriatrician, how many community staff?  I don’t see anyone making real use of data.

The medical training model has hardly changed in 30 years.  As Sam Everington says; ‘training is not fit for purpose now, never mind the future’.

Worse still, the idea of long-term planning.  Ten year plans?  Yer ‘aving a larf.  They are always inaccurate.  Eighteen months is long enough.  Even then, managers will want to fine-tune.  

Planning is not about a document it’s about a way of thinking.  A way of thinking that takes us into every nook and cranny of NHS development, innovation and change.

Plans to shift, wholesale, care into the community needs more community staff being trained right now.  

Scenario planning takes the place of workforce planning.  Policy planning, IT planning, innovation planning only works if there is an understanding of the impact of the scenarios on workforce.

If we don’t understand why workforce planning has failed, we’ll repeat it with another ten year plan.

If the NHS is to change the way it does its business, more than likely it will need to change the workforce; what they do and where they do it.  

Turning out doctors not trained to use Skype and FaceTime… potty.  GPs not confident to use telephone diagnosis.  Nurses that can’t prescribe.  OT’s and Physio’s that can’t do pain control.  Community nurses that aren’t nutritionist and chiropodists.

Workforce planning starts with the needs of the patient and works backwards.  

I don’t think we’ve even begun.

Says it all…

I listened to The Maymite’s speech about the long term future of the NHS.  I’ve got to be honest.  I’m sitting looking at the cursor blinking on the screen, thinking where do I begin.

 I’m thinking how can anything so good, so well intentioned end up in such a mess?  Is there anything that this woe-begotten government can get right?

 NHS’ 70th birthday is an entirely artificial event.  Not that we shouldn’t have fun and be reflective, it’s just that seventy is not sentinel, it is not a proper anniversary like 50, or a hundred and it has come at a most inconvenient time for a divided struggling administration.

 The Conservative’s intentions to score a PR victory and turn up at the front door with a big present, like a long-lost Uncle, have turned into a self inflicted embarrassment and a row the NHS does not want to be at the centre of.

As the Service disappears under a bow-wave of irrecoverable debt, swamped with patients and drowning in ludicrous bureaucracy, joining in the celebrations and giving it a bung seemed an easy present.  

 It turns out it has all the thoughtfulness of gift voucher from Amazon or a bunch of petrol station flowers.

 The historical low that the NHS finds itself in is horrific.  Four million people on the waiting list.  The cost of sorting that out?  Call it eight billion.

 Most targets abandoned, three quarters of Trusts up to their armpits debt probably around £2bn.  A £5bn backlog of repairs and maintenance, an unfunded pay deal, call it £1.5bn.  Add to that the arcane fact; the pension discount rate is changing and that will cost the NHS, maybe, three quarters of a billion.

 … and The Prime Minister has the temerity, the brass neck, to infer, that without a stern warning from her, the NHS may not spend any uplift in funding ‘wisely’.

 The NHS that works unfunded overtime, uses knackered equipment in buildings falling apart, with rota gaps and shortages.  It is only the NHS smarts and wisdom that has keep it going. 

 The woman who trooped through the lobbies in support of the Lansley lunacy, now has the cheek to say that any change to the bureaucracy has to be clinically led and well thought through.

 Where do I begin… 

The ‘present’ is an uplift in funding of below the sixty year average: 1948, the birth of the NHS to 2010, the Coalition’s handbrake turn on public funding… just on 4%. 

After eight years of near flat line funding, this 3.4% is enough to keep the lights on, to keep us ticking over. 

As for the ludicrous idea that it will transform mental health services, make everyone present with symptoms of cancer, earlier and project the NHS into some sort of Star Trek future is a madness that would only occur to someone that had no idea of the scale of the problem. 

The Maymite read her speech at the speed of a bloodstock auctioneer and with all the sincerity of a station announcer.  She wasn’t in the room.  She was in Europe, the Cabinet and the private battles we only hear rumours of. 

I have no idea where to begin! 

All of this nonsense without a mention of how it is to be funded.  Increase taxes will break a manifesto commitment, more borrowing will delay the target to balance the nation’s books and the ‘Brexit Bonus’ has been blown out of the water by the Institiute of Fiscal Studies. 

Without a clear plan on funding, this birthday present could turn out to be a birthday IOU. 

And, by the way, not a mention of social services; surviving on a picture of money and reminiscence therapy of what a pound used to look like. 

The question is not what the money will be spent on.  All the focus is now where will it come from. 

It would have been so easy to say; ‘Happy Birthday NHS, here’s a few quid to tide you over and thanks for what you are doing.’ 

Instead the Government had to big it up, showcase it and now through stupid strategy and hubris is imbroglio in rows about Brexit, taxation, wriggling out of the Health and Social Care Act and reality. 

There is one absolute rule in life;  

Actions speak louder than words… this speech said it all.   

Brothers and sisters in care…

The rumour mill has been working over time.  On Sunday we got a good idea what The Maymite is planning to do about the money.  

If you believe what’s in the papers, to pay for it, expect anything; an increase in VAT, a hike in National Insurance, taxes up, more borrowing, the European ‘Bus Money’… just the ticket (except there is no Brexit Bonus), a levy on your first born. A granny tax and a car-boot sale outside Number Ten.

The row between the Chancellor, who wants to hold on to the money, austerity and cutting the deficit and The Maymite who wants to look like she is still in charge… appears to have been settled.

Good job too, although writing in the Mail on Sunday The Maymite made it clear, there were still decisions to make over how to fund the increase.

In real terms, around £4bn per year.  That’s 3.4%, enough to keep the NHS ticking over.  However, significantly lower than the 4.3% annual growth, the Office for Budget Responsibility’s called for in its projection of what’s needed for the future.  

Whilst all this is hitting the headlines, social care is quietly slipping down the toilet.  

In one area, Nottingham social care; they are faced with a £46m increase in demand, a 52% cut in their budget and somehow have been able to deliver £255m of savings.  They aren’t unique.

In the enthusiasm to celebrate our NHS with a birthday bung, we forget it is social care’s birthday, too. 

For them, no fanfare.  For them, no specially minted coins, no Park Run, no conferences, tickets for the tennis, balloons or brouhaha.   

They were born when we were born.  They are as old as us.  The same time as the NHS Act, we had The National Assistance Act 1948, to;

‘…  provide help to elderly Britons who required supplementary benefits to make a subsistence living and obliged local authorities to provide suitable accommodation for those who through infirmity, age, or any other reason were in need of care and attention not otherwise available…’  

If twins shared the same birthday would you buy a present for one but not the other?  Would you make a cake for one and not the other.  Would you buy a card, wrap a present and make a fuss of one and not the other?

Apparently, social care have to wait as their settlement is bound up in allocations for local government, the bin men and holes in the road.  They can’t expect a birthday gift from Number 10.

New money for health will disappear on paying legacy debt and catching up on waiting lists, in time for the election… 

The Maymite knows she can’t go into the next election with the NHS in the state it is in now.  Hence breaking the Chancellor’s
 austerity rules, the inevitability of tax rises and more borrowing.  The NHS is too high profile, too easily filmed.  

The plight of social care is all but invisible.  Masked by raising the bar on eligibility criteria… it is families and an army of carers that are filling the hole in local government funding.  

That is no cause for celebration.  

Local authorities contract at around £600 a week for a care home placement, families are asked for four times that amount.  

That is no cause for celebration.

The frail elderly marooned at home, existing between fifteen minute visits.  

That is no cause for celebration.

Patients stranded in hospital, waiting for care packages, as their acuity ebbs away.  

That is no cause for celebration.

There are over 900,000 people who used to benefit from social care who, since the eligibility bar has been raised, no longer do.  That’s nearly a million people who are refugees in our care system.  Families left to fend for themselves.  

That is no cause for celebration.

Would you party on your birthday if your twin were left out?  Struggling to exist.  I don’t think so.

Do the decent thing; leave the candles on the birthday cake burning, let them throw some light on what’s happening to our brothers and sisters in care. 

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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.