NHS Trusts planning job cuts and reductions in pay

Repost of my blog from earlier today. As ever, for links to sources please visit the original post at: [You must be registered and logged in to see this link.]


10 days ago, I wrote about the letter that North Tees & Hartlepool NHS Trust had issued to all of its employees, threatening to sack and re-employ them if they refused to sign a variation to their Agenda for Change (AfC) contracts removing the right to unsocial hours enhancements to sick pay. As I wrote, while I appreciate – and staff mostly concur – that there is some abuse of sick leave by a small number of staff, this should be addressed via disciplinary measures on those staff and not by penalising the vast majority of hard-working staff who are likely to be absent because of stress, infections or injuries (back injuries, for example, are commonly incurred while lifting patients or trying to prevent falls) picked up in the course of their work.

If you want to see the letter in full and see the coercive tactics being employed by the Trust, please read the whole article linked above.

However, it gets worse. Months ago, I put in a Freedom of Information Act request to the Trust asking (among other things) for details of any planned job cuts. I made the request on 4 July, and by law should have received the answer no later than a month after that. In view of the plans to dismiss and re-employ all its staff, I can see why the Trust delayed its answer.

However, I finally received it today – and it reveals the duplicity of the way in which the Trust is approaching the current issue of unsocial hours payments. In the letter to staff about the planned contract change, the Chief Executive of the Trust lists the ‘benefits’ to staff of the proposed new arrangements. Included in these was the following:

“Financial savings will help reduce the likelihood of redundancies“

Job-security, dangled as a carrot to help induce staff to meekly sign away their rights. Understandably, health-workers might feel that losing a nationally-agreed right is worth it if it will protect their jobs.

However, the response which I received today runs as follows:

“Dear Steve

Thank you for your request of 4 July and your request for further information. You asked about contracts and staff reductions.

We are undertaking organisational reviews, at this current time, in the
following areas:

· clinical support services with an expected reduction of 2.6 whole time equivalent posts (wte)
· community services with an expected reduction of 7 wte
· estates and facilities with an expected reduction of 4.11 wte

Where possible staff displaced in these organisational reviews will be redeployed into vacant posts in the trust to limit any redundancies.

We cannot share future proposals as these might not come to fruition, however, we have carried out a workforce review for our outline business case in preparation of developing a new hospital which suggests that by 2016/17 we will have in the region of 426 fewer posts.”

Reductions are already in the pipeline for 14 fewer posts, and the plans for a new hospital to replace those at Norton and Hartlepool are intended to result in a further reduction of 426 positions.

A total of 440 jobs to be cut – even if staff allow their arms to be twisted into accepting a unilateral and illegally-imposed reduction in their conditions. 9% of the workforce – and no mention of that until forced to by an FOI request.

And not only that – other cuts are being considered, but the Trust declines to disclose these on the grounds that it “cannot share future proposals as these might not come to fruition“.

I’ve challenged the withholding of this information, as my request for plans by definition refers to things that haven’t happened yet and ‘might not come to fruition’.

Whatever the outcome of the challenge, it’s absolutely clear that North Tees & Hartlepool NHS Trust is offering job security with one hand as a tactic to achieve its immediate aim, while with the other it’s drafting plans to reduce employment that make the job-security ‘carrot’ as fake as a plastic prop on the counter of an IKEA display kitchen.

Sadly, this seems to typify the way in which the majority of NHS Trusts seem to regard their hard-working and vital doctors, nurses and other staff as disposable dupes to be strung along while they’re needed and then disposed of when it’s convenient – and to hell with their welfare or the consequences to patients.

Meanwhile in the Tees, Wear & Esk Valley NHS Trust

Doctors have been severely restricted to what drugs can be prescribed in order to cut costs, and managers have actualy been interfering in doctors medical decisions to issue prescriptions.

In one recent incident a vulnerable patient had her medication withdrawn due to presure to save money, the woman later threw herself off a balcony and ended up in James Cook Hospital with broken bones.

York & North Yorkshire NHS Trust

This particular trust is under immense presure to save money before it is probably handed over to private companies next year as part of Lansleys health reforms.

The trust is in the middle of formulating plans to close wards, reduce services and withdraw many services from rural areas - so much for David Cameron saying "cut the deficit, not the NHS".

Recently a lady from the Whitby area who suffers from a crumbling spine and terrible pain was told by the specialist at James Cook Hospital that they could no longer give her the pain killing injections because the York & North Yorkshire Health Trust were no longer willing to pay for it.

There are hundreds of stories like these, operations been canceled, routine operations been withdrawn and postponed, the government are deliberately putting presure on the NHS in an attempt to make it look inefficient and to boost private health care.

Havent you noticed - the adverts from private health providers are suddenly everywhere on the internet with headlines such as > "jump the NHS queues".

But the Health Minister, Jeremy *unt says he believes in homeopathy.

Which may provide a clue as to the main thrust of NHS medical treatment once things settle down.

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A very interesting set of emails has come to my attention. If, like me, you’re passionate about the NHS and have been following developments in the South West region, where 20 NHS Trusts banded together into a cartel to attempt to force staff to accept the degradation of their pay and conditions to the tune of about £1,600 per year for the next 5 years, then the emails are not just interesting but explosive.

The email exchange is between Tony Spotswood, Chief Executive of Royal Bournemouth and Christchurch NHS Trust, and Chris Bown, Chief Executive of Poole Hospital NHS Trust, who has also been acting as head of the regional cartel. The emails show the existence of an incipient plot to bring down the NHS Employers group that represents all employing organisations in the NHS, and to replace it with a different group that is more supportive of the cartel’s attempts to coerce health staff into accepting worse pay, terms and conditions that those to which they are entitled under the ‘Agenda for Change’ (AfC) national agreement.

I have scans of the emails, rather than copyable text, so I’ll insert an image of each one below, in order, and provide some commentary on each as it appears, with a summary at the end. If you have trouble reading them as inserts, you can click on each image for a larger version:

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Bown, head of the South West cartel, declares his opinion that NHS Employers (NHSE), of which his Trust is a member, cannot be trusted. NHSE is responsible for the ongoing national discussions with unions about AfC which are attempting to reach a nationally-applicable set of amendments to AfC to help employers meet the ‘Nicholson challenge’ – an ‘efficiency’ challenge by Sir David Nicholson, the chief executive of the NHS.

Official press releases by the cartel have insisted that it fully respects the national AfC principles and negotiations – so for its CEO to write to a colleague expressing contempt for NHSE and its efforts is in striking contrast to the public statements, and demonstrates the duplicity to which the cartel will readily resort in order to present a less unacceptable front to the public.

By contrast with NHSE, Bown states that the Foundation Trust Network (FTN) is ‘openly supportive’ of the cartel’s aims and actions. The FTN is the body representing all NHS Foundation Trusts – Trusts that have set themselves up according to a specific definition in order to be less bound by AfC. Under the Health & Social Care Act 2012, the government created a new requirement that all NHS Trusts must convert to FT status by April 2013 (which in itself is a sign of the government’s own desire to undermine the national AfC framework).

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In a quite astonishingly blatant response, Tony Spotswood replies to Bown outlining:

• His worry that measures implemented by the cartel may be vulnerable to legal challenge if the same changes are not agreed nationally

• a ‘wider agenda’ of having regional cartels replace NHSE, in order to become the body responsible for the national AfC discussions in order to get around the legal-challenge problem

• that this may be difficult because NHSE is part of the NHS Confederation and is the govt-approved body
  a plan to get around that problem by working with the FTN to deliberately undermine NHSE and achieve a vote of no-confidence in the group

Or, in simpler terms, a plan to carry out an extra-legal coup in order to remove the body responsible for national negotiations with staff unions and replace it with a set of regional cartels who will ‘rubber-stamp’ regional decisions to reduce the pay and terms of the hard-working NHS staff unfortunate enough to work for them.

Bown’s response is telling:

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No word of surprise or outrage at the idea of such a coup. Not a single one. Instead, he responds with some ‘good news’ that if the Trusts can get individual staff to sign away their rights (as one of my local Trusts, North Tees and Hartlepool, is attempting to do), then those rights are legally lost and no legal challenge can be mounted. Bown also demonstrates thinly-veiled contempt for unions and staff in his “the TU would I am sure make great noise if this [good news] were to happen“.

At this point, the two CEOs appear to realise that they’re on the record and take the discussion offline – either that or any subsequent emails still remain undisclosed.

It’s also worth noting something else that this final email reveals. The Trust has attempted to remove the name at the top of the email by blacking it out, presumably under a ‘section 40′ exemption. However, they haven’t done a very good job of it – the name ‘Pete Nicholas’ can still be read (click for the enlarged image to see it).

Pete Nicholas is the Trust’s ‘Information Governance Manager’, responsible for responses to Freedom of Information requests. That his name appears above a thick, black line means (in this format of email) that the message was forwarded by him to the person who released it.

That becomes significant because Poole Trust – after the date on which these emails were released to someone else – had responded to my FOI request asking for copies of Chris Bown’s emails by saying that it would cost too much to provide them, and it stuck to this decision even after I pointed out to them the cartel’s advice from its own legal advisers, that they couldn’t include time for sorting and redacting emails in the cost-exemption calculation.

They stuck to their decision on 1 Nov – but then released them to someone else.

Clearly, Poole Trust – which is leading the cartel – is perfectly ready not only to lie but even to break the law as interpreted by their own legal advisers, in order to avoid sending sensitive information to me.

Spotswood’s Trust has since left the cartel, reducing its members to 19. While this initially appeared to be good news, Spotswood himself has stated that he took this decision in order to concentrate on a proposed merger of his Trust with Poole – in which case, he can presumably then choose to have the new entity back in the cartel via Poole’s membership.

There is speculation that Bown allowed these emails to be released as revenge on Spotswood for the merger, which may well result in Bown losing his job. I have no way of knowing at the moment whether this is true or not.

What does seem clear, however, is that Bournemouth’s departure from the cartel is not the good news that campaigners (including me) initially thought. A man who is prepared to plot a coup against NHSE in order to push through pay-cuts is not going to simply give up on the desire to cut costs at the expense of his staff.

It looks far more likely that he wants to push through the merger in order to take personal control of the cartel and help further his coup plans. Which means that those who are opposed to the growing mistreatment of hardworking doctors, nurses and other health staff cannot afford to ease our resistance or vigilance for a moment.

On the contrary – we need to work even harder and intensify it. And the campaign should include a demand for the resignation of both CEOs for their part in plotting against the officially-recognised negotiating body – along with that of anyone else shown to be complicit.[list][*]

Much of this reminds me of the late 1980's when Thatcher brought in 'Clinical Grading' for nurses. It was sold at the time as a way of rewarding staff for the responsibilities they took not the title of their role...

But of course it was not that in reality many nurses were banded at a grade lower than the job they were doing and many had to appeal the grade.......

Some won and were graded at the higher grade.... Many did not.

I remember starting a 'work to grade' where by I refused to act as the key worker for groups of clients or be involved in the assessment of student nurses as it was not with in my pay grade.....

Anyone wishing to express an opinion directly to the Trust will find the contact address(es) HERE:

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I’ve spent the last few days looking through the oral testimony given to the Commons Health Select Committee on 13 November, as well as through the lengthy written testimony given to the committee ahead of the hearing by various organisations, on ‘public expenditure’ – basically the state of NHS finances and the progress toward achieving the ‘Nicholson Challenge’ of £20 billion in savings over the period from 2011-2015.

I was initially drawn to this evidentiary session because, among the witnesses, was Tony Spotswood – the CEO of Royal Bournemouth and Christchurch NHS Trust. Spotswood, as revealed in an email exchange I was able to publish for the first time recently, discussed a ‘coup’ plan to bring down the ‘NHS Employers’ organisation (NHSE) with Chris Bown, CEO of the neighbouring Poole NHS Trust.

NHSE is responsible for national negotiations with unions on the pay and conditions of the UK’s 1.7 million (and falling under this government) NHS workers, while Bown and Spotswood were both involved in the South West Pay Terms and Conditions Consortium (SWC) – an admitted cartel formed with the aim of forcing cuts in pay and conditions on NHS staff in the south-west region.

The witnesses also included Chris Hopson, the recently-appointed CEO of the Foundation Trust Network (FTN) which, despite its name, includes all kinds of ‘public provider’ NHS Trusts, and not just FTs. Spotswood’s and Bown’s emails indicated that the FTN is fully and openly supportive of the SWC’s attempts to force regionally-lower pay on NHS workers, so I was very interested to see what they would say to the committee of MPs on their activities.

What they said and wrote to the Select Committee was very revealing about the real aims and mores not just of the SWC but of the FTN’s board toward our hard-working health-workers. But there was some other information, from other witnesses, that provides critical context for understanding just what kind of treatment and attitudes our doctors, nurses and other NHS staff are being expected to accept while continuing to save lives and maintain (and even improve) standards of care.

The cost so far – and we’ve barely started

I’ll address the SWC and FTN culprits’ evidence in a moment, but first I want to look at statements by Sir David Nicholson – the author of the ‘Challenge’ – and David Flory, respectively the Chief Executive and Deputy Chief Executive of the NHS. These statements provide a concrete indication of the extent of the cuts that have already been forced on our NHS workers.

The Chair of the committee asks Sir David to clarify how much of the £5,8 billion of savings in year one of the Challenge were down to pay, leading to the following exchange:

Sir David Nicholson: £850 million.

Q126 Chair: So virtually £5 billion is unrelated to pay.

Sir David Nicholson: No. There are other savings that we have made in relation to pay. For example, there is the general productivity and efficiency savings that some of our colleagues talked about. An element of that is pay. There are the significant reductions we have had on agency spend in the system and the reductions in sickness absence. All of those things attach to pay. We have also had a reduction in pay drift, the expected pay drift that you might get in a system, which again has all added to a figure which is probably £1.5 billion altogether.

Chair: So £850 million is simply pay rates not going up as fast as they previously would have done.

Sir David Nicholson: Yes, that is right.

And another £650 million is attributable to slower grade drift. Is that what I heard?

David Flory: The £850 million is essentially the avoidance of what we had assumed would otherwise have been a 2% pay award. So that is £850 million. On top of that, the evidence of reduction in agency spend is somewhere in the order of £240 million in 201112. Reduced expenditure due to reduced levels of sickness among staff is £160 million. Then, the number that we do not have such a precise analysis of, but we can see evidence of coming through in a number of local plans, is the point Sir David makes about managing a reduced rate of increase in pay drift which we have seen each year.

I’ll sum up: of the £5.8bn, £1.5bn is related to pay. Of that £1.5bn, around £400 million is because of reduced spending on expensive agency staff and £160m in reduced sickness absence. That leaves £1.1 billion that would have been spent on staff salaries and wasn’t.

According to the NHS website, the NHS currently employs around 1.7 million people. The ‘economy’ of £1.1bn on pay means that, in the first year of the ‘Nicholson Challenge’, NHS staff have already borne an average loss of just over £647 each.

The news gets worse. £647 loss in income is a substantial sum for most people, and if that was all that was going to happen it would be bad enough. But according to the evidence given to the Committee…

We’ve barely even started yet

The written evidence submitted to the Committee by the FTN states:

60-70% of an average Trust’s costs are spent on pay bill and greater flexibility and scope for innovation around terms and conditions of employment are essential if further efficiency savings are to be realised

and

We expect our current survey to confirm our view that the two key strategic issues facing NHS Trusts in their ability to generate significant further efficiency savings longer term are service reconfiguration and staff terms and conditions

Hopson’s evidence indicates that the ‘easy’ savings have all been made. The only two options remaining for further savings are ‘service reconfiguration’ – ‘streamlining’ (i.e. reducing) services to patients – and cutting staff terms and conditions, which is primarily pay.

This is corroborated by the written statement from the NHS Confederation:

Good progress has been made in meeting the ‘Nicholson challenge’. However, NHS leaders tell us that the efficiency savings which have been delivered so far are predominantly the ‘quick wins‘

In other words, ‘We’ve hardly begun on staff pay yet‘. This fits with the aim, made public but in a veiled form, of the SWC cartel: to cut over £1,600 per year from staff pay each year until at least 2015.

Yet now we see that, just as Bown and Spotswood indicated in their email exchange, the FTN is fully supportive of the SWC’s aims for the South-West – but not just for the South West:

Local ‘flexibility’: everywhere

The FTN envisages recreating the SWC’s cartel-like behaviour on a national scale, to achieve the further cuts of £15 billion still to be implemented for the £20bn Nicholson Challenge. In his already-mentioned email, Tony Spotswood indicates a ‘wider [FTN] agenda‘ of having a national group of regional consortia (read cartels) ‘displacing NHS Employers‘ – the body responsible for national negotiations on staff pay and terms, and discusses how this might be achieved.

The FTN’s written evidence to the Committee is fully in line with this ‘wider agenda’:

Again, in a recent FTN survey, members were unanimous that reform to pay, terms and conditions is now essential for Trusts to stay within their financial envelope.19 There is a strong belief across all Trusts that the current national pay system is too rigid and can no longer adapt sufficiently to reflect financial and service challenges.

Spotswood’s and Bown’s emails from September alluded to a ‘wider agenda’ within the FTN to depose NHS Employers as the body responsible for national pay rates in order to achieve ‘rubber-stamped’ regional flexibility. Now, in formal, written evidence to a Parliamentary Select Committee, the FTN essentially confirms its desire to shatter the national framework. But that’s not all:

What do you give the Trust that has everything?

This passage from the oral evidence is quite long, but I ask you to bear with it and read it from start to finish, because not only does it give a flavour of the evasiveness and double-speak typical of the whole series of responses given by 4 highly-paid NHS chief executives to an official committee of MPs, but it also gives a chilling insight into the scale of ambition and depth of callousness of the FTN’s CEO:

Andrew George: Coming to the question of bearing down on costs, I noticed in paragraphs 20 to 27 of your supplementary evidence that you particularly emphasise that the biggest pressure is pay, and that clearly comes out. Given, as Barbara has said, that we are debating very keenly the politics as well as the practicalities of the potential threat-or the opportunity, depending on which way you see it-of regional pay, or various ways of bearing down on pay costs, I wanted to be very clear and, if I could, Chris, ask you first what freedoms you believe you have under present legislation to step outside the Agenda for Change arrangements and to use employment law, as I understand the 20 trusts in the south-west are looking at doing, to offer a different arrangement in terms of pay for all levels of staff? Do you understand that under legislation for foundation trusts you have greater freedoms to use those flexibilities to offer something outside the Agenda for Change agreement?

Chris Hopson: We were very struck by the results of another survey we did of our members about three or four months ago. You are always interested when you get a survey answer that comes back with every single trust agreeing, but what was interesting was the question that was asked was, “Do you want more flexibility than the current agreements allow?” Every single trust came back and said, “Yes, we do want more flexibility.” The issue is that there are differing views among our members about what is the best way of achieving that…but there are a number of trusts which feel that, taking a three or four-year view, they are going to need to go substantially further, which is why you have seen a number of different trusts-and obviously being a south-west MP you will know the south-west consortia are-looking at how they might band together and how they then might use alternative ways of gaining that flexibility.

Andrew George: That is using existing flexibilities. Your question is, “Would you like more flexibilities?” Are they aware of the flexibilities that they have at present, which clearly the 20 trusts in the south-west believe that they have, otherwise they would not be spending so much money and effort looking at how to exploit those flexibilities now?

Chris Hopson: There are a number of different ways that you might go about this. You have already talked about the fact that one trust is looking at the idea effectively of making its work force redundant and coming back with a new set of terms and conditions. The south-west is still at relatively early days. It seems to me that it is saying NHS trusts would like to have the opportunity that virtually every other employer has had over the last two or three years of having a dialogue with its work force about how to ensure improvement in the quality of service and also balance that off against work force costs.

One of the things I find slightly frustrating is that there is a natural assumption that that debate will end up in something that necessarily harms the work force. There are plenty of employers over the last three years who have had a debate with their work force and said, “We are willing to trade off, for example, an employment guarantee going forward, for a change to terms and conditions.” So I think it is important not to prejudge what the results of those conversations might be.

Andrew George: But my question is really a legal one. I am asking you about the legislation as it applies to foundation trusts. As the Department has explained it to me, I understand that existing legislation provides for freedoms for foundation trusts to negotiate outside Agenda for Change, to use employment law to renegotiate with their staff a different set of conditions outwith Agenda for Change. That is a freedom which currently exists and they can exploit if they choose.

Chris Hopson: As I understand it, it does not just apply to foundation trusts. It applies to all trusts.

Chair: So when they ask for more flexibilities, what do they have in mind?

Hopson then starts to give such a vague, circuitous non-response that the Chair cuts him off:

Chair: I am sorry, but it is a very precise question. If the legal status already allows them the same freedom as any other employer within the terms of employment law, what more flexibility do they want?

Chris Hopson: They want the ability to have discussions separate from the national agreement to basically talk to their staff about different terms and conditions.

Chair: The advice is that they have that freedom.

Chris Hopson: Yes and therefore they are in the process of gathering together to see how they exercise that freedom. Tony, you are probably better placed than I to answer. Do you want to give your perspective?

Desperate not to have to give a direct answer to a very clear question, Hopson palms it off to Tony Spotswood – who talks in vague terms about the SWC but also fails to give a clear answer. The questioning then switches tack to a completely different topic, so that the evasive respondents get away without actually answering the question. You can almost hear their collective sigh of relief.

But the answer is there, nonetheless, if you read carefully enough. Pressed on the matter, Hopson admits that the Trusts – as announced in Parliament by then-Health Secretary Andrew Lansley just before he was sacked – are allowed to implement different pay and conditions locally. But Lansley said something very important:

Although they [NHS employers] are free [under the Health Act 2006] to opt out of the national pay framework, they cannot do so unilaterally; they must consult and seek agreement with their staff and representatives…

‘They cannot do so unilaterally‘. As Andrew George states, “existing legislation provides for freedoms for foundation trusts to negotiate outside Agenda for Change, to use employment law to renegotiate with their staff a different set of conditions“.

Under existing legislation, Trusts have the freedom to suggest different terms to their staff – but to actually implement the changes, they have to achieve agreement.

So, if the FTN wants more flexibility, in spite of Hopson’s unwillingness to actually say so on the record yet, this can only mean one thing: they want the freedom to be able to impose changes without agreement. He touches on one way this might be achieved when he mentions some Trusts dismissing and re-engaging employees on different terms. But it’s plain that his ambition goes further – he wants political support and the implementation of legislation that will allow Trusts to unilaterally change pay and terms, and to present the changes as a fait accompli to staff and their unions.

There is much more worth noting in the written and spoken evidence discussed in this committee hearing on 13 Nov, so there will almost certainly be a ‘part 2′ of this post, but for now I think I’ve given you enough to digest so I’ll stop here and let you think on this fact:

The FTN, an organisation that has an agenda to overturn the formal, acknowledged structure of NHS governance and pay negotiation, intends a massive, prolonged and nationwide attack on the pay and conditions of our doctors, nurses and other health-workers – and wants ‘special’ freedom to be able to just go ahead with it without the agreement with unions that even the lamentable Health and Social Care Act 2012 requires.

When the Chancellor of the Exchequer announces a Billion pounds of cuts in an organisation, the Management of that organisation need to respond with either action or their resignation.

Absolutely. I wrote last night to a union contact in the SW:

"any Trust board worthy of the name should be manning the barricades alongside the unions and raising hell in the local and national media about what the government is doing"

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I haven’t seen any official announcements yet, but I’m hearing reports that North Tees and Hartlepool NHS Trust has decided to up on its plan – or at least set it aside for the time being – to dismiss and re-engage its staff in order to force them to accept cuts to their pay and conditions.

I understand that the Trust has said it’s now going to wait for the results of the ongoing national negotiations between unions and NHS Employers over proposed changes to Agenda for Change (AfC) conditions before deciding on any other measures.

This is a fantastic victory both for commonsense (as the Trust was resorting to sack/rehire for a measure that would save only a fraction of its target) and for unions and campaigners who have been opposing such plans in the north-east and around the country.

The change of direction by North Tees – like the change by NHS Gloucestershire following fantastic campaigning by ‘Stroud against the Cuts’ – shows that resistance and campaigning are not the hopeless cause that the government would love us to think. People do care, and Trust boards can be influenced to turn away from unreasonable and callous steps if objectors work together.

Congratulations to all the staff at NTH NHS, and to the unions who’ve fought for them – and I’ll even allow myself a little smile at the thought that this blog might have made some small contribution.

But the fight is far from over – this is a battle won, not yet a war. All those who love the NHS – or for that matter who love fairness and decency and who care about the vulnerable – need to take encouragement from the victories achieved so far, and to learn from them and from the defeats.

And then we need to roll up our sleeves and move on to the next battle, until we can get rid of this woeful coalition ‘government’.

The restructuring plan is only useful for getting rid of dead wood in an organisation and only when it is applied to the management level. The NHS is so top heavy at the moment and surprisingly still top heavy even after all the hoohah about spending cuts. Our hospital claims it needs to cut staffing costs and so they look at the bottom instead of the top. Our CEO makes more than the prime minister. If that is true of all the trusts in the UK, I would suggest making a major pay cut for the CEO's to the tune of 50% to bring them into a manageable pay bracket that justifies their position. Cut consulting fees for out sourced courses for staff. I went on a 1-day audit training course with 5 other people. So that's the daily pay for 6 staff not doing their regular work plus the fee for the course and the fee for the instructor. The course did not teach me anything I couldn't have learned from an online course or even a handout in half the time while staying at work. There are hundreds of these courses going on all the time in the NHS and they are basically inefficient and a waste of money.

The NHS works under the ethos of 'crisis management'. No plans for rolling stock in computers or equipment. Nothing gets replaced unless it is absolutely 'dead' and then it is just a patch replacement of some workable piece of kit to get us over the hump until that one breaks down as well. It's a ridiculous, costly and inefficient way to run a service. My computer at work is 9 years old and takes 20 minutes to boot up. Computers attached to lab kit is ancient and practically requires gymnastics to make them work properly, accurately and reliably.

The NHS has too many high paid managers, not enough good equipment and too many poorly trained and underpaid front line staff.

"The NHS is so top heavy at the moment and surprisingly still top heavy even after all the hoohah about spending cuts ...."

Not really a surprise. The whole ethos of current Tory policies is directed at a widening separation between "them" and "us". By definition, the administrative level of the NHS will be accepted as fellow Tories.

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I’ve written before about the contempt shown by some executives of the NHS Trusts involved in the South West Pay Terms and Conditions Consortium (SWC), when they think nobody will find out, for the hardworking staff providing healthcare to patients and for the unions that represent them.

As I wrote back in September, Malcolm Cassells, Financial Director at Salisbury NHS Trust, wrote an email to a contact that conveyed a disregard for the wellbeing of health-workers, a sense that they should consider themselves lucky to have such ‘generous’ benefits, and a contempt for unions that are ‘not as stupid as they look’.

It appears that Salisbury may be a hotbed of such attitudes, mixed with a generous helping of greed and hypocrisy. A different FOI request has revealed emails between other executives from that Trust that betray a flippancy about the effects of the cartel’s aims on staff.

Flippant jokes between co-workers about their work have their place. However, that place really isn’t between senior executives who are looking to cut the payand benefits of around 63,000 health-workers who are not very well-pad to begin with – and especially when those same executives have awarded themselves not only a pay-rise but also a bonus, and all this at a time when their Trusts are supposedly facing financial pressures of such severity that the only way to be ‘sustainable’ is by cutting pay for nurses, healthcare assistants and other low-paid, hard-working people.

The first of the emails is from then-COO (Chief Operating Officer) of Salisbury NHS, Peter Hill, to the Chief Executive of the Trust at that time, Caspar Ridley. It commented on an email from Mark Wareham, a Unison rep at Salisbury, to Mr Ridley challenging an accusation by Ridley that unions had caused staff ‘unnecessary anxiety’ by publicising what the cartel was doing:

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In other words, ‘This is a rant, and if you bother answering you’ll just trigger a series of rants’. Was it a rant by Mr Wareham?

If you wish, you can read it in full here, but it seems very clear that it was not. His email makes the following points, in emphatic but reasonable language:

that staff have every reason to feel anxious about the formation of an organisation whose express purpose is to reduce how much they earn and increase how many hours they have to work to get it, in contravention of ongoing national discussions.
that Mr Wareham has been advised by at least one Trust of intentions to cut staff salaries by 15%
that staff and unions were not consulted about the formation of the cartel or its aims and does not accept them
that such moves will inevitably impact on staff morale and hence on patient care
that attempting to carry out its moves belies any notion of ‘partnership working’, even if the organisation’s spokespeople say otherwise, and is in fact a unilateral attempt to impose regional pay
that the unions will be ready to enter discussions if Salisbury Trust exits the cartel
None of this constitutes a rant or ‘diatribe’, even if Mr Wareham makes his points emphatically, as indeed he should – in which case Mr Hill’s comment is merely insulting and dismissive, and certainly not in keeping with the supposed desire of SWC executives to ‘partner’ with unions and staff to find a solution.

And this is very bad news for NHS staff at Salisbury Trust. Caspar Ridley resigned the position of CEO after only 6 months, and the Interim CEO is…

none other than the mocker of unions himself, Peter Hill.

Our next little snippet is from an email exchange between Salisbury HR Director Alan Denton and his deputy, Jenny Hair. Commenting on coverage of the cartel by the BBC, and attaching his comments to a Unison newsletter sent by the same Mark Wareham to his members, Mr Denton starts off with a message which, although brief, speaks volumes about his attitude:

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‘It’s terrible this pay cartel thingy isn’t it – whose idea was that, then?‘

Ms Hair’s response is fairly bland – she seems to attract flippancy rather than spout it, as we’ll see shortly – as she mentions articles in the press as well as on the BBC, and comments that the language in a leaked cartel paper wasn’t very ‘discrete’ (sic):

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But Denton’s response is in a similarly light-hearted vein to his first message:

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“I presented it at the Chief Execs meeting with my posse as Steve was ill. Alternatively, I deny all knowledge of it, and don’t know what you are talking about.”

Remember, this is a man talking about taking potentially over £6,000 each from the pockets of over 60,000 poorly-paid people – and advising that he wrote and presented one of the first papers about how to do it. But ‘terrible thing, this cartel thingy‘ and ‘presented it..with my posse..alternatively I deny all knowledge of it and don’t know what you are talking about‘ show a quite remarkable levity about the whole matter. Again, you can view the entire exchange here should you wish to.

I’m heartened that Mr Denton has a ‘posse’, in spite of his attitude. Sadly, he’s not finished yet. In another exchange with Ms Hair, this time from November 2012, he again forwarded an email from Mark Wareham – this time a 5-month-old one about a petition against the cartel – along with a quite impressively facile and insensitive comment:

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Mr Denton – the man who is looking to cut the incomes of over 4,000 staff at Salisbury, and who helped author a plan to cut it for over 63,000 across the region, thinks pay-cuts and petitions against the organisation planning them are a matter for humour.

Perhaps Ms Hair is just so stunningly gorgeous that men lose their heads around her and start cracking inappropriate jokes to try to impress her. Far more likely that Denton, Cassells and their new Interim CEO Peter Hill are just being themselves and evincing a deep-seated contempt for the people who actually do the work of providing healthcare at their Trust – and in the other 18 Trusts that are still part of the cartel.

Given the exchanges outlined above, and the emails between SWC CEO Chris Bown and another CEO that discussed bringing down NHS Employers, the organisation responsible for national pay negotiations, in order to achieve their pay-cutting goals more quickly, it’s reasonable to conclude that many SWC executives are utterly disconnected from the real-life situation and problems faced by the people working under them.

Perhaps we shouldn’t be too surprised.

You see, Alan Denton and Ms Hair, as well as Peter Hill, Chris Bown and Tony Spotswood are all on salaries of well over £100,000 a year, so it must be hard for them to imagine what it’s like to face an income that won’t cover even the essentials.

Not only that, but the FOI reveals that – while imposing pay-freezes on their staff and looking for ways to cut their pay – the executives of Salisbury NHS opted to award themselves both a pay-rise and a bonus.

It appears that the revealed emails are indicative of a severe lack of empathy and understanding of the lives and troubles of ordinary people among executives at Salisbury – a problem that is probably widespread throughout the SWC.

Public statements by the cartel say one thing, but what is said out of the public gaze conveys something else entirely.

Perhaps they can’t help themselves. They do say the truth will out, after all.

It always has amazed me that you can get more money for not doing the work in your organisation than you can for actually doing the work your organisation is supposed to be there for

Empty vessels make most noise. Public figures seem to spend an inordinate amount of time and energy in protecting their position.

From skwalker1964.wordpress.com:

I wrote this morning about the ‘pernicious viper’ contact email address on the South West Pay Terms and Consortium email address (SWC), and what it said about the morality and aims of this de facto cartel.

One comment on Twitter – from a union – not unreasonably suggested that, while interesting, the selection of the email address may not be significant, as it was probably someone’s personal email address.

It seems that it is indeed someone’s email address, but this doesn’t remove the significance of the selection – because the person put it on the website appears to be a central figure performing a key role within the SWC: Jon Fisher, Communications Manager of Poole NHS Trust and ‘Communications Lead’ of the SWC.

On 28 August last year, Mr Fisher sent this message to Peter Hill (by then Interim Chief Executive of Salisbury NHS Trust):

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Make of it what you will!

Since the coalition came into power there has been an increase in Doctors of just under 4,000 and a decrease in Managers and Senior Managers of just under 4,000.

That is of course nationally so individual trusts probably have separate stats. Overall though it would seem they haven't lied regarding the NHS and the removal of bureaucracy and increase in front line staff. Perhaps they're simply not able to sell the facts to the public?

tlttf. It takes seven years to train a doctor, so trying to give this disgusting government credit for the increase in numbers is pathetic and just more of the dishonesty we've come to expect from you.

Tories haven't lied about the NHS? Yes they have. There were going to be "no cuts to frontline services", and there are now almost 7,000 fewer nurses. There were going to be 3,000 extra midwives and there aren't. But most of all, the NHS was going to be "safe" in Cameron's hands and there would be "no top down reorganisations". The reality is the biggest reorganisation since the inception of the NHS, much of which is now in private hands for private profit.

Current criticisms from the Quality Control inspectorate are making it hard for Jeremy *unt to maintain that having fewer nurses represents an improvement in the services provided.

tlttf wrote:Since the coalition came into power there has been an increase in Doctors of just under 4,000 and a decrease in Managers and Senior Managers of just under 4,000.

That is of course nationally so individual trusts probably have separate stats. Overall though it would seem they haven't lied regarding the NHS and the removal of bureaucracy and increase in front line staff. Perhaps they're simply not able to sell the facts to the public?

There has been a decrease in nurse numbers of over 7,000 and counting, while the government claims an improved nurse-to-bed ratio - because bed numbers are being reduced even faster than nurse numbers!

There is no increase in frontline staff, it's just playing with statistics. Empirical evidence as well as statistics show an increasingly overstretched workforce. One perfect example, from a post I wrote recently looking at an evidence session to the Commons Select Committee on health by NHS CEOs - this is from Bournemouth NHS CEO Tony Spotswood:

For example, in my organisation over the last three years we have reduced our bed base by 240. We have treated more patients. How patients report the quality of care has improved and it is a better allround experience for patients. Into the future, the key is that is going to be much more difficult and requires more substantial, complex and structural changes, as Jim was indicating earlier.

He then continues a little later:

we have reduced our bed base by 240, we will need fewer nurses because we have fewer beds

Fewer beds, fewer nurses - yet treating more patients. That inevitably means:

- shorter stays per patient
- earlier discharges, with attendant risk of relapse/readmission
- higher intensity nursing leading to:
- greater risk of error
- greater likelihood of delay in bedbaths etc (and perfect fodder for Telegraph stories of 'my dad sat in his own piss' etc)
- far higher stress on nursing staff
- more staff illness/injury
- higher turnover and loss of experienced staff

and so on.

The government's claims to be protecting the NHS and to care for patient welfare are a convenient nonsense.

skwalker1964 wrote:There has been a decrease in nurse numbers of over 7,000 and counting, while the government claims an improved nurse-to-bed ratio - because bed numbers are being reduced even faster than nurse numbers!

There is no increase in frontline staff, it's just playing with statistics. Empirical evidence as well as statistics show an increasingly overstretched workforce. One perfect example, from a post I wrote recently looking at an evidence session to the Commons Select Committee on health by NHS CEOs - this is from Bournemouth NHS CEO Tony Spotswood:

For example, in my organisation over the last three years we have reduced our bed base by 240. We have treated more patients. How patients report the quality of care has improved and it is a better allround experience for patients. Into the future, the key is that is going to be much more difficult and requires more substantial, complex and structural changes, as Jim was indicating earlier.

He then continues a little later:

we have reduced our bed base by 240, we will need fewer nurses because we have fewer beds

Fewer beds, fewer nurses - yet treating more patients. That inevitably means:

- shorter stays per patient
- earlier discharges, with attendant risk of relapse/readmission
- higher intensity nursing leading to:
- greater risk of error
- greater likelihood of delay in bedbaths etc (and perfect fodder for Telegraph stories of 'my dad sat in his own piss' etc)
- far higher stress on nursing staff
- more staff illness/injury
- higher turnover and loss of experienced staff

and so on.

The government's claims to be protecting the NHS and to care for patient welfare are a convenient nonsense.

In that same session, the CEO of Heatherwood & Wexham NHS, Philippa Slinger, made the following claim:

I have recruited 350 staff in the last year, including qualified nurses and midwives.

Sounds quite a lot, doesn't it? But the facts weren't quite so rosy. I put in an FOI request for the details of the appointments and of unfilled positions at the Trust. The reality was:

New starters:

Staff Group WTE (‘whole-time equivalent)

Add Prof Scientific and Technical 3.80
Additional Clinical Services 119.53
Administrative and Clerical 82.84
Allied Health Professionals 29.64
Estates and Ancillary 2.00
Healthcare Scientists 5.00
Medical and Dental 25.90
Nursing and Midwifery Registered 90.65

So only 91 nursing positions filled. The number of unfilled positions?

Medical and Dental, 24.29
Nursing & Midwifery & Health Care Assistants, 206.57 wte
Professionals Allied to Medicine, 22.54 wte
Professional & Technical, 23.73 wte
Scientific & Professional, 3.55 wte

So, still over 200 unfilled positions on the front line - meaning staff that are on the front line have to stretch to manage the workload. Which leads to more of the problems and risks to both patients and staff that I listed above.

How could that nice Mr. Cameron have lied to us so convincingly? He looks the perfect Gentleman. Who is really pulling his strings? The first thing any General must do before commencing battle is to positively identify the enemy.

Who is really pulling his strings?

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Source: bhopal.org

Ivan wrote:

Who is really pulling his strings?

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Source: bhopal.org

One of many! An ideological oligarchy - best identified, most likely, by a look at the list of major donors to the Conservative party.

Cameron Offers Patients Reassurance About the NHS

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" ...and I understand a nurse will be available to see you on Thursday week..."

Phil Hornby wrote:Cameron Offers Patients Reassurance About the NHS

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" ...and I understand a nurse will be available to see you on Thursday week..."

The only reassurance I'd be looking for is that he'd never, ever be next to my bed again..

Original including numerous links at: [You must be registered and logged in to see this link.]

I’ve blogged variously about the South West Pay, Terms and Conditions Consortium (SWC or ‘cartel’) that was formed to try to bully NHS workers in the south-west into accepting worsened pay and conditions compared to the nationally-agreed Agenda for Change (AfC) framework.

The tactics of this cartel have been various and unsavoury in pursuit of its aim of reducing the income of its workers by over £6,000 in order to reduce its overall costs, including the evasion of Freedom of Information (FOI) Act requests in contravention of its own legal advice and a threat to sack and rehire all its staff if they refused to accept the erosion of their pay.

A finance director closely involved in the running of the cartel mocked its workers in an email to a journalist, and two Chief Executives of cartel Trusts were even revealed to be planning a ‘coup’ to replace the NHS Employers group responsible for national pay negotiations in order to achieve a fragmented NHS pay landscape that could be attacked piecemeal.

For the sake of NHS staff in the south-west and of everyone who believes in and loves the National Health Service, it’s been absolutely essential that the cartel’s activities be exposed and blocked. Staff and unions have been resolute in their resistance to the bullying, and adverse publicity around its actions and intentions have increased the pressure on the cartel, but its members have, for the most part, continued to pursue its aims.

However, it appears that this is about to change. A new FOI request indicates that 5 Trusts have decided to reject its proposals, and I’m assured both that the information is ‘cast iron’, that a 6th Trust has now joined them, and that it’s only a matter of days before the whole ill-advised venture collapses.

The list of the Trusts (out of 20 members at one point) rejecting the cartel so far therefore stands as follows:

- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust,
- Dorset County Hospitals Trust,
- North Devon Healthcare Trust
- Poole Hospitals NHS Foundation Trust &
- Salisbury Foundation Trust)
- University Hospitals Bristol NHS Foundation Trust

If the collapse of the cartel is indeed imminent, as it seems to be, then this is cause for great celebration for NHS staff and supporters both in the south-west and all over England.

And in a period (since Monday) where the NHS is under severe threat of privatisation because of the government’s new commissioning system and its underhand ‘secondary legislation’ manoeuvres, it’s fantastic to see that resolute, united resistance can defeat attempts to undermine and degrade the NHS.

It’s a grim time for the NHS at the moment, with a concerted, co-ordinated attack by government and media threatening its very core. But those of us who are committed to its survival should take encouragement and heart from this news and redouble our efforts to defend it.

If you’d like to make a practical contribution to this defence, please visit CCGWatch.org.uk and read how – and make a donation if you can. And whether you can or not, find any ways you can join the fight – and dive in!