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You keep using that word…

August 5, 2015

By Basket Press

Ho hum…Another day, another piece of “official advice” in which David Bennett, the chief executive of Monitor, tells foundation trusts to ensure that staff vacancies are filled “only where essential”, but without offering any advice as to what essential actually means…

The excuse is the usual: save money, y’know, the same reason we have all heard for years why posts are frozen, recruitment is suspended until the next financial year, yada, yada, blah, blah. As David Byrne so perspicaciously put it, same as it ever was.

I don’t know about you, but I would expect a man who in 2011 was the highest paid employee of the NHS in England and was described by the Health Service Journal as the 8th most powerful person in the English NHS to be capable of giving some clearer guidance here. A man who spent 20 years dispensing advice to others about how to run organisations when he worked for McKinsey (yes, that McKinsey, the mega firm of management consultants who seem to run the world) and earned a salary well in excess of what any of us mere nurses are ever likely to see for doing so. But apparently he can’t. Which makes me wonder what he’s there for.

Ever since the first Griffiths report back in the ’80s gave us general management and started the cult of managerialism we have been told that managers should be allowed to manage, and yet here we have one of the top, most highly paid NHS managers side-stepping that very responsibility and passing it on to someone else.

Anyway, “essential”: my handy copy of Chambers says things like “necessary to the existence of a thing” or “indispensable or important to the highest degree”. So how does this translate into NHS terms?

I believe it is time to break out The Basket Press Three Phase Model of Organisational Structure (patent pending), which can be applied to most organisations I’ve come across.

Phase One consists of those staff who carry out the core function of the organisation. In the NHS this means clinicians, nurses, doctors, physios, psychologists, OTs and so on and so forth. That’s us, the ones who do the direct health bits. Without Phase One the organisation might as well pack up.

Phase Two is those staff without whom we don’t function, which is secretaries, receptionists, payroll, porters, pharmacists, lab staff various, radiographers (OK you can make an argument that some of these might go into Phase One, but bear with me as it doesn’t change my overall point), catering, technicians various, and apologies to any I have missed. Without Phase Two we can pretty much pack up also.

Phase Three is the staff we can do without for significant periods of time, if they are needed at all. This brings us to pretty much all management and HR, non-exec board members and the like. If we lose some of these do you actually notice? We can certainly carry on for quite some time, unlike the loss of the other 2 phases.

Now before I am accused of being anti-management, which I’m not really, I just think what we have is over-rated , let me tell you a story or two to expand on this.

In my last job there were regular and frequent times when we were down on clinical and/or admin staff and the rest of us and the patients knew about it every single time: not enough staff for clinics; waiting times going up; prescriptions not written; assessments taking longer to complete, if they could be completed at all; longer for diagnoses to be made; longer times between appointments; inability to respond to crises; letters not sent; appointments not arranged; reports not compiled; phones not answered. Mostly posts were kept empty, as mentioned above, for financial rather than functional reasons, for as long as possible, which just compounded the difficulties created.

And yet, on more than one occasion, we went for up to nine months without a service manager: none of the patients noticed; clinical work happened as it should; the service carried on running; a couple of us signed time sheets and expenses forms; the sky didn’t fall in.

The same was true when the trust did not have a permanent chief exec for months, when there were vacancies for senior HR bods, when we were without a couple of non-exec board members: no-one noticed; patients were still seen; everyone else just got on and delivered the services. And when those posts were filled we still didn’t notice, patients were still seen, only a name on the letter head changed…I can’t remember when I last actually met a chief exec and have certainly never met a non-exec board member and this is after over a decade as a senior nurse.

In another job we had one of those interminable trust mergers, which meant that for over 6 months there was a management vacuum while everyone above an H-grade (Band 7 in current money) played hunt the desk and hunt the job, no-one was contactable, we never saw them, and yet clinical services went on, patients were seen and the sky remained resolutely over head.

And it is always, but always, thus: I’ve lived through several lifetimes’ worth of mergers and restructurings and reorganisations and whatever they call it this week and patients are always seen, even when Sherlock Holmes, a team of blood hounds and Hawkeye can’t find a manager or anyone else supposedly in authority or in any way running the organisation.

So, perhaps Mr Bennett in his position of great power and authority, with all the undoubted wisdom accumulated from years of telling other people how to do things, might somehow find his way clear to telling us what it is that he considers “essential” to the running of a health service? Pretty please, I’m asking nicely, with cherries on top. Please?

  1. lesley58 permalink

    Well said. It’s just what the nhs needs.

  2. Basket Press permalink

    Thanks, Lesley!

    I note that Monitor issued another statement saying that, of course, dear Mr Bennett didn’t mean stop appointing nurses…How hard would it be for him to have said that in the first place?

  3. lesley58 permalink

    They don’t know what they are doing.!

    We have just had a Senior nurse who retired but came back and is working on the shop floor as it were. take over from her and she complains she has had no break , paper work isn’t completed and obs are late!!….. all the things she would hector us about.

  4. Basket Press permalink

    Aye, there’s none so deaf as those who won’t hear…

    I had such a bee in my capacious bonnet about missed breaks, time owing I couldn’t take from my time as a NA or staff nurse that, as a ward manager I insisted that when anyone had accumulated more than a couple of days time owing they had to take it. And that if someone stayed over to complete necessary paperwork they would get time owing for it.

    I’m not suggesting that I was a paragon of virtue, but I did remember the things which had annoyed me and did subscribe to the idea of trying to look after colleagues.

  5. lesley58 permalink

    I wish you had been my manager !

  6. Basket Press permalink

    I think it was when I was a nursing assistant that I learned the old truism about if you don’t look after staff then how can you look after patients; a few incidents as a staff nurse which left me and others feeling distinctly un-looked after reinforced the necessity to do this…Or at least to try.

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