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7th October 2015 3

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New Health Chat

21st October King's Fund 5.30pm

Former boss of Addenbrooke's Keith McNeil

.......gives his side of the story... tells us

what it is like to be a CEO in the NHS. Impossible demands... is the job worth doing.

Selling out fast. Tickets... here.

Our people

News and Comment from Roy Lilley

As the CQC clod-hop about, bumping into the furniture, one thing's clear; they may as well template one part of their so-called 'reports'. The bit about the NHS doesn't have enough nurses.

According to this fascinating report, from NHS Liaison, the NHS doesn't have enough anybody. Thirty three ChEx posts are vacant; I've lost count of the Board positions that are not filled. At the sharp-end, Trusts struggle to cover shifts.

In the report we discover almost 85% of temporary medical locum staff bookings, excluding nurses, are made to fill vacancies for permanent positions. That costs around Ł1bn a year.

Eye watering? Try this; the top 10, highest paid locum consultants, cost us a total of Ł3.4m a year; enough to fund 21 substantive consultant posts. Oh, and the locum figure has increased by 18.6% in the last six months. Ouch.

I'll pause whilst you get yer head around that lot. Take a deep breath, there is more; agency staffing, as a whole, including nursing, costs around Ł3.3bn a year, up on last year by almost a Łbillion.

In the first 3 months of this year, Trusts booked over 3,500 locums for a total of over 481,598 hours costing Ł33m in pay and commissions to agencies; 40% of hiring's overrode standard NHS pay rates.

To put all this into some kind of perspective; Ł3.3bn on agency staff in 2014/5, equivalent to almost 70% of Health Education England's budget.

To make matters worse, in 2016, non-EU staff earning less than Ł35k a year will be sent home. Say; "selamat tinggal", to all the nurses from Singapore and "magandang hindi importanteng bagay" to the nurses from the Philippines.

We need an urgent, collective, sort-out-staffing-stuff programme...

Expensive forays into the EU, coming back with a handful of bewildered, home-sick youngsters won't fix this.

What might will not be universally popular. This ain't easy....

Start with the nurses who are not nursing. A fast-track, easily accessible, free, Return2Nursing programme. CRB check, local ten-days get up to speed and back onto the wards with a back-to-work buddy and one day a week in the classroom on-going training. Reduce income taxes for returning nurses to 5%... make it really worth coming back.

Sort out nurses and migration policy. The bobble hats at the Migration Advisory Committee seem to think we need ballerinas but not nurses. They are potty. Close them down. Cameron's idea; send-home nurses not earning Ł35k is plain bonkers. Simon Stevens is absolutely, 24Crt gold, copper bottom right. Nursing is a priority occupation.

Improve nurse and jnr Doc employment conditions; more flexible shifts, free crčche facilities (open places to the community to help pay for it). Packages of easily accessible discounts in stores, holidays, insurance, local clubs, restaurants and fee travel on public transport.... we all know it's a tough job so sandpaper the edges.

Special-rate home loans or help with deposits for rental accommodation. Do a deal with housing associations to convert surplus NHS buildings into social housing for NHS staff.

'Free' nurse-degree courses are not sustainable. Put nurse uni-training on the same footing as every other student. If we wait for government to have enough money to train enough nurses, we'll never have enough nurses.

Cap fees at (say) Ł6k, (to recognise the 'on the ward' contributions), change the payback rules to cut in at Ł24k. On that basis, I figure, nurses'll start paying at the rate of Ł7.50 per month, 3 years after graduation.

Before you write me an indignant billet-doux remember; For every one nurse training-place there are 5 applicants. Turning people away is madness. A Trust in the midlands is offering 'fee-pay courses' for nurses. They had 25 places and 1,000 applicants. Nursing is a career for life, transferrable, travelable, tough, exhausting but so very rewarding. It has to be worth seven quid. Trusts could offer bursaries.

By-pass HEE, encourage Trusts to set up their own training. Get the SEN curriculum off the shelf and use it for HCAs. Stop short of registration to avoid the palaver.

Cap all locum payments to NHS pay-grades, allow agencies a ceiling 4% margin. Set up generous, flexible in-house staff-banks.

Stick a bomb under the CQC. Change the staffing measure from the shortage of staff to the innovation, ingenuity and resourcefulness the organisation demonstrates in trying to overcome the problems.

Find out if doctors training here and going overseas is a big issue. If it is introduce a 110% payback clause. We cannot train the world's doctors.

Rotate care staff between care homes and hospitals. Alternate them to improve skills and widen experience and interest.

The NHS's dominance of care sector employment has made us lazy. We have to morph into being a 'first choice' place to work. Not 'slog it out day after day'. Not 'grind through a shift'. Not have daft rows over weekend working and pitiful contract disputes.

Message to managers, politicians and bosses everywhere:

Protect the front line, fund it properly and make it

fun to work there.

We'll never look after our patients if we don't look after our people.

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Academy of Fabulous Stuff;

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New 'shares' every day.

Make a note; be a sharer this week.

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Contact Roy - please use this e-address

roy.lilley@nhsmanagers.net

Know something I don't - email me in confidence.

Leaving the NHS, changing jobs - you don't have to say goodbye to us! You can update your Email Address from the link you'll find right at the bottom of the page, and we'll keep mailing.

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Disclaimer

Medicine for Managers

Dr Paul Lambden

Poliomyelitis

Bill Gate's quote at the end of this article is very thought provoking...

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The Academy of Fabulous NHS Stuff

Good ideas are a walk in the park. See some

Here.

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Latest 'shares'.

Using webinars to share Health and Social Care ideas; Dementia assistance cars (this is a great idea, have a look); models of dementia care.

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News and Stuff

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>> End of life care - the best in the world.

>> Do you remember Dr Shirt-Off, (he should have waxed) he was a Health Minister and got the sack in the last reshuffle. - he was inexperienced and nervous and let's hope they give him another go. This article in the Guardian, about the doctors' contract rows, written by him is today's must read. I'm beginning to wish I'd been kinder to him!

>> HSJ numbers - their estimate of the financial hole we are in. Probably right but this sort of speculation would stop if Monitor would publish some numbers.

>> Better Care Fund - dead duck; analysis from the HSJ's David Williams.

>> Breast screening - saliva test?

>> BMA ranks swelling - junior docs joining-up.

>> United NHS movement could rock government - the Morning Star; we haven't given them a plug for a long time.

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HealthChat

1st December

King's Fund 5.30pm

Janet Davies

New boss at the RCN

King's Fund 1st December 5.30 pm.

Details here.

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STOP PRESS

NEW Health Chat

21st October

King's Fund - 5.30pm

Keith McNeil

Keith McNeil was, until very recently, the Chief Executive of Addenbrooke's hospital in Cambridge, one of the nation's highest profile hospitals and leadership positions.

What is the full story behind his resignation?

What does he think of NHS leaders, their future and the way the service is regulated.

This is Keith McNeil's first live conference interview and will be a sell out.

Tickets are selling fast

Book now, right here

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19th November

King's Fund 5.30pm

Lord Hunt

Labour's Health Leader in the Lords.

Details here

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Dr Rodney Jones

New analysis

'Is Cytomegalovirus involved in recurring periods of higher than expected death and admissions?

Here

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JOBS

Tell us about your jobs and post them for free.

By the way

The King's Fund are looking for an Assistant Director of Policy - Ł90K. Blimey; I think I might see if I can fit that in!

Why pay to advertise when we will do it for nothing - and it works!

Give it a try.

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Gossip

This is what I'm hearing;

if you know different,

tell me here

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>> I'm hearing - CMO Sally Davies is stepping down from her R&D role. Her replacement is being sought via a strange letter sent to a number of insiders who are being asked to apply. There is no open advert. Getting yer mates to apply might be OK for the medics in the 60's but it's not what publically accountable organisations are supposed to do now, is it?

>> I'm hearing - NHSBSA are reporting a Ł2.3bn gap between CCG allocated prescribing budgets and end of year forecasts. Growth is running at about 5%

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Need inspiration, a good idea or solve a problem

Look here.

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>> Organ donation - changes in Wales finalised.

>> Essure implant - safe.

>> Targets - are they worth bothering with? Story from Scotland but the rationale applies here.

>> Embarrassing problems - I thought this was a really useful portal. Have a look.

>> Clinical coding - all you need to know.

>> PHE cuts - why are they so supine?

>> Options for integrated commissioning - an interesting report from the King's Fund and worth a read. For me it dances around the handbag, the big question; is there a future for commissioning at all?

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Fabulous Stuff

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