9th February 2016

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Prof Sir Mike (Deep-Diver) Richards - CQC
In conversation with Roy Lilley - King's Fund March 1st, 5.30pm
Tickets and details HERE

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News and Comment from Roy Lilley
Last December Health Education England published plans for the future of the workforce... they didn't inspire me.
There is a desperate need for nurses now.  'Now', meaning tomorrow would be good.
Looking after the +75yrs consumes about half the resource.  Complex patients grow by about 20%.  HEE's 6% increase in nurses didn't do it for me...
HEE are like a veteran at the Remembrance Sunday march-past.  The bands play, the parade Sergeant Major barks; 'By the left, quick march' and off they go... left-foot first, 30inch step, at 120 beats a minute.
Half way down Whitehall it becomes a bit too much.  Someone gets out of step.  Getting back onto the right foot (or in this case, the left foot) is impossible.
HEE are out of step.  In an interesting interview with the HSJ's Shaun Lintern, their  boss, Ian Cumming, admits as much.
They have been wrong footed by Treasury cuts to their budget, wrong footed by Trusts inability to retain staff and wrong footed by Government plans to scrap bursaries.
Cummin is frank:
"... HEE had invested more money in nurse training to deliver a 15% increase in university places during the last 3 years... the Treasury's decision to award...  flat cash settlement to 2020 meant its annual workforce plan had to be hastily rewritten, with training numbers balanced against what it could afford."
The impact of the spending review scuppered them.
Workforce planning... tortuous and the NAO, in this report have given everybody involved a hammering for getting it wrong, wrong, wrong.

Starting with Trusts estimating the number of nurses they need and can pay for, the DH decides how many training places they can afford, that dictates the number of training places the HEE can arrange with the Uni's.
It all goes terribly well until... the Chancellor pulls the plug on the money.
So, it goes something like this:
  • Trusts are under pressure to 'safe-staff' wards; meaning more nurses. 
  • They don't have more nurses so they resort to agency nurses. 
  • Agency nurses cost more
  • There is no more money so the DH cap agency costs. 
  • Trusts don't have a Plan B. 
  • There are not enough nurses, so safe staffing goes out of the window.
  • The CQC turn up and bark; 'Not enough nurses!' this Trust is badly led. 
  • The Chief Executive gets the bullet.
  • The Chair and half the Board quit.
  • Monitor put in an interim at three times the salary.
  • Panic sets in; more agency nurses are allowed.
  • The Trust gets a bung.
...  we celebrate by organising a party in the mad house.  Management by mayhem.
Dumping the bursary, (aside from the philosophical and moral dimension to the role of the state in educating its population, student debt and all the rest that I am well aware of), might attenuate the problem. 
Where Trusts have set up non-commissioned courses they have been hugely oversubscribed.  There's no shortage of people wanting to be nurses, willing to take on loan repayments that start at about £8 a month.
However, it creates more problems for HEE.  After 2017 how do they fit into nurse training and workforce planning?  Perhaps they don't.  The combination of the 5YFV and Vanguards says to me, a very different workforce with horizontal skills is required. 
Cummin's budget has a £70m hole.  Not good.  Where Cummin has a bang-dead-to-rights point is; Trusts are poor at nursing-staff retention.  He says:
"...[there is ] enormous variability in retention rates between similar NHS providers... [that] couldn't be explained by... factors such as pay."
We know the question we have to answer; what makes a good employer.
How about

flexible rotas; child friendly (a crèche); a culture that is kind, creative and fun; whole person training and development; dump bully-bosses and staff who behave badly; listen to people; realise your people have a life outside work; find out what inspires people and do more of it; show people what good looks like and help them achieve it; accept pay is a 'national thing' but figure out what you can do locally with access and discounts to become the local employer of preference...
Shall I say is again?  Protect the front line, fund it properly and make it fun to work there.  It works.
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We are taking  
HealthChat and the 
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on the road.
Come and join us , 
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11th February at  
Aintree University Hospital.
New Health Chat
Prof Sir Mike Richards
Chief Inspector of Hospitals 
1st March 2016
King's Fund 5.30pm
You don't want to miss this - do you?
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Recording here
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At the Edinburgh Fringe
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>>  I'm hearing - Chair of the HSCIC is standing down.  Kingsley Manning is going.  Mmmm, I wonder what is happening there? 
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