28th July 2016

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Ed Smith
Chair of Not-Monitor, or whatever it's called.  In conversation with Roy L
Good conversation, networking and a glass of wine.  What's not to like!
Why not you?
News and Comment from Roy Lilley
Here's a question for you.  Who tipped-off the BBC to do an FoI on the amount of overtime NHS consultants were being paid to do?
We all love Aunty but we know she is a bit slow off the mark when it comes to the NHS.  Seldom does the BBC create stories; they usually report them.  They are not sensationalist.  Quite right, too.
So, what encouraged the Steady-Eddy-Editors at the BBC to fork out a fair few quid, do a write-round and collate the data to discover some NHS consultants are earning more than Croesus for scything their way through elective lists at the weekends?
Who would have most to gain?
The Tinkerman got himself into the mother-of-all messes with the junior doctor's contract; trying to sort out weekend working, overtime and rotas.
Talks with the consultants, on the very same topic, are ongoing.
Consultants have a national contract that equates to a 40hr week.  The rest is left to the locals to sort out.  Some Trusts get their Docs working at weekends, for non-premium rates, others can't seem to manage it.
For the Trusts who have soft Boards, a national overtime deal would mean they can duck the tough issue. Instead of running their Trust, they are content to run behind it.
It is one thing for the Tinkerman to go to war with 'exhausted, exploited' junior doctors and lose.  It is quite another to go to war with consultants earning 300k in weekend bunce.  He's learned and he's picked a winner.
Of course; not all Docs do have their arm in the till, not all Trusts pay it... but enough do.  Enough to get some great headlines; enough to make the Consultants think twice about their negotiating strategy.
The Tinkerman looks like he has won a messy lesson in dealing with the BMA.  Get the mood music right, set the scene and get public opinion working for you?  Not for nothin' was he once the Secretary of State for Kulcha, Meedya and Tickets.  Use the media.  It's what it's there for!
How neat, too, for the Jim Reaper, struggling to extricate himself from some careless talk about cutting staffing costs.
The Reaper wants to 'dial-back' staffing costs to 2014 levels, attenuated by a formula that no one outside Mensa understands and stuffed up the back-passage of the controls totals.  The details are here, start at page 9 para 4.2.
If you run a delivery company your biggest cost will be fuel.  If you are sensible you will send your drivers on economy-driving courses.  Hire more drivers to avoid wage cost inflation and overtime.  Fit thingamabobs to the engines to get more miles for the gallon, plan journey times and deliveries to keep away from peak time traffic jams.  You'll check tyre pressures, maintain the fleet and shout at your MP over the fuel price escalator.
If you run a hospital your biggest cost will be people.  Patient facing people.  We know what happens if you cut staff to balance the books.  No one wants a return to those days.  Read the HSJ's Shaun Lintern's warning here
That's the worry.  Everything the NHS does needs people and the people we have are working flat out.  Seventy percent of our costs are nurses, never mind the rest. 
Somehow we have to find the trick of helping everyone to be more efficient, get them more thingamabobs to help them get more effective, do away with the idea of plain-days, weekend-days, premium-time and peak-time traffic.  Plan the delivery of care better, spread the cost of the overhead, make the assets sweat, check to organisational pressure and train colleagues to be at the top of their game.  The NHS is 24-7, get over it.
And, we need to get a real grip on recruitment and training.  HEE and the uni's have simply got to stop palavering about.  Shout at our MPs over NHS cost escalators and funding and make them deal with the bursary issue one way or another..
But... and it is a simple but... Trust Boards have simply got to get better at running their hospitals.  

If the Reaper bench-marks staff costs and ask 'why are you more expensive than someone just like you', it may put a Trust Board in an embarrassing position but it puts him at the very heart of good business management.  Why wouldn't you want to know, act and sort out anomalies?

If Cardinal Foster at Wrightington, Wigan and Leigh NHS Foundation Trust, can sort out his overtime payments, the The Reaper has every right to use them as a yardstick and ask why not you...  
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