Strikes as #NHS staff try to cope with a system broken by #government (#UK #Politics #austerity)

nhsstrikesNHS staff have planned several strikes in the New Year as protests against the government freeze on their pay.

The first strike is planned for 12 hours on 29th January, and again on 25th February and includes nurses and porters.

Ambulance staff in England and Northern Ireland are considering a two day walk-out  on the 29th and 30th January.

In addition to strike action, Unison members will work-to-rule between the planned January and February strikes, only working their contracted hours, taking all breaks, and will not work unpaid overtime.

Christina McAnea, head of health at Unison, told BBC News “Our members’ pay has been frozen or held down for the past five years and there is no end in sight. On average, they have lost around 10% in the value of their pay over the life of this parliament.

“We now have no option but to escalate and plan for longer strikes.”

The GMB says it is holding urgent talks to consider a two-day strike in the ambulance service in England and Northern Ireland on 29 and 30 January.

Rehana Azam, the NHS national officer for the GMB, said “It is regrettable that GMB has no alternative but to escalate the strike action in the NHS.

“The Secretary of State for Health, Jeremy Hunt, is acting irresponsibly with a continued entrenched position by not engaging in any meaningful talks with the health unions.

“Further stoppages across the NHS are inevitable should Jeremy Hunt continue to refuse to hold discussions to settle the pay dispute, a dispute created by him when he dismissed an independent pay review body’s recommendation for NHS staff pay.”

The on-going battle over pay in the NHS continues as staff come under immense pressure to provide services to the public with fewer resources.

Recruitment into nursing has declined in recent years because of continual government cuts to budgets, resulting in a national shortage of qualified nurses to fill vacant positions.

Qualified nurses are reluctant to join or re-join the NHS because of the working pressures nurses are placed under, and the instability of working in the NHS as more pressures are placed on staff.

In between all of the propaganda and excuses the hard fact is that hospitals have been forced into a position of running a service as a business. Consequently rather than the focus being on the NHS’ core function of providing care it is now focused on budgets and cost cutting.

‘Managers’ and accountants look at their highest expenditure and try to make cuts.

With the highest expenditure in trusts being staff, ‘managers’ and accountants see this as the primary target for quickly saving vast amounts of cash. We then have a situation where the one resource the service needs and can not operate without is being cut to the bone with little thought of the impact this has on service delivery.

Staff are expected to do more for less, services are operating on the absolute minimum of staff, there is little capacity for peaks in demand, and the whole thing comes crashing to a grinding halt.

No wonder working in the NHS has gone from being seen as a stable and lifelong profession to being a source of uncertainty and stress for employees.

The last thing a trust should be doing is killing off the one resource which is essential to its operation.

If savings are to be made, this should be achieved by restructuring the many bloated levels of management which exist within most trusts, reassessing expenditure on local and national contracts which provide poor value for money (including contracts which trusts are forced to take through centralised government agreements which offer little or no local value), and finding alternatives to the expensive central purchasing agreements for supplies which many trusts are obligated to use.

In addition, trusts should be more proactive in negotiating contracts for essential services, including power, fuel, communications, IT, and other utilities, as well as maintenance contracts. But they should also be aware of value for money and not automatically choose the cheapest option at the time, which may turn into a much more expensive option in the future if the supplier is poor quality.

Overall the NHS is more of a lumbering dinosaur than an up-to-date care provider.

One common area where the principles of business apply to a service such as the NHS is that of staff.

Staff need to feel as though they are valued and (more importantly) are able to do the job they have chosen as their profession. People in the NHS do not choose to undergo extensive training and continued development because they want to be caught up in a bureaucratic storm, constantly having to fight for fundamental rights and job security. Most of them want to get on and do the job they are trained for and feel properly supported in doing it.

Organisations which expect staff to do their jobs efficiently without the proper resources to enable them are self-defeating. It doesn’t take long for staff to become disillusioned or adopt a poor attitude if they feel they are being taken advantage of or are unsupported.

The inevitable result is resistance against the organisation rather than cooperation with it. The threat of losing their job only serves to breed more resentment and eventually something has to give. People will either stop making an effort to achieve high standards, leave the organisation, or will become more resistant to everything the organisation may try to do.

‘Managers’ need to move away from seeing their staff as a necessary evil and start treating them as the essential and valuable resource they are.

Some trusts are experiencing the repercussions of failing to give staff proper and appropriate consideration. They are finding it hard to recruit staff for vacancies ‘managers’ were responsible for cutting in the past, and have since discovered that their initial short-sightedness is causing them more problems today. By cutting training and staff several years ago they have created a shortage of qualified and willing recruits now. It was an inevitable outcome which should have been foreseen.

On top of this, we have government interference – which is rarely helpful.

This has created a similar situation in which short-sighted pressures placed on health trusts are now having ramifications across the service today.

The health service is sustainable even as more demand is placed on it as time passes. This is an inevitable consequence of an increasing population which can be foreseen and planned for. There is no excuse for the government blaming ‘increased demand’ when they have known the level of increase in population for at least the preceding five years.

With the current government there seems to be another driving factor. That is to run the NHS into the ground as much as they can get away with and open it up as some kind of flea market for private business (mostly their ‘preferred partners’).

Every time the government comes up with yet another target or ill-conceived initiative it requires the allocation of resources. Unless the government provides additional finance to cope with the additional demands placed on trusts inevitably it is front-line services which will suffer.

Another initiative/target costs cash to implement and administer. Probably more staff (a person has limits to how much they can do in a day) to handle the administration and possibly someone to oversee or be in charge, more IT, more ‘reporting systems’ taking up staff time, more stationary (even in this ‘computer age’ the amount of unnecessary paperwork generated and sent to all and sundry (most of whom are probably not interested in it except how it affects their personal position) is phenomenal waste), printing glossy reports, wasted time in meetings on how to implement and administer it, and further pressures on front-line staff who are required to do more administration than care and whose focus is shifted from doing their job to attaining ‘targets’.

The administration and finance departments in some trusts are incredibly big, often with the number of employees disproportionate to the total number of front-line staff. Not all of these ‘administrators’ are necessary to the core functioning of the organisation, but have become necessary due to the increased demands of accountants, ‘managers’, and government recording and reporting requirements.

Another area which is leaking cash out of many trusts is the use of ‘business managers’ and ‘business consultants’.

In essence, it is not a bad idea to have someone who has commercial awareness.

A lot of middle and lower management in the NHS are health professionals, which is fine for clinical management. Unfortunately many of them are also expected to perform business or corporate management which is outside of their knowledge and skills. It doesn’t matter how many ‘management’ courses trusts waste money sending people to, if they have little or no natural management ability (or interest) they will be forced into a position which they do not have the knowledge or skills to do.

When clinical managers are forced into a position of taking on more commercial tasks it takes their focus away from what they do best, and which is an essential part of providing care – clinical management/supervision. So again we have a situation where a clinical manager’s ability and time to focus on care provision on the front line is severely impaired.

The natural human response is to try and cope – no matter how stressful or inefficient that may be. This is not in the best interests of clinical or commercial management, nor is it in the best interests of the person or those in their charge.

Bringing in outside ‘business managers’ or ‘business consultants’ is something of a double-edged sword.

On the one hand, if they are skilled in delivering efficient high quality service and understand the unique environment of healthcare on the front line, then they could be a valuable addition. On the other, if they have no idea about health provision and the basics of delivering high quality service then they are a waste of space and money, as are ‘business managers’ (or any manager) who bring in ridiculous ‘efficiency’ schemes which may be fine in a shop or McDonalds but have a detrimental effect on the time front line staff can allocate to performing their main purpose.

They also need to understand that there will be high purchasing and operating costs across a range of essential and unique healthcare services. Quality equipment, drugs, and expertise all cost cash and there is no getting away from it.

Presuming there is a suitably qualified ‘business manager’ or ‘consultant’, the next hurdle is how much freedom they have to develop the service. In most trusts they will have no choice but to rely on the existing management structure that has clinical and operational knowledge. Consequently, if that structure is poorly skilled or managed, or is in self-protection mode, it will be unlikely that any changes will be implemented efficiently, or that information on which those decisions are based is accurate.

It is also essential that the government recognises the uniqueness of providing healthcare as a service and does not engage in ridiculous ‘business’ strategies based in their (mostly) unskilled and ignorant knowledge.

Overall, the NHS is in a bit of a tough place right now, and there needs to be a significant change in attitude on both sides of the fence.

Staff are a valuable asset not a liability, and they need to be treated as such.

Providing healthcare costs money – and lots of it.

Government has more than enough money in the public purse to finance an efficient well-staffed service instead of wasting it on frivolous and vanity projects. They need to get the basics sorted out before spending billions on things the country as a whole doesn’t need and which will only go to benefit a few.

We need to get away from the academic focus of nurse training (in particular) and go back to a system where student nurses were employed and received on-the-job practical experience from experienced and standards driven Sisters and Matrons.

Student nurses would still have plenty of time to study for qualifications, but would do so in a real environment where they could put their knowledge into practice, instead of the ridiculous situation we have now where they go to university and have occasional placements in different places where no one gets to know or mentor them properly.

In my experience within healthcare there are far more unsuitable nursing students than there have been in the past, and the worrying thing is that they obtain jobs based on their qualifications rather than all-round suitability.

Being able to retain and regurgitate information like a robot is one thing, but being able to provide quality care takes a whole lot of other skills.

The quality of some of the nurse training provided by universities is variable, and in some instances questionable. Again based on my practical experience, there are students who have managed to survive year after year based purely on their academic achievements, and yet they seem to be seriously lacking very basic skills considering the stage of training they are in.

Even though their lack of skills is brought to the attention of the training provider by very experienced medical professionals, the same situation still happens year after year.

Of course, this is not the fault of the students, they are doing what they are told which they will automatically accept as being correct. They only discover their lack of basic skills when they start real employment – embarrassing for them and an encumbrance on other staff who then have to virtually train or retrain the person in basic skills. There are exceptions of course, but the overall shift of basic nursing training to academia at the expense of real-world training is no good to anyone except the universities making a nice earning from healthcare.

Student nurses should be employed, properly assessed by experienced professionals on a continual basis throughout their training, and have real support in their studies. That is what professional nursing is about.

Until the focus of the NHS shifts from trying to be a business back to being a public service there will be problems which are insurmountable, and which will certainly not be helped by cheap private companies taking over essential services.

So it is no wonder that NHS staff feel the need to vent their frustration by striking and working to rule.

They deserve the best training, the best working environment, and the appreciation of the government and NHS trusts for the dedication they show, the stress they are under every day, and their goodwill.

Strikes are a result of not being listened to or being given proper consideration. No one wants to lose pay through strike action, but sometimes it is the only way left to make a protest when governments and NHS trusts refuse to listen.

Unfortunately unions tend to be tigers without a full set of teeth nowadays after decades of disempowerment.

So for trusts and the government a couple of days of strike action and a work to rule is not going to have much of an impact, and will certainly not make any difference to the current raping of the NHS the government is currently involved in.

Even so, we wish the NHS staff involved in industrial action the best of luck in trying to achieve their goal.

Coming from a family of nursing professionals, many of them having held positions as Sisters and Matrons throughout the 1960s and into the 1980s, the ones who have passed would be turning in their graves if they saw the NHS and nursing training of today.

Follow @martynjsymons

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5 thoughts on “Strikes as #NHS staff try to cope with a system broken by #government (#UK #Politics #austerity)

  1. How does the NHS compare with the US model of entirely private healthcare which obliges everyone to pay either by regular insurance payments to private companies, or by struggling to find the cash when they are sick or injured? How do the poor survive in the US health care system?

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