Regional pay cuts for NHS staff (Except if you’re a top exec on a commissioning body)

Sometimes I think Andrew Lansley exists purely to make me angry. I’m sure one day I’ll wake up to find him vomiting in my shoes. This morning, however, what I woke up to find was that he’s backing regional pay cuts.

Andrew Lansley, the health secretary, is threatening another controversial revolution in the NHS by proposing that its staff be paid less if they work in poorer parts of the country.

The cabinet minister is backing a plan for regional pay, which would mean that nurses, midwives, hospital porters, cleaners and paramedics would earn less if they work in the north or the Midlands rather than in the south of England.

Yep, we’re going to follow the private sector in a race to the bottom, and helping to further entrench the North-South Divide while we’re at it?

But what if it creates skills shortages? Surely there’ll need to be exemptions to make sure clinically-vital posts get filled?

Official documents reveal that the only backed by the Department of Health would be for highly paid managers working in new bodies established to deliver Lansley’s controversial NHS reform programme, widely criticised as a privatisation of the health service.

The department, according to a submission to the NHS pay review body, believes special arrangements would be necessary for this new cohort of executives to “attract and retain high-calibre leaders and staff responsible for transforming delivery”

So, the only posts for which we need to “attract and retain high-calibre leaders and staff” are for the commissioning bodies that nobody wanted in the first place?

I’ve said before and I’ll say it again. What a complete and utter Lansley.

Andrew Lansley Definition Competition

A few days ago I jokingly ended a post about our beloved Health Secretary with the words, “What a complete and utter Lansley.” Bristol Michael commented on this,

Could there be a competition to define a ‘Lansley’? The usual packet of Jaffa Cakes on offer as a prize.

That sounds like a gauntlet being thrown down. Some of you may remember the American comedian Dan Savage previously held an online competition to define the word ‘Santorum’ in resonse to Republican presidential candidate Rick Santorum’s homophobia. If you choose to find out the winner by googling the word ‘Santorum’, I recommend you don’t do it from a work computer.

Leave your suggestions in the comments boxes, and vote on the suggestions you like by clicking on the thumbs-up icon. As this blog is used by professionals, please make your entries work-safe.

Meet the New Boss, Same as the…Oh Wait, it IS the OLD Boss!

Here’s a shocker, the new GP commissioning bodies are…wait for it…rehiring the old PCT managers to do the commissioning.

Research by the Health Service Journal reveals that managers from the defunct primary care trusts are being rehired to lead the new clinical commissioning groups made up of GPs. Of 81 CCGs to have made appointments, 50 have chosen a manager.

Andrew Lansley, the Health Secretary, wrote to health workers last week, urging them to use their clinical expertise and their knowledge to ensure NHS services meet the needs of patients. “My ambition is for a clinically-led NHS that delivers the best possible care for patients. Politicians should not be able to tell clinicians how to do their jobs.”

But emerging evidence suggests the reforms, hugely rewritten in the face of opposition from Lib Dem peers and medical bodies, will put in place new complex management structures. Liz Kendall, a Labour Health spokesperson, said the next year will be focused on “creating a huge new bureaucracy”, including 240 CCGs, local education and training boards, a National Commissioning Board, an NHS Trust Development Agency and clinical senates across the country.

Oh well done, Mr Lansley, you have not empowered the GPs to take control of NHS decisions. You have shuffled some chairs around and created another layer of bureaucracy, at a time when the NHS can least afford it.

Who saw that coming, eh? Oh wait, everyone.

What a complete and utter Lansley.

Will Adult Social Care Reform Stall?

younger hand and older hand

The Health and Social Care Bill currently limping through Parliament is a mess. Even though I try to take an active interest in its progress, even as someone who is desperately concerned and involved (working, as I do, in an NHS team), I lose heart at trudging my way through some of the details which have been changed, adjusted and repackaged beyond the level of human (oh, ok, maybe it’s just me!) comprehension.

I was baffled though by this piece which turned up on the Guardian website yesterday.

Announcing that Lansley, having been stung and having lost credibility as his health reforms (hopefully) hit the buffers, is going to be delaying his announcement of reform in social care.
Continue reading

Creating a Two Tier NHS

Reports trickled through yesterday that Lansley has slipped a sneaky potential amendment through in the pre-Christmas rush that allows NHS Foundation Trusts to increase potential provisions for private patients from a current average of  2%  to a maximum 49%.  This post on Though Cowards Flinch sharply points out the this is a total income rather than based on the number of beds which is an important distinction.

The details are explained well in this post at NHS Vault which I recommend highly because there is a lot more detail than I’ve garnered. My response is a undoubtably less erudite than both the previous posts but based unapologetically on my gut instincts and experiences of working in and around the NHS. Continue reading


Yesterday, it was announced that the government was going to set up a website, the details of which would be unveiled  in the Spring White Paper on Adult Social Care which could bring a kind of ‘Trip Advisor’ model of rating and commenting to providers of care homes and nursing homes.

Sounds good so far. I certainly welcome more open and accessible information for those who are choosing care homes but there are some real and obvious differences that need to be highlighted between the choices that are available to those who are picking hotels in New York City and those who are choosing care homes for Granny in Wallsend.

On a positive note, Burstow claims that these plans came from user-led discussion groups which shows that he is listening but there are some important points that have to be taken into consideration, lest this is seen as a way of trying to provide regulation on-the-cheap because the actual regulatory body – the CQC – is unable to carry out its function.
Continue reading

Families and Hospital Wards

There’s an interesting article on the Guardian’s Comment is Free site, discussing the suggestion that hospital visiting times be extended so that families can be more involved in their care.

The suggestion, previously made by Peter Carter of the Royal College of Nursing, had been the focus of a lot of criticism. Some suggesting it’s about too-posh-to-wash nurses, others that it’s an admission that the wards are too overwhelmed to provide basic care.

Peter Preston has a different take on it. He points to his experience of being in hospital in Spain, where the whole family tends to troop in along with the patient.

And the deeper point, revealed time and again, has absolutely nothing to do with cost-saving – or with graduate angels too proud to plump a pillow. The Spanish experience is instinctive and positive. It doesn’t make family involvement a passed parcel of sneaky budget savings. It says, simply, that this is what family life is all about. Hospitals aren’t carved up between them and us. Hospitals are more joint community centres in a society used to doing the right thing.

It’s a valid point, in my opinion. I remember when my father was terminally ill in hospital. I spent a lot of time sitting at his bedside, making sure he ate the food that was in front of him, giving him occasional sips of water…nursing my own Dad. It didn’t just mean that Dad didn’t get malnourished or dehydrated. It also gave me a bit of closure on the relationship with my father that was coming to an end, and it helped later on when I was going through the grief process.

Regarding the criticisms of Carter’s suggestion, I’ll start by saying that I don’t agree with the suggestion that nurses are “too clever to care” with hoighty-toighty degrees but too proud to wipe a bum. Admittedly I’m biased since I went down the degree route myself, and I’m currently in a role that doesn’t involve bum-wiping (I spend much of my time doing cognitive-behaviour therapy with self-harming teenagers. I think they’d be a bit unnerved if I offered to wipe their bum.) However, when I was a staff nurse on a ward I felt it was very important to show that I wasn’t too proud to get mucky with the basic care. As for the slogan, “too clever to care”, my experience is that clever people tend to make for outstanding nurses. If a staff nurse thinks something is beneath them, my experience is that those nurses are usually muppets.

Also, those who insist that nursing has been ruined by the British university system tend to forget that much of the care on our wards is done either by people who trained in the Phillipines, India or Africa, or by healthcare assistants who didn’t go to university at all.

As for the other criticism – that it’s a sign that the NHS isn’t coping. Well, that one’s a little harder to argue with. Just this week the Care Quality Commission reported that half of our hospitals are failing to ensure elderly patients are properly nourished. They give some pretty clear indicators of the reasons.

One nurse said: “Sometimes I am the only staff member to feed on the ward. How can I feed all these people?

“Sometimes by the time I get to the last bay, either the food is cold or it has been taken away.”

There’s the usual mouthwash from the health secretary Andrew Lansley about how he wants poor care “identified and stamped out”. Naturally he’s talking utter drivel. NHS trusts are freezing recruitment left, right and centre. The wards will get more understaffed, patient care will get worse and there’s not a damn thing that Lansley can do to stop that.

So, should families get more involved in patient care? I can see valid social reasons in favour of it – both from Preston’s article and from my own experience. But there’s also the brutal reality that we may have to just to make sure our sick relatives are getting enough food and water.