Wednesday, August 01, 2007

NHS Pay- A Triumph Of Simple Shopping

The magic beans were even more useless than we imagined

Our very first blog about the Simple Shopper was on the new GPs contract (see here). We asked how the Department of Health could possibly have given away such a heavy milking cash cow in exchange for a few magic beans that never even germinated.

Right across the NHS, the Department stuffed mouths with Gordon's Gold (make that our gold), and got virtually nothing in exchange. The authoritative King's Fund reckons around 80% of the extra money went on higher costs (eg see this blog). What's more, right across the board, the pay reforms cost much more than planned:

Yesterday we got confirmation of just how badly the Department of Health fumbled the new GPs contract:

"The NHS work of the average GP in England has been cut by about seven hours a week since the government introduced a new contract in 2004, official figures revealed yesterday.

The contract, which removed GPs responsibility for treating patients outside normal office hours, increased their earnings by 25% in the first year, raising the average for a dispensing partner in a GP practice to £117,000. Many doctors boosted earnings by selling out-of-hours services to their primary care trust that they used to provide for free.

A report from the government's information centre for health and social care showed the average GP worked 36.3 hours a week for the NHS in 2006-07, compared with 43.5 hours in 1992-93. The reduction was due to more part-time working and fewer out-of-hours responsibilities.

The latest figures showed only 62% of GP partners and 22% of salaried GPs work full-time."

But why? Why would the DoH give away all that money without getting anything in exchange? We know they're incompetent, but surely even a two year old would want at least a few sweeties in exchange.

It turns out that the DoH really did believe they were getting something in exchange: staff and contractors' buy-in to reforms with portentous titles like Agenda for Change. The idea seems to have been that in exchange for a mountain of cash, workers would consent to being managed by the commissars and their legions of bureaucrats.

Earlier in the week the King's Fund reported on the implementation of Agenda for Change, which was the reform programme for pretty well everyone in the NHS except doctors.

The bottom line is familiar: this was a top-down programme imposed on local managers and staff without any detailed consideration as to how it was to be implemented.

A key part of the "reforms" was to be a much closer dialogue between staff and their managers, based around all the usual paraphernalia of the HR consultant's art: formalised "job design", personal development plans, regular appraisal/performance reviews, more training, etc etc.

Now, anyone who has ever attempted to implement such schemes in the real world knows they are much easier to talk about than to use. Even if you manage to tick all the boxes- making sure everyone has a job description and a regular documented appraisal review etc- that by no means assures better management. Badly handled, they can make working relationships much more difficult.

Which is precisely what seems to have happened in the NHS. The King's Fund reports its own survey results showing that actually things have gone backwards since the reforms (see report table 4). Fewer staff now have appraisal reviews, fewer staff think their job is "well designed", and fewer staff express job satisfaction.

The appalling upshot is that only one quarter of staff now feel their work is valued by their employer. A total collapse in morale.

Finally, fewer than half of staff now "have a positive view of patient care" (42% vs 54% in 2003). Alarming.

As we've said many times, there's simply no way of managing a guargantuan blob like the NHS. Top down perestroikan reforms like Agenda For Change will never work.

The government has now hit the panic button and put in union man Johnson to stop the engines. So we are now into a long and dangerous drift downstream.

What we desperately need is a government that will bite the bullet, grasp the nettle, and carpe the diem. We need to break up the whole monstrous edifice. Competing social insurers is the way forward.

Sadly, our centrist first past the post electoral system looks incapable of delivering it any time soon.

Which is A Problem.


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