Former NHS Nurse and manager now contemplating the NHS from outside

Archive for the ‘Count down to the extinction of PCTs’ Category

Business as usual

In the middle of a chaotic reorganisation we carry on regardless. We are busy supporting our network groups, arranging workshops and training, recruiting users to help with service developments and reporting on things that have been done. We are busy full stop. We work hard and we work pretty long hours between us. But, you might ask and I often ask, why? Why are we bothering to put so much effort into things that we don’t know will continue in the future?

Well partly because we are kind of required to do so. There are rules in place, there are requirements on us and they haven’t gone away. There are also people out there, clinical people, who still need our support to be able to meet together and discuss how they can continue to improve things for people with cancer. There are campaigns for early diagnosis that we are still involved with and detecting cancer and doing so as soon as possible is a priority area. We are also trying to create some kind of legacy, to make sure that what we do, what has been done continues. While people in high places continue to work out how the new world will work, we carry on working in this world.

We are interacting now with the new CCGs; the board members, GPs who are finding out about their responsibilities to their populations. They find that we do useful work, have knowledge they can’t hope (or want) to learn. They wonder how, come April they will be supported in making sure that cancer and end of life care is best commissioned.

We prepare to apply for jobs. The adverts were meant to have been released last week, now apparently it will be this. The top job will be appointed to in the next week or two and then that person (and who knows who else) will interview us sometime in the run up to Christmas. In the new year we will know more about what those with jobs will do in them and we will discover if we continue with business as usual in the old set up.

It all feels a little unreal. But of course it is real. These are real people, with real jobs, real mortgages and bills who shop in real supermarkets and go on real holidays. It is easy to write off those who work in some kind of administration. But the fact I left clinical practice enables others still seeing patients to spend as much time as possible doing so. If there are fewer of us doing those supportive jobs, either fewer patients will be seen or else fewer patients will be able to be sure that advances in implementing best practice will take place.

Those of us who get jobs in the new world of strategic networks will work hard to make sure this doesn’t happen of course. But there are no guarantees. Of course I may be wide of the mark and the new systems may be an improvement on the old ones. Lets hope so for all of our sakes!

Patient involvement in the new NHS

My last two jobs have heavily emphasised the involvement of patients in healthcare. When I was commissioning maternity services, those patients were called women and now in the world of cancer they choose patients and carers over the more common term ‘users’. Both of these areas of healthcare have, for many years placed the experience of patients using their services at the centre of planning and delivery of services. At times those involved have felt that professionals pay lip service to this prescribed requirement. But I know that my senior midwifery and nursing colleagues have taken their role seriously as have I. Putting what is discussed in meetings into practice can be difficult as real events take over and people struggle with the realities of their job.

Most of the NHS Trusts (providers) have specific Patient and Public Involvement committees and groups, but these are not specific to a single condition or disease. Maternity is definitely different from the mainstream, given that in the main pregnant women are not ill and are not patients as such. Cancer (rightly or wrongly) also considers itself to be different with unique needs.  Peer review measures for User Involvement require us to have a User Partnership within the Cancer Network, laying down a number of ‘measures’ relating to both the experience of patients and the involvement of service users and carers in services.

The new NHS throws all that we know about this kind of service (or disease) specific involvement will take place. I have had the pleasure of working with some amazing people in both areas over the years. They work hard, give up so much of their own time, often in conjunction with running their own busy lives. Sometimes in the case of my current user colleagues, they continue to manage the after effects of cancer or to battle recurrences of ill-health. They are not surprisingly a little anxious of what will become of their efforts once PCTs (who have been statutory expected to manage Maternity Services Liaison Groups) have been abolished and Cancer Networks have been subsumed into Strategic Clinical Networks.

Will the clinical networks be able to support real patient involvement within the entirety of their portfolio (cancer, maternity, children, mental health, stroke etc etc). Or will it be left to the NHS Trust, CCG and other more general Public and Patient Involvement groups to pick up the mantle. Will the stalwarts of maternity and cancer involvement join in with them, will some of them who are part of the Links mechanism become part of the Health and Well being Boards. Does it matter if this is about general patient experience and involvement or should their be something special for specific groups. Or will we lose something from all of this and will some of those committed individuals walk away. From some of what I have heard, many are disgruntled and hurt that the work they have done so far will apparently be lost, and they might just.

Time for an update

Was it really March when I last posted here? For a long time this year, very little happened in my bit of the NHS. Essentially we got on with the day job and waited. I had got fed up with writing about it here and if I am bored, I can guarantee that it wouldn’t make very interesting reading. I think that situation has changed and that what is currently happening in PCTs (and elsewhere) to be honest needs to be written about, since there is little being said in the media or newspapers (other than the Guardian). I predict that once the dust has settled and the ‘bureaucracy’ has been removed, some people will be very shocked by what is left. They will be surprised that the NHS isn’t actually being run by GPs (though they have a wonderful nominal role) but by rehashed senior managers some of whom work in Leeds and many more work out in the local areas.

Over the next few days and weeks I will try to explain the mess that Andrew Lansley put in place and what the implications are for people like me. More importantly though what are the implications for people working on the front line, and vitally what does it mean for patients? Will any of this matter? Time will tell I guess but I suspect that perhaps it will.

The Cancer Networks, one of which I work within, will be subsumed into a new kind of Strategic Clinical Network. This will include not just cancer, but heart disease and stroke, mental health and maternity and children. There will be 12 of these networks which will be hosted within some of the Local Area Teams of the National Commissioning Board. Staffing will be reduced from current levels, but with just a few months to go, we don’t really know by how many nor indeed to we know exactly what these people might do.

My job is about facilitating clinical people to work together to improve cancer outcomes. Some clinical people, I might tell you, need a hell of a lot of ‘facilitating’. I also work with patients and carers to make sure that they are able to contribute to the development and delivery of services. When (rather than if) that kind of support is not available, I am not quite sure what will happen. The work of course will go on and best not to engage in some kind of amateur dramatics here about the value of me and my colleagues. But there are lots of things that we do, that appear to be valued and necessary that I can’t imagine being picked up by any one else. So as things emerge, I will try to discuss them here.

We really are on count down now, and likely by the end of the year many of us will be on notice of redundancy. Others though are luckier, particularly those working in areas where they can be mapped into jobs in the CCGs, the CSU or Public Health. I hear you cry what is a CCG? What is a CSU. Well good question and perhaps I could do a little bit along the lines of trying to define them. Maybe you can tell I am just a little bit more keen to return soon and say more. Time to resurrect this dying blog and wonder about what Life in the NHS is like right now!

Spring has sprung

I love this time of year. Each day as I look out of the window, drive to work and back I notice that the leaves have a little more blossom, a few more leaves. The daffodils are now in full flower and to top it all we have been experiencing highly unusual sunny and warm weather. It makes you feel good. Spring is a time of new beginnings a time to clear out the cobwebs, to clean the house, to get ready for the summer ahead. This year I approach spring feeling refreshed because I have recently had 3 weeks off work; 2 in USA and 1 at home. I have taken a break from work, and from concerning myself with the problems of the NHS. Now though I am back in the mix and raring to go.

The Government must also be glad that with the advent of spring, they have finally got their Health and Social Care Bill through; it will receive royal assent within the next couple of weeks. Mind you I believe they have other worries (a budget that many felt favoured the ‘haves’ rather than the ‘have nots’, scandal over dinners with David Cameron and an impending fuel tanker strike to name a few).

Next week we start a new financial year, the last of the PCTs. This is going to be an interesting year as we head towards transition towards the new world of healthcare commissioning and provision. Already our PCT is getting ready to become a Commissioning Support Unit. Local Clinical Commissioning Groups are preparing to be ratified or whatever the process is called and everyone without exception working in the health economy faces the reality of doing more for less money (that’s just the budget but personally we face similar challenges).

I don’t agree with the Bill but enough is enough. We have to move forward, we have to prepare for new beginnings. I fear things won’t go completely as the Government would like and in a perverse way I am quite looking forward to seeing how it all pans out. It would be fun if this wasn’t public money, real lives and real jobs. What is worse is that this is healthcare; mistakes can lead to people missing out on the care they need and it can lead to death. We watch and wait.

Meanwhile I’ll enjoy the good weather while it lasts; it will turn cold by the weekend and eventually it will rain!

A slow death

So the progress of the NHS Health and Social Care Bill goes on and on. This week the Bill has gone back to the house of Lords, where the hundred or more amendments will be debated and either rejected or passed. Everyone who understands anything about this Bill and it’s implications knows that it is doomed to failure. We know that rather than less bureaucracy, more will be created, that where private industry is brought in to run services they will soon realise that healthcare doesn’t tend to run at a profit, unless you are a GP lining your pockets. The people to suffer for this mess will be the people in England with the greatest need; people with little or no income, who lead what might be described as unhealthy lives, who can’t articulate what they need and often who suffer from more than one long-term condition.

Those of us who work for PCTs will now have to go through a final, slow and painful journey to whatever awaits us; NHS commissioning board outpost, Commissioning Support Unit, Clinical Commissioning Group, Local Authority. Fewer people doing the same or more work. Contrary to what the government say it will be the same people doing the work next year, only there will be less of us and we will be spread around a number of organisations. The outlook feels gloomy.

Short term though I finish work tomorrow for 3 glorious weeks away from the PCT.  2 weeks visiting my lovely son in California for his 21st birthday and another resting  up at home. Hopefully I will return refreshed and ready to face the final year of the PCT; I think I am going to need it!

Of course we can only hope that while I am in the USA something untoward happens!

Too little too late

So the RCN and RCM have withdrawn their support for the NHS Health and Social Care Bill. About time too in my opinion, but you have to wonder exactly why it has taken so long. It is 18 months or so since the Government first published their ideas for abolishing PCTs and putting GPs in charge of commissioning as well as a whole range of changes which will apparently increase competition and fix the mess that apparently is our healthcare system. Since then we have paused, given our views, seen some cosmetic changes and started the long weary process to change. The Bill still isn’t law but I suspect that will come soon. At the same time we are to save £20 billion, because after all the NHS is wasteful.

I respect the RCN both as a professional organisation (I studied for my BSc through them) and as a Union. But I wonder why they have chosen now to declare outright opposition. Is it as Andrew Lansley says that they are doing this because of the changes to public sector pensions? Because nursing is getting a bad press right now? Or is it because at long last people are realising that the current pressures on nurses which appear to be resulting in a deterioration in the level of care nurses are able to provide will only get worse? Nurses have been telling whoever will listen to them that this reorganisation is being done for its own sake and that services are being affected and people are losing their jobs. It is good to know we are being listened to by someone – at last!

This weekend I am meeting up with some of the people I trained with 30 years ago. Over lunch we will no doubt reminisce about the good old days and will talk about nursing today. We may well talk about the mess that political meddling has done and will do in the future to the NHS and to our profession. We will also wonder how on earth patient care will improve as a result. We might wonder if actually it is too late and we are lucky that we are approaching 50 rather than just starting on our careers.

Happy New Year!

So 2012 has arrived. It is good at this point in the year, i.e. at the start to reflect back on the good, bad and ugly of the previous 12 months and to look ahead to the coming months. 2011 was pretty eventful. In June I was interviewed for a job which finally in October I was able to start. In December I was at last allowed to stop doing two jobs at once, just as well as the new one has just got pretty busy. There are lots to do to help support the improvement in services for people with cancer. I just hope that this job can last past the end of my secondment (March 2013); as the year goes on that should become clearer as we await a report on the future of clinical networks which is due in the next few weeks. The great thing about a new job is that it means you have new things to learn, and things have moved on massively in the world of cancer care since I was working clinically so my learning curve has been pretty steep. I actually look forward to going to work each day and that is a pretty good thing.

I am also pleased to report that my dad, who was coincidentally diagnosed with cancer around the time of my interview, has completed chemotherapy and at present seems to be doing well. This is a huge relief as the cancer is secondary and probably cannot be cured. It was great to see him eating and drinking well and buzzing around us all as usual. Fingers crossed that the scan he had a few days ago confirms this.

My son, who is studying in California for a year is home for Christmas. It has been great having him home even if it seems to have doubled the amount of washing and ironing I have to do and has increased the food bills considerably. He goes back on January 15th, but this time we can look forward to seeing him just a month later when hubby and I visit for his 21st birthday.

So I start 2012 hopeful that this might be a reasonable one for me personally. At work we continue to live through the protracted process of the new NHS Bill which is not yet law, but which is causing a fair amount of change for the sake of change. The GP commissioners are flexing their muscles but at the same time discovering that commissioning is not about telling people what to do and expecting it to just be done. From my new position within a clinical network which will be part of the Commissioning Board I am finding all of the PCT related stuff interesting. People are not surprisingly positioning themselves and that is always fun to observe!

New years resolutions? Well probably best not to promise anything but I will try to blog more (but then I have tried that before).

I wish everyone who takes the time to read this blog post a happy and healthy new year. I hope 2012 is full of promise for you too!

A bit of a mess?

It seems that the Health and Social Care Bill, the legislation designed to cut bureaucracy and fix an NHS that is not quite broken is in trouble. For months now, health unions, professional bodies and respected ‘Think Tanks‘ have described deep flaws within the proposed legislation. To us, despite the length of the numerous papers produced so far, firstly as white papers, consultations and discussions and now as a Bill, it has produced many more questions than answers. How will specialist services be commissioned and managed? How can we be sure that GPs will be willing and able to commission all of the services needed? How can we prevent GPs being part of businesses that are set up to provide services and then giving them huge profits? How can we be sure there will be sufficient levels of accountability? Will there be enough money / people / resources in the system to actually do the work? Will patients really get more say in their care? Do people really want choice or do they actually want a well-functioning local hospital which they can access? Can we be sure this isn’t the thin edge of the privatisation wedge?

It turns out there really are more questions than answers and apparently the bill is to be delayed while more of the answers are explored.

Meanwhile people within the much maligned PCTs are leaving. Last week we had 3 retirement lunches in one particular meeting room, two on one day.  2 colleagues within my own team have found new jobs and will be gone by summer, a third has an interview at the end of next week. We all check the job adverts weekly or even more regularly. The GPs that are currently sorting themselves into consortia are beginning to worry that even if they have the management budget to pay people there may be insufficient useful people around to employ within the new system (that is if they actually employ them since it is now rumoured that there will be some kind of commissioning hub).

I might be a PCT employee but I am not daft. Greater GP engagement and accountability in commissioning would be welcome. Less of a head count in the PCT was desirable and probably necessary. Perhaps public health might be better placed in local authority. But it actually didn’t need to be as nasty as this.

What next? Maybe little will change? Maybe progress will slow? The damage is already done though. We have been tarred as useless managers who do little for the actual patient. When actually I believe we have the potential to do much that is good. We wait and we will see!

Just make it up as you go along

The NHS and Social Care Bill is currently being examined by the Health Parlimentary Committee. Information coming out from meetings being held at this stage of the process is fascinating. Andrew Lansley, the Health Secretary who dreamed all of this up was yesterday grilled by said committee. The following paragraph is taken from the Guardian online:

“He surprised some MPs when he admitted they were “still thinking through” what would happen should one of the newly empowered GP consortia go bust. Lansley said: “The responsibility lies with the NHS commissioning board. To identify and then intervene – they will have powers to take over responsibility or ask another hospital to take over.B ut he said there was still a debate about what would be the “trigger” for the NHS commissioning board to step in”

And this:

In an overture to those concerned about the reforms, and in a nod to the parliamentary push back from Clegg’s team, Lansley said there would be “opportunities to clarify, if not improve, the bill as it goes through parliament.”

and finally this:

“Lansley insisted that the bill was compatible with EU law and that he was supported by legal advice. But when pressed five times by Labour MP Valerie Vaz to publish the exact legal advice, he appeared to refuse.”

As someone living through this debacle and who will certainly lose the job I have even if I do get myself another.  As someone who may be a patient involved in this mess in the future, I wonder if these people know what they are doing to the health service? What is more don’t they actually think it matters if the potential problems are worked through before the Bill becomes law? Obviously they don’t or else you wouldn’t have the feeling it had been invented at a cocktail party, written down on the back of an envelope and then presented as a fait au complit!

Lies, damned lies and statistics

Politicians love to give us statistics. They love to tell us that the reason that things are so bad is because of the poor performance of their predecessors. apparently the financial deficit is this bad because the previous government spent too much money (this might be true, but doesn’t take account of the banking collapse and subsequent global recession) and apparently the NHS is in the mess it is because faceless bureaucrats waste money and generally don’t make clinicians perform better.

From my point of view though when governments try to justify policy on a complete and deliberate misinterpretation of statistical fact they have gone too far. According to Andrew Lansley and his colleagues one of the key reasons for needing to dismantle the NHS is because of the UK’s poor health outcomes. They say that despite the massive investment in healthcare we are less likely to survive a heart attack or cancer than other European countries. This article in the BMJ suggests that is plain wrong. It also suggests that the government are misrepresenting what the statistics are actually telling us.

Too Little, Too Late!

Contrary to what the government might like us to believe, and also contrary to what the Department of Health might think General Practitioners are not the only doctors working and living in England.

This quote from the DH follows the exceptional meeting of the British Medical Association (BMA) today:

We are disappointed the BMA has decided to take this step, including now opposing elements of the Bill they previously supported, rather than work constructively with us to improve services for patients. The BMA’s own survey shows their position is not representative of many of their members, who are keen to be involved in our proposals. The reality is over 5,000 GP practices, covering two-thirds of the country, have already signed up and have started to implement plans to give patients better care.

I have a few things to say about the comment – firstly, when was it the job of the DH to comment about policy that isn’t actually law yet? Secondly it suggests that all doctors are GPs and that the BMA leadership has had the support of their membership in agreeing to the policy change. My understanding (and I am sure someone will correct me if I am wrong) is that it is because the rank and file membership of the BMA did not actually agree with the stance of the leadership that today’s meeting was held.

But of course the Bill has been published and it is progressing through parliament. No doubt this and other criticism might lead to a few tweaks of the finer details (plus a few more major changes) but essentially the GPs of England are to be the commissioners of health services and no extraordinary BMA meeting will change that.

It is my belief that even if Andrew Lansley was to be told that this policy would result in half the doctors in England resigning and a catastrophic deterioration in health outcomes he would not change his mind and alter the Bill significantly. Bloody mindedness prevails and we are on a collision course for people to line their pockets, for people to set up their own little businesses and for the dismantling of the NHS as we know it.

What is clear is that none of the health unions in this country can make a blind bit of difference to this mess at this stage; the titanic is already approaching the iceberg and those on board can only hope for a safe trip in the lifeboat to shore!

Celebrating 30 years

Last Saturday I enjoyed a great lunch with some of the ‘girls’ I trained with. Just over 30 years ago in October 1980 28 of us arrived at John Astor House to start our careers in Nursing and in the NHS. Some of us never made it past the first year, but 24 qualified in 1983. This was only the 3rd time we have managed to get together in all of these years, though of course various of us have met up with each other at various times and some remain firm friends. What is more at this event there were just 9 of us, what with family commitments and the distance of oceans. What was gratifying was that of that 9, 8 are still working for the NHS and 8 are working clinically. I was the only one of the group not in daily contact with patients.

30 years is a long time, but strangely as we chatted over our wonderful lunch a stones throw from where the hospital we trained in used to lie, the years slipped away and we remembered days and nights on the various wards, nights out together and the amazing responsibility we were given at such a young age. We agreed that our training had been a good one, and it had prepared us well both for our careers and for life in general. We also agreed that some of the changes within our profession had not been for the best. We also wondered about the impending change; apparently for changes sake.

Ben Goldacre today in the Guardian (and on his Bad Science blog) says that there have been 15 NHS reorganisations in the last 30 years, this means that we have lived through each one. Some of those will have passed us by, after all, when you are busy working clinically, caring for patients you can often continue to provide that care as the world seems to move around you. This was the case for me until about 10 years ago just as I prepared to move into a managerial position. My employer merged with another and a number of managerial changes took place. This was around the same time as the PCTs were formed and that was where I headed for.

I left clinical practice at that time because I was weary. My job was a struggle as my patients needed access to new medications but these were expensive and they and we seemed to be fighting unendingly for them. The work was hard and I seemed to be allowed to expand my practice to take on an unending number of tasks. Fearing burn out I thought a job in education within the new PCTs would allow some relief and what is more it would mean I could make a greater difference to more people.

Clinical work, and for me, nursing remains amazingly important work. In some ways I would like to return to it, but in what capacity. Generally my student colleagues work part time and have husbands earning far greater wages than I do. If I return to practice I will have to take a pay cut, and essentially I am not sure I can afford to do this. I also don’t really know what nursing job I would want to do, or if my body would stand up to the pressure required of it.

I also happen to think that it is important to have people who have worked as nurses and to whom nursing and the care of the patient is important, working within management. When politicians belittle those of us working in PCTs they appear not to know or care about this and apparently think that we were born in a pen pushing role and have little or nothing to contribute. What is more, they don’t seem to value nurses in the same way as doctors and GPs at that. I wonder if they will yet receive the awakening they need before it is too late!

I become a union activist!

The Joint Negotiating Committee met this week. The meeting was mighty odd for an RCN member not currently actually practising as a nurse. Still I am a nurse and to prove it my annual re-registration fees will be due in November.  I also pay my RCN fees monthly and my job is going to be at risk, therefore it is time to become something of an atavist!

This occurred because the PCT is a commissioner (all be it one with a short shelf life).  The requirement that the provider arm of the PCT must become separate from its provider  arm necessitated that a PCT staff side was created. I as a person who cares about their own career and that of others in a world where the current government has decided to create a new health service felt the need to join the new Staff side.

So back to the JNC. It was me and 3 men; 2 from Unison and one from Unite though he thought his union was one of its previous incarnations. My RCN colleague was busy on business in Antigua (something involving a pool or beach and a pina colada I believe).  This did not help me to fulfil her request that Mr number 1 Unison person was not allowed to be the Chair of Staff Side. However I am now a member of the risk committee (this sounds like something both important and necessary; oh the irony!)

The meeting was dull and do you know, there was nothing exciting or special that I learned that I didn’t already know. What is more I sent apologies to something actually more important – I gave up my afternoon for a half hour meeting which followed something of a fisaco of a real union actavist trying to make people think that the whole thing might turn out to have some importance.

I am not convinced, but I am on the other half sad. This is a real issue, we are real people faced with either the loss of our career and livelihoods or else the loss of something greater our dignity! Hopefully by the time of the next meeting in November we will actually know what is likely to happen to the health service and also my RCN friend will be back from Antigua!

What a busy August!

Maybe I have been living in a romantic rose coloured world where August meant people went on holiday, few meetings took place and you had time to clear your inbox and do some filing (if people still file things in a place other than the bin). This month at work however has been both surreal and busy. Surreal because we eagerly await the politicians of Westminster to return from their summer holidays. I know that for some the  summer has been busy, however, except for the wife of the prime minister giving birth and the health minister announcing the demise of NHS direct it has been pretty quiet for the health service. No new policy, no information to tell us how to implement the already announced changes to policy. Still though it has been quite mad.

If you work for a PCT then only one thing is assured. By April 1st 2012 (shortly before the arrival of the Olympics) the organisation for which you work will have ceased to exist. Those at the top and second tier of PCTs are an expensive commodity, often referred to during the election as faceless bureaucrats. In my opinion these people have lots to prove to those who in the future may pay their wages and therefore it goes without saying that they might like to spend August planning their future and in the process getting people like me to work very hard to begin the process of saving their backsides.

At the same time and without really knowing how powerful they might become in the future (but thinking that they may be about to inherit the earth (or the NHS)) some people who work for GPs have begun to behave as if they are already very important. The top tier and second tier people of the PCT, not wishing to miss a trick have jumped when told and people like me have been made to work even harder.

No one knows if the work we do now is worthwhile. No one knows what the future holds. But I can tell you that from where I sit September won’t be any better than August was.

August made me ill.


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