Former NHS Nurse and manager now contemplating the NHS from outside

Archive for the ‘NHS’ Category

Back

After 3 months of rest, recuperation, holidays, spending money and general enjoyment I am now back working for the NHS. Note the word ‘for’, since I am not actually part of it. I am now an independent contractor working on a project that was left unfinished. I am back with my ex boss and her small team. I am back in the same office, in the same building I left at the end of March. I have re-instated my nhs.net account and hopefully in the next few days I will be able to log onto work computers again. Yesterday I went into the office; it was to say the least surreal.

I used to look at the invoices of contractors and discuss with colleagues that they seemed to earn a lot of money for what they did. I am not sure that the rate I have negotiated is excessive, since I will have to pay my own tax and national insurance, but it is a reasonable amount. I am going to be working 3 days a week for the next few months and hopefully that will put me on a footing for more work in the future.

The building now contains several organisations, where in March there was one. I heard that the staff working in the CCGs are not always pleasant and friendly to those working for the CSU. I heard that already people are leaving, jobs are becoming vacant. I heard that a number of those who were made redundant, are like me, back working. I heard that those working in the CCGs are still trying to work out what exactly they are doing. I guess that is no surprise.

I found yesterday in the office a little claustrophobic. It is 3 months since I sat still for so long, since I sat in such a small office for so long. I think that 3 days will definitely be enough in one place. Mind you I will be out and about a lot, my job is to try to sort out the clinical groups so that they are fit for purpose in the future. I am going to finish off the job we couldn’t do last year and which predictably there currently are insufficient permanent staff to manage.

Still it is nice to be back in the world of work even if I will now have to juggle it around my expanding social life. But, I do still have some bills to pay even if I am now completely debt free!

Using Twitter to discuss nursing issues and share information

wenursesbadgeBefore my redundancy I had little time to explore how social media is being used by healthcare professionals. I knew that our PCTs and Trusts were using it to report what was going on, but I had no idea about how many individuals were doing the same. Since I finished work though, I have joined Twitter myself and started to follow some of the people out there who are tweeting about nursing and healthcare. Of course, I have other interests too and am also following a few celebrities.

Unlike Facebook, people on Twitter tend not to lay bare their entire lives. This is helped by the fact you can only post 140 characters or less at a time. It seems an ideal way to share news and information with others. Some individuals are quite prolific in their posts, you wonder how they find time to get anything done. Maybe, they are the irritating people you see at meetings who spend the whole time studying their mobile phones. I used to think those people were answering emails, but perhaps they are on Twitter?

I have been interested to see read the tweets of nurses and doctors who work at the bedside, quite rightly of course they will be offering general information and personal opinion. Just as with blogging there are massive pitfalls to writing online about work. But it is great to see that people are overcoming the potential minefields of confidentiality and employer resistance to social media. Many NHS organisations don’t allow staff to access social media from their work computers, but since everyone now has a smart phone, this doesn’t stop people.

A couple of weekends ago, as a celebration of International Nursing Day, @WeNurses held a ‘tweetathon’ for people to post stories of nursing and to send pictures of badges and buckles. They also hold regular discussions about pertinent issues for nursing and healthcare; today there was one about the Liverpool Care Pathway. Because this discussion takes place in an open forum, as members of the public and media get to know about them, there is a greater chance that people will see nurses in the positive way we need. They will see professional discussion from caring and intelligent people. They will see the sharing of best practice, they will see compassion in action and they will see that some of the recent rhetoric is plainly untrue.

Social media seems to be here to stay and for me it seems to be a great way of finding out what is happening out there and for getting to know the lives of other people.

You can follow me here¬†Though of course, I don’t have loads to say just yet. Hopefully that might soon change!

Why are more people going to A&E?

That seems to be the question which is currently challenging health politicians and the media. Of course it is not a new question for those working in healthcare, since it is perfectly possible to track each and every attendance and episode of care that takes place. Even before I stopped being a commissioner at the end of 2011, senior managers were scratching their heads about the increase in ‘unplanned care’ and trying various methods of ‘managing activity’.

There is no doubt that attendance in emergency / unplanned care has increased, but why? The analysis we are given doesn’t tell us about when people attend, but in trying to answer the question, they point to changes in GP out of hours services. That suggests that there are no problems with the availability of GP services ‘in hours’. However, when a new Urgent Care Centre was opened in this County, it was discovered that faced with the chance to attend and be seen immediately rather than wait for an appointment at some of the less well run GP practices, people chose the former. It wasn’t all about out of hours services at all.

The lack of ownership by GPs in out of hours care is also blamed, but many out of hours services are literally owned by GPs as well as provided by them (it just isn’t obvious since they are contracted out). Of course, if you contact these services you are unlikely to see your own GP, therefore you might as well go to an urgent care facility. When you get there though, you might find yourself triaged into a GP service, where the same doctors providing out of hours care are also based. Funny how that isn’t mentioned.

Patients and their individual needs, are quite rightly being recognised as central to health provision. But with that recognition comes the realisation that people will use those services in the way that feels right for them. That might mean accessing emergency care for things that they perceive as needing attention now, even if those providing the care don’t think that is what is needed. If you feel you need to see a health professional and you know you have to plan to need it to attend your own GP surgery what will you do? Probably access a place you know is always ready to take you.

Then there are the telephone advice services – first NHS Direct and now 111. In deciding to change the focus of these services, a decision was made to completely dismantle the former in order to start up the latter. As NHS Direct ran down, then more people were referred to A&E. Everyone knows that assessment and triage of the patient are the most important parts of deciding what is wrong with someone, who is best placed to help them and what should be done. The more experienced the person doing this is (on the phone or in person), then the more effectively that problem will be dealt with. It stands to reason then that if you get rid of qualified staff before the new system is in place you are asking for problems.

Finally something that no one has mentioned. Children are some of the biggest users of emergency care. They become ill quickly, in an unplanned way. Parents rightly worry that they need attention right now and take them to A&E. We know that the birth rate has been rising steeply, we know school places are under massive pressure. I wonder if some of the increase in attendance relates to the increased number of under 5′s?

Like most issues in healthcare, this is complex. I doubt there is no easy answer nor a single cause. The propensity of politicians to blame in turn the previous government or GPs is simplistic and plainly wrong!

Celebrating Nursing

Over the past 6 weeks or so I can honestly admit that I have been taking things rather easy. I am now over the experience of organisational change and redundancy and from my encounters with colleagues employed in the new worlds of NHS England and the local Commissioning Support Unit, I am well shot of it all. My pension has now paid up (suggestions by NHS Pensions that it would all take 3 months were unfounded) and I am about to become an investor in ‘funds’. Soon, I will swop the Nursing Times for the Financial Times, well, maybe not.

I have begun to consider what work I would rather do in the future and on balance, while I am unlikely to find my way back to a bedside any day soon (my back has been playing up something chronic), I would like to work closer to the patient and hopefully with some nurses. A week ago I helped out at a training session for community staff, something that I have contributed to a number of times. It didn’t take longer than coffee time to dust off my brain, and I know that I could and would like to do more of that. I also stepped up and sorted out a presentation for an ex boss last week, banking a few hours of self employed work (there is more to come). Plus there is a job in the pipeline which I intend to apply for, but which I am waiting for the advert to appear.

Yesterday though, I went of my own free will, unpaid to a nurses day celebration and I am glad I did. It filled me with an enthusiasm for nursing and the NHS that I have not felt for a while. So much has been written and said about the state of the health service, about whether nurses have forgotten the purpose of providing care, forgotten perhaps how to care.

It is easy to buy into the idea that nurses who are out there now are in some way inferior to the way they once were. The concept that they have in some way lost their vocation and that they lack the compassion to deliver the best that they can. It is easy to believe that nursing leaders are lacking in some way, that they are not committed to ensuring that they set the vision, to inspire and support their workforce.

The conference took place at a local university, run jointly between acute, community and mental health Trusts. Present were all of the nurse leaders from those Trusts as well as in excess of 100 nurses from across the area. The purpose was to celebrate nursing locally and nationally, to inspire and to inform. It did just that. The keynote speakers, one from the chief nurse and the other from someone who has achieved so much despite and because of his disability were great to hear. But equally the quality of presentations from local nurses was of equal quality. It made me proud that I am still a nurse and it inspired me to get back to work soon. I want to work with these people, to be able to support their ability to overcome the negativity and continue the great work they do. To recognise the complexities of modern healthcare and to show people that compassion still exists in nursing. To celebrate nursing.

Near the end of the day, we were shown this youtube clip. I think it tells us what we need to know about the future.

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Process

The process which led to my redundancy and now it seems, beyond progressed neither smoothly nor as it should. I haven’t written about this before because I believed that I had put it all behind me. Yesterday I discovered that this is not the case.

A few weeks before my redundancy I received one of many letters from HR, this time offering not just redundancy, but a choice of that or taking one of two pension packages. I was surprised, despite still being in the 1995 pension scheme, and having paid in for over 30 years, I was (and still am) only 50. I sought financial advice and decided to take the maximum pension lump sum, a monthly pension and a small redundancy payment. I duly completed the forms and sent them in to payroll. Yesterday, more than 4 weeks later, I contacted NHS pensions to discover that my employers did not submit the online application to them until 2nd April and secondly that it takes up to 3 months to process a claim. Employers are meant to ensure that employees apply with 3 months notice.

Of course my employer would have preferred not to make me redundant, therefore they were late to give me any notice at all, and until about a week before they acted as if a magic job might appear on the horizon for me and my colleagues. Therefore everything was completed at the last minute, or in my case beyond that date.

Thankfully I have some money to ensure that we don’t starve before July, NHS pensions say that any payments will be backdated, but really that is not the point. This is really just about the way I have been treated from the moment it became apparent in around November that this wouldn’t be a smooth process. Consultation processes were not completed as they should have been, interview processes seemed at the best odd and then there was the whole ‘at risk’ situation and the feeling that you could be shoved into any job. One day, someone approached me and offered me a job in IT on a lower salary and for fewer hours than I was at the time contracted to work. Suitable alternative employment it was not.

I was not obstructive, I did as I needed to do and applied for no end of jobs. Jobs that I could see myself doing. I had been in this kind of position before and wanted to come out of it with my career and reputation in tact. That slightly went wrong and I am required to be compensated for that. I am annoyed that yet again the process has let me down! I am also annoyed that I can’t get my kitchen refitted yet, and that by the time I do I fully expect to be back in work (more about that when things are confirmed).

End of rant!

Where should people be cared for?

An article in the Guardian a few days ago caught my eye. In it Dr Michael Dixon suggests that much of the care currently provided in hospital could be provided at home, or much closer to it. That hospitals should be slimmed down, and that Clinical Commissioning Groups (CCG), should and will want to move services away from acute Trusts and into the community. The political rhetoric for years now has been to shift care ‘closer to home’, to consider if certain services should be provided outside of an acute hospital setting. More than 10 years ago, when I was a specialist nurse, we discussed how outpatient clinics could be provided in community hospitals and clinics. In theory the idea was a good one, but the provision of rheumatology services involves the need for additional support (pathology, radiology, therapy services) and also for some patients to be admitted to hospital. Perhaps those making the decisions were more easily reassured that the current practice was best, that it would be too costly to move them, that services would be disrupted. Certainly we never actually asked the patients. GPs locally weren’t worried that our service took place in the hospital, they were more concerned that we kept on providing it and didn’t give them more to do.

Redirecting services to new places, shifting care into a community setting requires the will to do so, and it requires people to be willing to shift their working practices. It requires the accommodation for clinics to take place, it requires inpatient facilities if that is what is needed or a great many community staff if care is to be provided in the home. Each time there is a suggestion that hospital services are cut back, changed or heaven forbid closed, there is an outcry within the local community and the political leaders of that area. It is hard for people to imagine the change that needs to happen to allow services to move. It is hard to see how taking the money away from one place can in turn be utilised elsewhere. Often the amount of money released might be insufficient to set up something new somewhere else.

There is also the issue of people’s attitude to healthcare, the days when everyone accepted ill-health as an inevitable outcome of life and expected to die in their 70′s has quite rightly gone. But now people expect the best and most high-tech input, they expect to have access to ¬† specialist services and they expect it as soon as possible.

I am at heart a district nurse, so my instinct is that patients should be cared for in their homes or close to them, where possible. But I have witnessed failed attempts to persuade people that is exactly what they want or need. Yesterday, I drove past my local hospital. Currently its A&E and acute services are being expanded, pretty much rebuilt. This is partly due to the downgrading of services at another hospital. But it is also because people are using acute services much more. They are bypassing primary and community services and turning up at the Emergency room. This increase in unplanned care has been going on for a few years. the way Trusts are funded contributes to this increase, since being paid for each time a patient attends increases their income. Commissioners can try to cap this activity, but no one seems yet to have informed the patients.

In my two most recent jobs, I have learned that if you want to find out what people using your services think then you need to ask them. If you want to develop the best services, you need to work with patients in developing them and if you want to change policy you should actually consider what real people think about it. If the CCGs would like to significantly change the face of healthcare provision then they will need to weather a serious political storm (previously endured by managers) and the views of the people who will use those services.

The first week

So a week has passed and to be honest it has felt like I am on holiday from work. In fact, I have not had a full week off since last autumn, as I have tended to take a couple of days here and there to make long weekends etc. I was surprised by just how tired I was, but not having had a break and having been involved in a very protracted and stressful HR process it is not surprising.

Of course, I have not spent the week being idle, that really isn’t me. Nor have I yet worked out how to sleep in past about 7am, perhaps that is healthy since I am not finished with work by any stretch of the imagination. The first thing I did last Friday was to buy myself a new laptop; a MacBook to be exact. I am now converted to Apple, last year I got my first iPhone, for Christmas an iPad and now I have the full set. I had to get some kind of computer since my previous laptop died a few weeks ago and I had been using my work one. That and my Blackberry were returned last week. So now I have just one phone rather than two, and I am getting myself set up for some home working.

I have watched the news coverage of the NHS changes with a kind of detached interest this week. All of a sudden the news channels and papers other than the Guardian work up to some of the issues of the new NHS. Things like the conflict of interest that GPs have faced for years, but are only just being challenged about. Like the fact that many of them have shares in the companies that they commission to provide services. Then there is the role of the NHS Commissioning Board, now renamed NHS England (we did laugh last week when colleagues who have jobs with them discovered the rebrand). How will this highly centralised organisation carry out the job of performance managing the CCGs? Nothing has yet been said about the Commissioning Support Units and the duplication that their existence will surely bring about. Or about the fact that most of the hated managers still retain places within the CCGs, often they are the accountable officer rather than a GP. No one has yet asked, who is really in charge here? Does the balance of power really lie with clinicians or does it lie in Leeds and their various Local Teams. All of these questions will no doubt be asked in the future.

For me, well my week has been filled, as promised with some reading, some retail therapy, some resting up and pottering around the house. I have made a start on sorting the spare room, but need to replace the chest of drawers in there with a desk. I need to buy a printer as my lovely son has claimed the family one and it currently resides in a house in a university town. I have seen my financial advisor about investing my lump sum, but NHS pension hasn’t produced any actual money yet so there isn’t actually anything to invest. The PCT was late in offering me this option and therefore the forms were completed at the last-minute. The lady in payroll who deals with pensions told me on Tuesday that they had been very tricky to work with. I have updated my CV with the final bits that say that my job ended in March 2013 and I have updated my Linkedin profile with the same. I have arranged my first bit of paid work for next month and am expecting to hear about some more work in the next week or so. I need to complete an application to NHS professionals for another piece of work and I need to send my CV out to a few people. Work then for next week!

So at the end of week one, I feel a little more alert, a little more rested and a little more ready to face whatever is ahead.

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