Any observer of our NHS quickly concludes that it is littered with positive language and ‘right on’ strategic policies. Whether it’s ‘releasing time to care’, ‘staff governance’, ‘patient safety networks’, clinical governance’, ‘mandatory workforce planning tools’ or ‘cash releasing efficiency savings’ at a strategic level at least, the NHS in Scotland is able to tick lots and lots and lots of boxes.
However closer examination of staff surveys, sickness absence, critical incidents, trade union surveys and internal reporting mechanisms starts to suggest that the perceived wisdoms are not necessarily representative of the reality at the coal face. These factors and others, including the outcome of the Rapid Review Into Patient Safety at NHS Lanarkshire recently led Labour’s, Neil Findlay MSP, to call for a system wide review.
Whilst some organisation backed the call, UNISON did not. Having been at the centre of the political maelstrom since 1999 (and before) Scotland’s NHS actually needs a period of stability, not another restructure. That’s not to say that we wouldn’t benefit from a discussion and hopefully a consensus on the model of care and direction of travel, but a system wide review won’t bring anything new to the table and is unlikely to deal with the chronic short staffing/ under resourcing which seems to be at the centre of much of the service’s bad press.
There are however two or three simple steps that could be taken now and would make the world of difference.
At a strategic level NHS Boards should be made to set agreed ‘establishment’ figures for all grades and job families with local and national reporting required to ensure that at all levels the Board is as near fully staffed as it can be.
We already know that the nursing population is aging – fast. We also know that there is a sizable cohort of staff aged 55+ who could leave the service now. Whilst planning is underway to try and meet the future demand, the uncertainly of staff working longer added to the removal (rightly) of the mandatory retirement age, makes even the simplest form of workforce planning no more than an educated guess.
Government and Heath Boards should be actively working to make it attractive for older staff to stay on in the workplace. That might be lighter duties, shorter days and or shorter working weeks. We may need to review some of the pension rules to make coming back to work attractive, but the positives will far out weight the negatives in terms of service delivery and retention of experience.
The same approach could be applied to staff with young families (experience suggests that some areas are very resistant to nurses working ‘short shifts’ – even if refusal forces experienced and well regarded staff to leave the service, whilst their children are in infancy).
Setting to one side the general view that NHS Boards are ‘managing vacancies’ to meet budget pressures (Incidentally we’d welcome some hard commitments on this too), the NHS is painfully slow at filling vacancies once approval is given. For an organisation that relies so heavily on people, it has to be unacceptable that at best it can take 12 weeks to fill even a basic entry level post. We recently saw an example where it had taken so long to make the formal offer; the applicant had found another job!
No one believes that the NHS is safe from or managing to avoid public sector spending cuts, now is the time to be honest in that regard. At the same time a root and branch review will do nothing other than further de stabilise an already tired and demoralised workforce. The challenge for politicians is to set aside the spin and rhetoric and instead work with staff, unions and Boards to invest in their greatest asset.
Matt McLaughlin is the Secretary of UNISON Scotland’s Nursing Sector Committee
This article first appeared in Healthier Scotland – The Journal Published by Socialist Health Association Scotland March 2014