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Archive for the ‘NHS’ Category

Awakening

This is less an entry and more an attempt to put work-life into perspective. It would easier to hide my head in the sand, bury myself deeper and deeper, and I have been trying that tactic, but avoidance is not my natural behaviour and just results in tremendous unease. I could continue to deceive myself and make believe that all is well, after all I have managed to keep my council on the RCOG calling for more women to be cared for in MLU’s; the ‘riots’, some other interested party wanting more obstetrically, trained physicians and the BBC’s Panorama programme about the midwife shortage, but a silly little incident has spurred me out of my silence.

Why am I in such a slough of despondancy? Well, the miasma of NHS bureaucracy has finally overwhelmed me, I am entirely embroiled in the totally mad maze of management which consticts every aspect of being employed in the health service, and it is frustrating me beyond belief. I am terrified that I could well give into panic if I don’t get a grip on all the ends which are snaking
around at will, needing to be organised, needing to all join up. The maze is constantly causing me to bang up against seemingly inpenetrable, prickly hedges so I backtrack and try another route, wasting more time and energy, only to meet another vicissitude.

I don’t want to be a manager in the NHS, I can’t imagine why anyone would want to, it’s a thankless task. Yes. There are too many managers but it’s all do with the way the NHS has developed, it strikes me that everything is kneejerk rather than planned by individuals who understand how the whole organisation functions. Nothing is radically re-organised, rather, another side-shoot is
grafted on to the already overburdoned branches. The new little side-shoot is given it’s task and it happily thrives, initially. It receives adequate nourishment and produces acceptable fruit. After a while the environment changes, the nourishment is rationed slightly but demand for it’s product increases. Initially the side-shoot responds by exploiting it’s reserves but they are limited and soon it displays signs of weakness. What to do? Look for stronger branches to share the workload, perhaps form a framework, no, just graft on another shoot to further drain the whole organisation.

Don’t expect any of this to make much any sense, it makes no sense to me so why should any innocent, who has never really experienced the NHS, understand this rambling. Many have tales of their encounters with the NHS, those at the receiving end, patients, or clients as we now have to call them, let me assure you working for the NHS is no bed of roses either.

Anyway, where was I? I don’t want to be a manager, but I do really, not for ever, or even a month, just a day would probably allow me time to formulate a structure which would enable me to work logically and efficiently. Mind you, the Trust Board would need to be disempowered during my frantic reorganisation, because I wouldn’t have the time to wait for them to rubber stamp my decisions, and I would need to be able to command co-operation from other drones but, given those criteria, I would be flying.

I’m just going around in circles. My new job is an absolute, organisational nightmare, I keep taking 2 steps forward and one step back. I have 2 different managers who act as if they function within 2 different organisations, although we all work within the maternity sector they carry seperate budgets, which they guard ferociously this impacts adversely due to others not appreciating that I cannot cross theoretical boundaries. I can’t go into detail so it possibly sounds as if I’m making a mountain out of a molehill, maybe I am but that molehill is wrong-footing me, constantly.

As if the actual working maze is not frustrating enough there is also the minor fact that, 3 weeks after I started my new role, supposedly on a contract, my new manager confessed to me that she hadn’t gone through the right process so Ihave been working on ‘bank’ since I started. I’m just wondering if this is a double-edged sword as it does mean that I could walk into my new managers office and tell her to stuff the job. The trouble is that if I can create logical working pathways the role is one that I would love.

 P.S I’m still having real problems posting anything other than the title and category. Wrote this last night but it has taken me hours, literally to post it and it’s still a mess. I give up!

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Honesty and the NHS

Lots in the news at the moment about how NHS employees are being suspended on full pay. What have they done to warrant this? Are they suspected of professional misconduct or of gross negligence? No. They had the temerity to speak out about areas of NHS care, or highlight examples of poor management, which concerned them.  So much for the guidelines which were issued to encourage and protect staff who ‘whistleblow’. There is a hope that things might change as the Department of Health are just issuing new guidance on best practice regarding how to encourage a ‘culture where staff feel able to raise concerns about malpractice or potential risk to patient safety’.

I’m not convinced on this one, I have observed two examples recently of how staff are intimidated by management for breaking a code of silence. In the first case a report about local services closing appeared in the press, no one knew the origin of the information. A meeting was called and any staff who knew about the proposed service change were summoned and questioned by a manager, the rationale being that they needed counselling (?) No one admitted to leaking information. It certainly sent out a message though, keep quiet because to speak up is to require treatment, and a treatment which would doubtless appear on your employment record, allowing you to be labelled as a problem. The next example involves the ‘super-highway’ and people exchanging information on social networking sites. Those concerned may have been misguided, but my attitude is that if their working conditions were appropriate and they were happy with the care available then their comments would not have been made. All those who took part in the on-line chats have been spoken to by the HR department and have been advised not to broadcast how discontent they are with how care is provided (or not).

We are not talking here about national security, we are talking about a public service, something which the majority of us have an involuntary financial commitment to and which all of us will use at some time or another. The NHS administrators have been compared to the Stasi, certainly their attitude to ‘whistleblowing’ appears to validate this but why smother the truth, what is wrong with honesty?

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Mutually agreed resignation

So, it’s starting. ‘ …..our organisation faces significant financial challenges……..In order to respond to these challenges we must implement cost savings and efficiencies and begin to restructure the shape and size of our workforce. The Mutually Agreed Resignation Scheme (MARS) is a scheme ……..which an individual employee………chooses to leave employment in exchange for a severence payment’. In other words ‘Jump before you are pushed’!

Now, the scale of payments, if you’ve worked continuously for the NHS for a year – 3 months basic salary; 8 years – 4 months basic; 12 years – 6 months and if you make 24+ then it’s 12 months. Personally, I think that you do rather well if you only worked for 1 year but it’s rather an insult, where’s the pro rata here if you’ve served for 25 years?

There is a real sting in the tail though. You can’t qualify for the payment if you have secured another NHS post at the time of leaving and you can’t start NHS work within a month of the MARS payment.

I’m finding this really scary, I feel that I’m scrabbling to cling on to my post. My angst is increased because I had a cryptic message from a colleague telling me that she needed to speak to me. My first reaction was ‘what have I done wrong’, she’s a Supervisor of Midwives, but she messaged back to reassure me that it’s not practice related but due to her desire to contact our ‘union’ (RCM) rep about the ‘changes that will be happening’. What now? More changes and obviously not for the good otherwise the colleague would not be thinking union representation. How much more can they decimate the maternity services? Anyway, I thought that the NHS was ring-fenced.

The timing is just slightly wrong. I need another year.

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£1.7 BILLION

Yes, that’s how much the reconfiguration of the NHS will cost THIS time. I heard it last night on Question Time and, if I hadn’t been sitting at the time, I would have fallen over. Hubby was not able to hear much more of the programme as I was well and truly ranting. For God’s sake STOP IT, stop fiddling about and wait for previous changes, initiatives to show a result.

Polly Toynbee in The Guardian was so right when she wrote that ‘polititians have an obsessive, compulsive disorder’ when it comes to reorganising the NHS, it is ‘reorganising virus’ ‘ Polititians are bored by the fiddly stuff – making existing systems work, ironing out the glitches, fixing frontline obstacles for patients. Instead they reach for the big ideological lever…’  I just hope that she has not hit the nail on the head when writing ‘ and this time it might just break the machine’.

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Back in the middle of 2009 I was referred by my G.P to a London teaching hospital. After many trials and tribulations I finally saw the consultant, the decision was made to schedule surgery, the exact nature of which would be based upon the results of further scans and tests. I fairly bounced my way home, at last I could look forward to resolution.

I’ve spent the 2 years, since my previous surgery, in discomfort and, by the end of the day, in pain. I’ve put up with it and carried on regardless but increasingly it has been affecting more and more of my day-to-day life. As long as I believed that my op would be only a few weeks away I was prepared to ‘grin an bear it’ but last week my gritty determination crumbled. I had the tests and scans back in December, I had a further appointment last week where. after a 2 hour wait, I was called in. The doc, not the consultant, duly reviewed my scans and told me the plan, fairly simple operation with a reasonable recovery time, yeah! ‘When, when?’ I grinned and, after a brief discussion with the nurses, he told me, ‘ Probably June’.

I slouched home and then spent 10 minutes blubbing. How I wish that the hands of the clock did rotate at a visually disturbing rate, I just want things sorted soon, quickly. In 2 words the doc had made my symptoms escalate from bearable to unbearable. By the evening I’m really tired and extremely uncomfortable, on-calls are now more stressful. It’s not just my usual disinclination to get up in the middle of the night and drive to a previously unknown destination for an unspecified length of time but also a fear that I may not function at 100% when I get there. I mulled the situation over and decided to go and have a chat with the occupational health department. Dream on, what occupational health department, they have been re-branded, Workplace Health. No longer are they there solely for NHS employees, no, workplace health (WPH) are there for NHS, plus they are also providers to the public and businesses. I found this out when I misguidedly phoned them to arrange an appointment, another faux paux as there are no direct referrals, my manager has to refer me. I am now firmly off  into the land of Alice, for years I have inhabited a workplace where, if you had a work-related health query you would chat about it to occy health, you certainly didn’t have to spread word of your personal, health problems around. Right, in Wonderland I have to go to my manager, tell her what ails me and let her decide if I do need to see them. Manager then has to do a referral and then Workplace Health will triage (their word, not mine) me and arrange an appointment accordingly. I’ve done it all, I even made sure that HR were there when I spoke to my manager, I’m really dotting i’s and crossing t’s nowadays, I’m losing faith in people’s motives. HR advised me to phone WPH a week later if I hadn’t heard anything as she felt that I should see them sooner rather than later but I’m generous, I left it 10 days before I phoned them. They cannot find my referral, I have 2 copies, 1 sent by email and the other by snail mail but they haven’t received it in any form, not even by pigeon post. No referral, so no appointment. WPH want a new referral, I’ve sent them one of my copies.

It’s really difficult not to become extremely frustrated by all this paper-trailing, waiting and black holes that referrals disappear into. I can’t believe that I am unlucky enough to have this only happen to me, twice. I don’t expect an instant service, I know that the hands of the clock move slowly within the NHS, but I do expect that once paperwork has been sent that people can at least find it and that when they can’t they at least take ownership of the problem, not turn the poor unfortunate person who has been referred into a human ball being bounced backwards and forwards.

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Midwife Muse’s roll call of causative factors so far –

  • PCT’s for with-holding government monies
  • Groups who place the majority of their emphasis on THE BIRTH, and lobby accordingly, putting antenatal and postnatal care on the back burner
  • Trusts for employing too many managers

Fittingly the midwives come last, that’s the usual position we appear to occupy in any planning, so why alter the status quo? Why are we to blame then? Well we will do what we always do when change is foist upon us, we will grumble, get stressed, some of us will even rant, in private but ultimately we will comply. When I used to work in the unit the obstetricians, generally the registrars, would keep coming out with jokes which were always based upon how bolshie midwives are, ‘What’s the difference between a rottweiler and a midwife? A rottweiler eventually lets go.’ That may be true in the one-on-one clinical situation, when we are being an individual woman’s advocate, but as a group, when change is being imposed, our contracts being re-written or some other attack on our ability to provide the care we KNOW that we should provide we capitulate and fail to work together to resist or modify the changes.

My crystal ball is showing me that once again we will moan and have a brief, vaguely supportive interaction with our union, incidentally that won’t get us anywhere (prediction), a couple of us will leave, another couple will retire, half of us will apply for other jobs, perhaps midwifery related but the majority of us will just end up going along with a change we are intensely unhappy with.

Midwives are their own worse enemies. We are already working above our capacities, both within the maternity units and in the community but we don’t ‘work to rule’, we can’t, but we should. The managers are not ignorant of the ridiculous workload and the number of extra, unpaid hours the staff put in, in fact I do believe that the managers join in sometimes, so we are all colluding in the farce which will allow these changes to go through, these changes which will definitely affect the coal-face midwives, the women and babies.

For a profession whose members are portrayed as fierce we are badly misrepresented, we are actually shrinking violets.

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In Part 1 I identified the PCT’s role in affecting how midwifery care is provided in the community and then, in Part 2, I talked about how I believe that user and pressure groups, focusing their lobbying on the birth, has adversely influenced funding for other areas of maternity care.

Managers, and other higher grades. They are not dissimilar to metal coathangers really, turn your back on them for a while and they have replicated themselves, Southampton have managed a 85% increase in their numbers in 4 years.  Maternity services are not about to be out-shone by the other departments where the number of managers has risen 3 times as fast as the number of nurses.

Locally, 10 years ago we had 2 separate maternity units, each unit had 3 managers, including their Head of Midwifery, I’m quoting here from personal experience, but I doubt that my experience is different from many others. Anyway, within 5 years 1 Head of Midwifery had gone, this happened when the 2 separate units came under the umbrella of 1 Trust, but 2 more manager posts and 1 consultant midwife post had been created, so minus 1 but plus 3. When the 2 maternity units later amalgamated into 1 building it was imagined that a manager may lose their job but that didn’t happen, blink twice and there are 11. They don’t all have the title ‘manager’, there are ‘specialist’; ‘consultant’; ‘modern matron’ and ‘head of’ but, basically, they are all managers, I’m not including 9 ‘team leaders’ here as they are a sort of hybrid who manage but are predominately clinically based, unlike the afore mentioned menagerie. So, in summation, over a 5 year period 6 managers have become 11 whilst the number of midwives have increased by 6 therefore 1 more midwife has been employed on the coal face compared to managers. Managers are Band 8, clinical midwives Band 5 and 6. A look at current pay scales shows the difference in wages, bottom Band 5 = £21,000 pa, the same for Band 8 = £38,000 pa, that’s nearly a two for one situation, or scrub the Band 8 and that’s a saving of £38,000 + employers NI and pension contributions, that must take it well over £40,000, nearly what they are saving in mileage costs and stopping weekend/bank holiday working by ALL community midwives.

There, no consultation required. No cutting of domiciliary visits. Just get rid of ONE manager.

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