http://www.guardian.co.uk/society/2011/ ... line-staff

Front line jobs in health starting to be cut

Anyone who voted Tory or Lib Dem now going to vote Labour?

What a surprise the health service admin folks are laying off front line staff rather than themselves.

Who'd have thought.....

Murf, these are hospitals, not admin organisations

Admin organisations are being restructured by the government

The government promised no "top down re-organisation of the NHS" and lied

But they said all "savings" made from getting rid of PCTs would go to front line services

They lied about that too

Whilst I fully understand your position on the subject there are a few questions that I'd hope you could answer.


Why do you think it would be different under Labour ? From the same article

Simon Burns, the NHS minister, said: "The £20bn efficiency challenge was set out by the last Labour government in 2009. Unlike Labour, who planned to cut the NHS budget, the coalition government will ensure that every penny saved will be invested back into patient services. So while it is for local trusts to determine their specific workforce needs, we have been clear that money saved must be put back into improving care for patients."

If you know, could you clarify what the 2 points Kate Grimes is referring too

In an email to staff, its chief executive, Kate Grimes, said two key government health policies had forced the decision and warned that its action would soon be repeated by others.

The article refers several times to a £20 Billion efficiency drive & a restriction on budget increases of 0.1% per year until 2015. It seems that the NHS Management believe the best way to achieve that is by cutting jobs rather than trying to improve efficiency & cut waste. A pay freeze for NHS staff would be hard to sell but no doubt would be preferable to redundancy ?.

From the following quote, could you clarify whether the Nuffield Trust are suggesting that NHS Management are intending to cut the budget by 0.1% annually or whether it's a Government iniative

The Conservatives in opposition promised real-terms increases in the NHS budget. Ministers say they are giving the service a 0.1% annual increase every year from now until 2015. But independent experts, such as the Nuffield Trust thinktank, say the budget will actually fall by 0.5% over that period.

Yawn.

A significant part of the NHS' problem is that Trusts are burdened by the costs of paying for their shiny new hospitals under PFI deals.

These are the PFI deals that Gordon Brown (Britain's best-ever Chancellor, copyright Groomy ad nauseam) insisted on enormous use of in order to get government debt off balance sheet (because there was already more than enough on-balance sheet debt to worry about breaking golden rules etc. etc.).

These are the same PFI deals, put in place by the Labour government, put in place by the hero GB, that assert the primacy of PFI debt repayments over all other forms of expenditure. Yes, that's right, the contracts the Labour government struck provide legally binding obligations for Trusts etc. to pay their PFI debt before paying the staff. So when budgets get squeezed, they have to reduce the costs of employment, services etc. because they can't touch the PFI debt.

The PFI debt is an entirely Labour-designed catastrophe for the NHS.

So no, not a cat in hell's chance you'd catch me suddenly deciding to vote for the originators of the problem.

Turkeys voting for Christmas mate.
Turkeys voting for Christmas.

My view exactly el_pap. Spot on.

Tories really are a tribe

Will answer later, or you could do a bit of reading

I don't think you can really drag PFI into this. PFI is a way of paying for shiny, new hospitals. If the government had paid it themselves with loans instead then those loan payments would still be there to pay (ahead of paying the staff). I'm not saying PFI was right or even building as many shiny new hospitals was right - just that now PFI it merely a different way of financing the infrastructure that has been built. We are there now and there is no point harking back (bar a bit of fun to be had blaming Brown!) so we have to look at ho wto save money moving forwards.

The issue is now about reducing the costs of running the hospitals and NHS. This is being done inefficently (claim the tories - I believe them for what it is worth) with too much admin, red tape, pen pushing, management etc etc. So what happens? These admin, pen pushing, managers elect to reduce the costs by trimming front line staff rather than themselves. Qu'elle surprise / bleeding obvious / turkeys / christmas / etc

Maggie brought them into the NHS in the first place. Redwood classically stated that the proportion of non-medical staff in Welsh Hospitals was far too high, when he took over as Welsh Secretary. He was quickly told that Maggie was not best pleased, and quickly back-tracked.

Another issue is that Consultants\Surgeons are still too powerful. Moon-lighting is not acceptable, imho. Empty theatres, as they are working elsewhere is wrong. The "Managers" do not have the power to manage, from my experience working in one, and a Geoffrey Robinson documentary of him walking around a hospital open-mouthed....

The % salary of staff in a hospital versus clincial staff is tiny

You can't cut admin very much

Furthermore then managers in hospitals (and all organsiations) are every bit as fundemental to patient care (or whatever business it is) as the doers.

Health is no different. Hospitals are highly complex multi dependency organsations that require highly skilled management and administration to operate. Just like any large business.

Cutting admin staff is no use whatsoever without improving systems. If current admin / management is inefficient, then without improvements in systems then reducing managers and admin functions won't help. The main problem appears to be that the current management isn't good enough (and by that I'm talking more of the senior, strategic level management of the NHS rather than at line manager level, although PCT line managers did come under some fairly heavy criticism last year - pre Tory Government). Various studies and select committee reports have criticised the PCT's and (particularly) SHA's. Labour were planning drastic changes to PCT's - there was the slightly embarrassing episode last year when Labour criticised Tory plans to cut NHS admin spending only for a leaked document to come out indicating that Labour were contemplating very similar cuts.

I read a few weeks ago that inefficient and haphazard procurement in PCT's was leading to £1bn of wastage p.a. Pretty sure that was in the Guardian

I'm not convinced at all about the return to fundholding (although Blair did express regret at dismantling the previous fundholding regime). Whilst it may appear to be radical, it's really (IMO) simply shifting the PCT role to the private sector, and there's no guarantee that they will do any better job. I'm not convinced that there will be any greater efficiency. Is is just private co's doing the job of public departments?

I believe that Labour planned to shake up the PCT's without dismantling them. I think what it really comes down to is that PCT's haven't been doing a great job. The choice is to change existing behaviours in the legacy structure or to rip up the status quo and put in a new structure (probably cherry picking the best of the PCT managers to do it). There is of course no simple answer as to what is best, although with the NHS being as political as it is anyone with strong political leanings will have strong opinions.

IMO, a response of 'cut out inefficient management/admin' doesn't make sense. Of course, cutting clinical staff also doesn't make sense. The killer is that the staus quo also doesn't make sense.

I believe that the shift back to FundHolding is a lot of effort for most likely not that much change. I don't believe the Government have been creative enough. Do I think that Labour would do anything better? Probably not.

Anyway. I wish I knew the answers, but I don't. I just know that knee jerk responses like 'there's too many managers so get rid of em' are just pub soundbites, not solutions.

Do people know what the questions are?

From the outside (now) it seems to revolve around using the capital properly - buildings, wards etc; labour productivity; and buying stuff cheaper (from disposables through to machinery).

The idea of picking which hospital to go to is nothing but a smokescreen - we do not all live in London

Just to clarify regarding the effect of cutting admin staff and middle managers. The staff go but the work doesn't, it gets passed down to ward managers and other front line staff.

Anybody able to answer these questions ?

NHS Inflation is notoriously difficult to measure. It is heavily dependent on fuel (heating), labour, and other supplies, which are not RPI comparable. Hence the confusion over real funding rises\falls.

In fairness, those are all bills that every other 'business' has to account for. I realise the NHS is not a business in a sense, are you saying that it is difficult to measure due to the size of the operation or the variety of needs or both ?

No-one wants to see this but :-

1) 4,000 GP's earn more than 250K a year ; and
2) Some GP's earn up to 500K

now, why is that ? Who brought in the charging structure

Plus, how about cutting some of these http://www.independent.co.uk/news/uk/home-news/nine-thousand-public-sector-staff-earn-more-than-pm-2084129.html

"Based on the responses to more than 2,400 Freedom of Information requests to public bodies, they show that 38,000 were paid over £100,000 while 1,000 received over £200,000.

"That public service ethos is very important. People will come and work in a public sector for salaries that aren't competitive in a private sector sense."

The NHS was the sector found to have the the highest number of staff earning over £100,000 - 26,000 - with almost 6,500 paid more than the Prime Minister.

Those with salaries topping the PM's included 1,465 GPs - 10 of whom received more than £300,000. The highest earner was an unnamed GP working for the Hillingdon Primary Care Trust with pay of £475,500.

In the education sector, 385 teachers in England earn more than £100,000 and 17 get more than the Prime Minister.

The best paid was an unnamed teacher from Essex on £232,500, followed by Mark Elms, the head teacher of Tidemill Primary School in Lewisham, south east London, on £231,400.

A total of 196 police officers across the UK receive more than £100,000, with 45 earning more than the Prime Minister, headed by Metropolitan Police Commissioner Sir Paul Stephenson on £280,489.

The programme also highlights salaries in the BBC where 97 managers earn more than £160,000, 160 get more than £130,000 and 331 are on over £100,000.

Director general Mark Thompson is the best paid with total remuneration of £838,000, including basic pay of £668,000, £7,000 in benefits and an additional pension payment of £163,000.

In local government, 362 council employees across the UK get more than the Prime Minister, with Gerald Jones, the chief executive of Conservative-run Wandsworth Council in south London, getting £299,925.

The Civil Service has 241 senior officials receiving as much or more than Mr Cameron, with 26 in the Ministry of Defence, 22 each in the Department for Business and the Cabinet Office, 18 in the Department of Health, and 13 in the Foreign Office.

The Department of Communities and Local Government, where Secretary of State Eric Pickles has denounced the "gravy train" of top pay, has nine civil officials on more than the PM.

There are 832 members of the armed forces getting more than £100,000 and 2,013 people working in the judiciary - 211 of whom earn more than the Prime Minister.

The highest earners in central Government were the outgoing Chief of the Defence Staff, Air Chief Marshal Sir Jock Stirrup, on £288,700, NHS chief executive David Nicholson on £278,800 and the Office of Fair Trading chief executive John Fingleton on £277,500.

The overall figures compiled by the programme did not include publicly-owned corporations which operate on a commercial basis - some of which have very highly paid bosses.

These include the Royal Mail where, according to the programme, former chief executive Adam Crozier received a total remuneration package worth £2.4 million in 2009-10.

Ian Coucher, the chief executive of Network Rail, was said to have received a package worth £1.4 million, including supplementary pension contributions, while Financial Services Authority boss Hector Sants got a total of £795,192. "

Some frighteneing figures there. This is where the problem lies. These people above should suffer the cut backs. Not normal front line staff. How these people got these salaries in the first place shows there has beem a lot of wastage/frittering of cash in Local Govt in recent years. Spend spend spend.

Permanent heating, cooking, lights etc do set it apart; yes. It is hard to make labour savings as so many nurses are needed per patient all the time....... And if efficiencies are made, there is another patient(customer) waiting, so while more may get treated, there is no more money coming in - and more bandages etc are required... Think of a Theatre (the other sort), a play needs x number of people in the cast, and the theatre only holds y number pf people.... and the cast can only do so many performances a day. Well, the NHS is the similar, but with a conveyor belt of patients.

New medicines tend to cost more, compared to costs normally coming down (in real terms) in conventional industries - I think "old" drugs take forever to drop in price, if they ever do.

(Personally, I think there is all sort of 5hite going on with price-fixing of drugs\machines etc.)

Murf, we very much can and should drag PFI into this.

If the financing had been done by the Government, it would have been cheaper, and in the current climate simply another part of the overall budget. It would not have been attached to individual trusts which are now legally bound to pay those debts off before paying for anything else. So it makes a critical difference where the debt is attached to.

But that doesn't make a good story if you want to start a weekly debate about the latest cuts.

I would respectfully suggest that our learned OP seeks out the latest report from the Bank of International Settlements, which for a rather uncontroversial body has some extremely concerning conclusions regarding, among others, the UK's public debt progression and its associated impact, even allowing for draconian measures such as freezing age-related expenditure (i.e. health & pensions) at 2011 levels. If they are right, the current situation is a walk in the park.

I think the "construction" costs, are just more paper movement of money, it all comes from taxes etc.

Its also worth remembering that £ for £ the NHS is one of the best health systems in the world

The health and quality outcomes it produces are superior to many countries that put in more per capita than we do

The bottom line is this: unless we can reduce obesity, alcohol consumption, sedentary lifestyles and smoking then no system can afford the NHS.

Well at least I don't smoke.

Smokers pay a lot of tax

Diabetes, heart failure, CHD, COPD, cancer ................... the big killers, long slow deaths all greatly related to lifestyle all hugely expensive.

How do we change people's lifestyle?

Austerity measures ?

Less money in their pockets ? Cut off any sort of credit ? Massively inflate prices ?

& even then people still find the money for Booze, Cigs & way too much food.

Cigs and booze are massive earners.

So when do we change our culture which means we all take responsibility?

So far legislation is the biggest hitter: banning smoking in public places has been huge, we now need to control food outlets and alcohol - but people see that as "nanny state"

But we just can't afford the diabetes and cancer that comes from obesity - the cost of health care is going up and up as we get fatter and fatter, don't take exercise and drink more.

The person who can answer that has my vote for prime minister every single election he wants to stand for. The way many people in this country blame anyone but themselves and their own failings for their own misfortunes is unbelievable. "I slipped on a wet floor and hurt my knee!" - doesn't matter, sue the person who owns that floor because you couldn't be bothered to actually look at the surface you were walking on and taking appropriate care. I hate those ads....

Slightly more on topic, the NHS part of the austerity measures is something of an easy target for Labour to score political points, but as stated above they themselves were planning some major belt-tightening themselves anyway. The same as they were in education and most other departmental budgets. They must be laughing all he way to the bank that they managed to lose that election because now when the Tories have to play the bad cop and make all the cuts Labour can sit back and make Robin Hood speeches about how they would never screw the public over in this way. Pure BS. Brown could and should have made smaller cuts a long time ago (or at least not committed to continuous public spending rises we couldn't afford) which would have made the pain now so much less severe.

To be fair, the wet floor should have a sign advising as such, it's hard to tell otherwise, ie supermarket floors.