One of the hazards of working for the NHS is that you may hear that your job is changing when you switch on the Today programme in the morning.
For hundreds of NHS managers, 12 July brought even more of a shock. That day, health secretary Andrew Lansley announced that the coalition government would not be sticking to its pre-election pledge to avoid another major overhaul of the NHS.
Instead, he had decided to scrap both strategic health authorities and primary care trusts and to transfer their roles to other bodies, not least new GP commissioning consortia, who would take charge of 80% of the NHS budget.
Morale falls again
EHI Primary Care’s survey, launched a month later, found the result was an immediate and dramatic fall in morale. Of the 403 respondents working in SHAs, PCTs and health informatics services, 58% reported morale had deteriorated greatly.
Unsurprisingly, a large percentage of respondents expected to lose their job (40%) or were not sure what would happen to it (46%). A primary care IM&T manager with more than 20 years experience of the NHS says many of her colleagues were caught out by the decision to scrap PCTs.
She adds: “Those of us who have been around for a longer time were probably less surprised, but in the eight years I’ve worked for the PCT it has gone through four reorganisations. It’s only afterwards you realise how much it has stressed you in terms of having to apply for jobs and so on.”
Her views are backed by comments made by respondents to the survey. One said: “Morale has fallen very quickly in a very short space of time” while another added: “Working for the PCT IT department, my current job seems like a bottomless pit with plasters covering open wounds until the future is decided.”
But are these simply the thoughts of a disenchanted minority? Does a silent majority see a much more positive future for themselves?
David Stout, director of the NHS Confederation’s Primary Care Trust Network, says that the survey’s expectation of 40% job losses is not a ludicrously inflated figure, but closely aligned to the 45% management savings PCTs have been told to make.
He tells EHI Primary Care: “That’s a fairly plausible figure to come up with. What we don’t know yet is how it will affect different groups within the NHS.”
One IM&T manager told EHI primary Care that her directorate felt some reassurance following this month’s announcement about the future of the National Programme for IT in the NHS.
Although the government plans some changes to national applications such as Choose and Book and the Electronic Prescription Service, it plans to continue with them – which suggests they will still need local support.
Staff left in the dark
However, much still remains unknown. One of the key problems is uncertainty about how the reforms will work in practice and what it means for individuals. Three months after the white paper was launched, few are any clearer.
One respondent stated: “If you are going to tell a lot of people that the organisations they work for are being shut down, then it would make sense to wait until you can give them at least a clue about where they will end up. At least, it would if you want to avoid stress and worry and an unhappy, demoralised workforce…”
Stout says he is alarmed that only 26% of the staff who took part in the survey have so far had an interview with their line-manager about what is likely to happen to their job – even though NHS chief executive Sir David Nicholson has promised that all SHA and PCT staff will have such an interview by the end of the month.
Stout says: “Managers need to talk to their staff. Even if they don’t have answers to their questions, a good employer needs to have these discussions with their employees.”
Julie Wood, clinical commissioning federation director for the NHS Alliance and a former PCT chief executive, admits that uncertainty is tough for NHS staff.
“I can quite understand the anxiety about jobs in these circumstances, but it is still very early days. I don’t think there will be a massive leakage from the NHS, which would be a great shame.”
Wood says organisations like the Alliance are working with the Department of Health to design a system that works and is successful and that PCTs will have a critical role in shaping that future.
Her enthusiasm was not shared by those who took part in the survey. Almost half (47%) felt that many of their colleagues would lose their jobs and leave healthcare and 43% felt there would be a big loss of IT skills.
One respondent said: “We’re already losing good people and unable to recruit to those posts, which further impacts on morale. The snowball effect will continue until we once again realise we’ve over-compensated and lost too many skilled staff.”
Some opportunities but many uncertainties
Roz Foad, chair of the British Computer Society’s Primary Health Care Specialist Group, says her personal view is that the white paper is a major challenge, but that it can make a difference if implemented properly.
She adds: “There are some really excellent staff in PCTs, and I hope that the local GP consortia will recognise local expertise and ensure it doesn’t go to waste. But it has to be said that the NHS could probably run leaner, and there are savings to be made that I sincerely hope will go into direct patient care.”
She acknowledges, however, that it could be tough for staff facing redundancy to hand over budgets and control to GPs; who they may also feel are ready for them.
One IM&T manager told EHI Primary Care that many of her local practices were “terrified” of having to take on 80% of the NHS budget and saw themselves as principally as clinicians rather than as commissioners.
There were also mixed views in the survey about working for a GP consortium. Although 24% of respondents stated that they expected to be working for one in two to three years’ time, only 17% wanted to do so.
Most respondents (54%) wanted to work for the NHS, but not in a consortium. One PCT IM&T manager points out that for those approaching 50 the wish to continue with an NHS pension is also a factor.
She adds: “One of the fears is that if PCTs become different organisations – contracting out to the consortia – they might become private bodies. And then what would happen to our pension?”
Vision needed. Information will do.
For many staff in PCTs, the white paper comes on top of what are already difficult times for those working in primary care organisations. After all, they already need to deliver 45% management savings and divide provider and commissioning functions by April 2011.
One respondent commented: “My personal position as Head of IT Services will go within six months as we split my team up between commissioner and provider arms.”
Another said: “The management cost savings are hitting now and over the next six to 12 months, well in advance of full implementation of the white paper reforms.”
For those trying to work in such an environment, with one ear tuned for further DH announcements, more information about the future cannot come soon enough.