‘The NHS ‘should sack 137,000of its staff’’.   Well it’s all doom and gloom in the NHS at the moment; the press are having a field day and the headlines keep coming.  Rather than everyone getting outraged, let’s think this through. 


Question 1: Every one of us can name at least one individual who is not performing or where we are not getting value for money.  I don’t mean just administrators and managers, I mean all staff.  I bet we could all name at least one individual.  Be honest.  


How many people are being managed under the ‘benefit of the doubt’ section in the Performance Policy?   This is the section where an individual isn’t performing but they are either new or ‘just not quite bad enough’ to start formally managing.  Now just to be clear I do not mean to imply that ‘benefit of the doubt’ is not a valid or fair approach; people are of course worthy of a chance, however this should be time defined and when they do not improve they should be managed onto something more suitable for them or out.  How many people are under the ‘benefit of the doubt’ section for months?  Furthermore, how many have been under performing for years and are renowned for it?


Question 2: Ask yourself if you have ever said the words ‘they seem very nice and good, but I don’t really know what they do’.  Be honest. 


I suspect each of us could name at least one role in the NHS which isn’t important and when we think about it adds very little value.   This might be a difficult question to ask and some might not arrive at the answer that they want. 


Question 3: Can we honestly say that there is no unnecessary duplication in posts in the NHS?  Be honest.


Read a number of job descriptions; granted similar objectives come up in posts at different levels so you would expect to see a certain level of overlap, but there are many objectives and tasks where it is not clear who is really accountable.  Overlap is in abundance; not only is it a waste but it  further complicates by creating unnecessary work, the irony is that sometimes additional roles are created as a consequence.


Question 4: Do we have authentic clinical engagement?  Be honest.


My view is that the clinicians that really are engaged in the business are few and far between.   A good many are in the ‘good enough’ or ‘the best we have’ group, but the opportunities that could come from true clinical engagement are plentiful.   I still have great hopes and aspirations for SLR but even organisations who have implemented it have got some way to go to using it to its full potential.  There’s no point in having it but not using it, and using it means that some difficult decisions might have to be made.   Clinical Leads (be that Service Leads, Divisional Leads and also Medical Directors) have to know what is expected of them; I’m sure a great many (some through no fault of their own) don’t really know what their role is because we haven’t articulated it.


It would be a fair challenge to say that I too am talking about removing staff, so why is that so different from the headline?   I am talking about a sensible, logical approach to improving efficiency and one which is fair.   Consider the savings that could be achieved simply by addressing even some of the above.  Reduce overlap, reduce the amount of underperformance and hold people fairly to account. Whilst the entire deficit won’t be addressed it would make a significant contribution and it does not at any point touch on any of the individuals who truly affect patient care.     


Question 5: How do we address the inertia?