The must read stories and debate in the NHS

Exit warning

That the overall amount spent on redundancy payments has fallen is good news, but there are still some disturbing stories in the data.

Our analysis of the information from foundation trusts’ annual accounts shows a cohort of FTs with an alarmingly high spend on compulsory redundancies and other severance payments.

Most glaring of which is Northamptonshire Healthcare. In one financial year the £198m-turnover organisation spent more than 3 per cent of its turnover on parting with staff.

It was in the top five spenders on this category for 2016-17 also.

In common with other trusts, it says this was due to a restructure and ongoing savings plans.

In one (slightly sad) way, this is heartening. For a long time, cost improvement plans bore little relation to what happened in the real world.

If a trust made genuine changes to the way it operates as a result of national pressure then it would be heartening just for showing that central levers can work. It’s sad that people have lost their jobs but that’s what you would expect of an efficiency programme.

What makes it look like Northamptonshire’s re-structure hasn’t gone wholly smoothly is from another part of their annual accounts.

The 2016-17 document shows a large number of interims earning more than £220 a day and employed for more than six months. In fact, 13 of them had been employed in this manner for four or more years.

Managers in Partnership believe the national redundancy bill will have diminished under pressure from the centre (and those Daily Mail spreads showing senior managers daring to retire and go on holiday). But also because the amount of people available to make redundant has reduced.

Is this a good thing?

Not considering the service is under-managed, overall. Don’t just take our word for it, it was widely reported in 2011 by the Financial Times among others.

Feeling the strain

Meanwile, speaking ahead of the NHS Providers conference, which kicks off on Tuesday, chief executive Chris Hopson warned NHS managers’ careers “are being put in jeopardy because they are failing to deliver impossible targets”.

Without significant additional funding, the current performance targets were unachievable and left trust leaders “stuck in an endless cycle of not being able to succeed”.

He called for “recognition and honesty” from Jeremy Hunt and Simon Stevens about the dilemma facing trust bosses. Mr Hopson said the gap between providers and the centre was illustrated by September’s meeting about improving emergency performance, where some local leaders were made to chant “we can do this”.

“If people really think the failure to miss these targets is due to providers not trying hard enough then we are in danger of losing the plot,” he said.

Mr Hopson’s warnings were put into worrying context by Jon Restell, chief exec of the Managers in Partnership union.

Mr Restell told HSJ the mental health of under pressure managers is currently MiP’s “number one issue”.

He said: “The pressures are getting to some people. People are saying they are desperate, they are reporting suicidal thoughts and they feel the quality of their work is going down. It is leading to depression [and] anxiety. What worries me is how senior some of these people are. We are talking about chief executives and other senior managers.”

He warned the pressures would exacerbate difficulties recruiting leaders to boards or to step up to more senior roles, while current staff could leave the health service sooner, and called on the government and arm’s length bodies to come up with an NHS workforce strategy that included support for managers.