Daily Insight: Voting with their feet

Years of chaos

Managers in Partnership’s chief executive has made it clear there is no love lost between the chancellor and NHS managers: “Pushovers? How very dare he.”

Delegates attending the trade union’s annual summit yesterday left without a doubt that Jon Restall’s union had more than a few bones to pick with the government. The funding squeeze, organisational change, bullying and discrimination at work, and lost capacity in the healthcare team were named the “four evils” that have resulted in NHS leaders voting with their feet.

Mr Restell called for a workforce strategy that hits the reset button on the deal managers are getting, giving them a rewarding and sustainable working life.

Despite being present at the conference, NHS Improvement divulged little as to whether the workforce strategy and long-term plan would get the results the union wants. Director of people strategy Caroline Corrigan, who is leading on the workforce element of the long-term plan, remained tight lipped, only saying there would be a focus on the “notion of the team” and the importance of regional directors.

The room was clearly anxious about the NHSI and NHS England merger, with delegates pondering what it would mean for them. Ms Corrigan confirmed there would be an impact assessment, while NHSI and NHS England would be “rallying” to fill the gap until a chief people officer is appointed.

But, as Mr Restell acknowledged, managers have been tolerating “years of chaos”, so yet more reorganisation prompts more questions for this group. 

Big spenders

The headline figure of an 8 per cent increase in the cost of compulsory redundancies at trusts raises further questions. 

Why are mental health, ambulance and community trusts so overrepresented in the big spending categories despite being smaller than almost all acute trusts?

Of the 10 highest-spending trusts by this measure in 2017-18, none was a hospital organisation.

Ambulance trusts and mental health providers generally report a higher rate of burnout and stressed staff, which you might expect to see reflected in more compulsory redundancies as relationships become fractious.

But perhaps it has become a tool these bodies have become more used to using than the acute sector?

Community trusts get their income from fairly short contracts – typically three years. As other organisations take over services, you might expect to see larger sums being paid out on redundancies.

But, in some cases, the money spent is simply too big not to prompt questions.

Midlands Partnership Foundation Trust spent £5.7m over 2017-18 and 2016-17. This covered a period when the trust was being created from the merger of two smaller organisations, which usually involves some loss of headcount.

Stranger is the trust’s contention that the job losses came as a result of commissioners’ plans and that the clinical commissioning groups had agreed to pay nearly £3m of the total, an arrangement without precedent.

There were only two compulsory redundancy payments over £200,000 in 2017-18.

Midlands Partnership Foundation Trust also took the prize for single largest payout, awarding one staff member £354,000. The trust would not clarify but this looks like a director’s salary paid for two years, possibly in lieu of notice.

St Helens and Knowsley Teaching Hospital Trust paid one staff member £231,000 after a compulsory redundancy. HSJ understands it was a senior member of staff in a small service line that the trust was discontinuing.