Published: 09/06/2005, Volume III, No. 5959 Page 7
NHS staff are 'sick to death' of 'change being rammed down our throats', relations between organisations are 'almost bankrupt' and patients are being 'processed like peas, ' Department of Health research has revealed.
Over 200 staff were interviewed by market researchers for their views on the current reforms, as part of the process which led to publication of the NHS improvement plan in March.
The accounts from consultants, nurses, GPs, managers and ambulance staff paint a vivid - though anecdotal - picture of some of the tensions within the reform agenda.
Relationships between a primary care trust and GP practice are 'dire... almost bankrupt', says one practice manager; a consultant describes his foundation trust as 'financially haywire' while an ambulance worker says the introduction of Agenda for Change has been 'paralysing'.
Overall, the report - obtained by HSJ under the Freedom of Information Act - concludes that while changes have encouraged organisations to form an 'integrated approach to patient care' there is 'evidence of strained relationships between acute trusts and PCTs, social services, ambulance trusts and strategic health authorities'.
Policies on foundation trusts and independent treatment centres receive the most flak, with resistance to change most marked among consultants. One describes 'enormous rifts' between ITCs and foundation trusts. Another describes 'appalling' relations with the local PCT. Meanwhile, a foundation trust manager admits the amount of change in the system is 'traumatising'. Nurses and allied health professionals working in foundation trusts spoke more positively about the new organisations.
HSJ requested the confidential report to ministers in February, but the DoH withheld the information for three months while undertaking a public interest test to establish whether it should be handed over.
Last week it decided to release the 100-page report on the basis that the research was now completed, and that publication was in the public interest given that policy development on the basis of the research remains ongoing.
Market researchers TNS conclude that of the 203 respondents - who were surveyed in 30-minute interviews - many were positive about the ideology behind the reforms.
But the report warns that pace of change, workload pressures and the 'development of a 'tick box' culture' have created negativity and resistance to change.
An allied health professional says her acute hospital is guilty of 'processing people like peas, just to get them off trolleys into wards and out of the back door of the hospital'. A psychiatrist is 'sick to death of change'; a GP says 'everything is rammed down our throats at such a rapid pace, without piloting or trials'.
The report concludes: 'Reassurance is needed that changes are indeed patient focused and will... be beneficial for both patients and staff.' It calls for a 'softer organisational culture' to replace the focus on targets. The report also stresses that 'the vision of how private provision fits into the health economy should be better considered and communicated, as there is poor understanding of this among NHS providers'.
A DoH spokesperson said: 'We are always keen to hear and understand the views from the front line, and [health secretary] Patricia Hewitt has made it clear she wants to listen and learn.'
Project fatigue lies behind discontent NHS Confederation policy director Nigel Edwards said the report showed 'a lot of frontline staff are lost in the reform process'.
He told HSJ: 'The reforms have been carried out as a project. What people seem to see is an overwhelming number of things happening, a number of separate projects, without any compelling story about why. That is a real problem.' But he urged the DoH to resist the temptation to solve the problem by coming up with yet another project: 'The DoH solution to one policy problem is to produce another policy. The last thing we want to see is another project - called 'clinical engagement', with its associated roadshows, in an attempt to solve this problem.' He said the task of making the case for change fell largely to local leaders. But he said the DoH could support them by being more explicit about the fact that what staff perceived as the 'unintended consequences' of reforms - such as service closures - were 'entirely intended, ' given the nature of competition.
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