Change Begins on the Front Line in Healthcare

By Danny Bowman, Director of Mental Health

This is the second of six blog posts looking at innovative ways in which we can reform and improve healthcare in the United Kingdom.

When we think of healthcare in the United Kingdom, it would be a surprise if every citizen didn’t immediately think of the three words that have defined our approach to health for 70 years; the National Health Service.

The NHS has unquestionably been the best solution when it comes to managing our citizens health from ‘cradle to grave’, but we must not become dogmatic on healthcare.

Whilst acknowledging the importance of such a service, we need to look at new innovative solutions to the constant stress around healthcare.

When it comes to the frontline of healthcare we have all seen from the figures released yearly, the constant reduction in staffing levels:

There are shortfalls in every area of the NHS when it comes to staffing with almost 50,000 vacancies across clinical staff as of 2014 according to the National Audit Office.

The hardest hit areas are nursing and midwifery with shortages equalling 27,980 and in addition, there is a shortfall when it comes to junior doctors of 2,550 as of 2016.

To address this issue, we need to look at a multitude of different areas including working hours, investment in training within key areas and in the reduction of pay for those at the top and making sure change starts from the bottom.

Flexi-Working Hours

It is hard if you are not a health worker to know how stressful life on the frontline can be – constantly rushing from patient to patient or house to house. This is the reality for many health workers in the NHS right now and it’s causing negative adverse effects on individuals within the workforce.

Research by the mental health charity Mind – they found that 40% of GP’s suffered from a mental health problem. In certain cases the heavy workload and intense levels of responsibility are the reason for bad mental health. In addition, we have heard horrific stories of doctors experiencing suicidal thinking due to “Long hours, work-related anxiety, and despair” as parents who lost their daughter who was a junior doctor wrote.

For best-practice in a globalised society, we need to change the working arrangements of doctors and other health professionals in the NHS.

By implementing flexible-working hours for doctors and health professionals in certain areas we can revitalise the health workforce and deliver better and more efficient care to those who use the NHS.

By implementing flexi-hours to health professionals, we will no longer see a tired workforce, allowing healthcare workers to do what they love in an environment in which they feel supported and not over stretched.

Although there is already ‘flexible working’ within the NHS – I believe we need to go further and acknowledge that every healthcare professional can sometimes need time off who may not fall into the current criteria for flexi-working. That’s why we need to make sure that flexi-working is ingrained in the apparatus of the NHS.

Investment in Training

As discussed above, the change comes from the front-line, but unfortunately due to staff shortages and the lack of trained individuals coming out of our universities going into the healthcare professions such change is not possible – we need to make sure we invest not only in training, but subsidise training in certain areas of most need including:

  • Nursing (in general).
  • Mental Healthcare
  • Healthcare scientists

These areas are just some of many that needs investment for training to renew and revitalize our workforce allowing younger voices to come through.

It is my belief that we should firstly start with nursing – in nursing there is a high shortage of staff and to enable us to train the next generation we need to invest in subsidizing a certain amount of degrees every year, but we should expect more from those we train.

An example of this sort of approach comes in mental healthcare, where I authored a policy paper on behalf of Parliament Street to train 15,000 more mental health professionals:

  • 15,000 more NHS mental health nurses – over a nine-year period by subsidising the university fees of 5000 individuals each year. Furthermore, those in receipt of this subsidy will have to work in the NHS for a minimum of five years. The salaries of individuals who take up this subsidy will be capped at £30,000 a year for five years which is high enough to entice individuals, but low enough to create savings.
  • Newly qualified nurses start at a Band 5, but the proposed amount that the salary would be capped at does not prevent them gaining promotion to a high Band 6 or a low Band 7.

The overall cost of such a policy would be £2.6 billion. With just a 3% saving in the cost of bad mental health, the policy would have already created economies.

This sort of approach could be implemented in other areas of healthcare where by investing in training more people, could save money in the long term. I believe that such an approach in nursing would invigorate people into studying it at university and with only 5000 subsidised degrees a year – competition would be stiff meaning we get the brightest and the best into the nursing profession.

A Meritocratic Pay Scheme and Cutting Down on Abuses at the Top

It has been acknowledged that the rise of chief executives and managers in the NHS has soared whilst we still experience shortfalls in the number of nurses, doctors and other healthcare workers.

It has been found that the number of managers within the NHS has risen by 11 per cent between October 2014 and 2017.

In addition, there have been jobs created in the NHS, but the type of jobs are communication executives and management teams according to a report by the Health Foundation with combined annual salaries equating to £8.5m.

To add, it was found in 2017 by data obtained by the Telegraph that 600 health quango chief- executives were earning six-figure salaries and 93 of them getting more then the prime-minister.

Managers and executives are important, but it should be acknowledged that over investment in these areas of the health service is not only causing an over bureaucratic system but is costing the NHS an unnecessary amount of money.

In a modern healthcare system, we need to incentivise the nurses, doctors and other healthcare workers to work in the NHS and feel like they are rewarded for their hard work.

We need to make sure that a modern NHS believes in meritocracy, where regardless of status within the organisation, you can be rewarded with a bonus for exceptional work.

For too long we have seen some at the top being rewarded with pay-rises for failure. I believe we need to only reward exceptional success across the board. This is an approach that should be implemented across the board.

I would have no problem with a chief-executive being awarded a bonus for exceptional success over years and neither would I have a problem with a nurse who has shown exceptionally high standards being given a bonus – what we need to avoid is bonuses for failure.

In addition, we need to cut down on the number of abuses by those at the top for example a redundancy pay-off of almost £1 million for a married couple of health chief executives who within months were in high paying jobs in another NHS trust. This is unacceptable.

I believe for a modern NHS to thrive in the 21st century it needs to become a rounded organisation which incentivises and rewards those at the bottom as much as it does those at the top.

These changes will enable the NHS to become an organisation moving with the times, enabling innovation and change coming from the frontline. In addition, the NHS must become meritocratic for those at the top, as well as those at the bottom.

We need to recognise that training the next generation of nurses, doctors and other healthcare professionals is vital as part of an invest to save scheme. If by increasing the number of trained professionals in an area of the NHS will save money by training more staff – we must invest to achieve that.

Finally, we need to acknowledge that as the population grows, more pressure will be put on the NHS and to sustain the high standards expected by the public, we need to look at expanding flexi-working hours to all.

This will not only allow for a refreshed workforce, stopping staff sickness, but will incentivise those that may have been discouraged from doing a healthcare profession to believe in it again.


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