Hospitals Trust Workforce Plan – like pulling figures out of a hat

The Workforce plan aims to solve the problem that Calderdale and Huddersfield hospitals Trust doesn’t have enough staff and money by cutting the equivalent of 479 full time staff over next 10 years, through natural turnover. This would cut about £30m from its paybill.

But many of the workforce plan assumptions are questionable and we wonder if the Trust has just pulled figures out of a hat, like so many conjuror’s rabbits.

Even if we were to accept Calderdale and Huddersfield NHS Foundation Trust’s Full Business Case on its own austerity bullsh*t terms – which we clearly don’t – we would reject it on the grounds that it’s  largely un-evidenced, has evaded scrutiny by Councillors and is deeply flawed.

We have scrutinized the Full Business Case through the lenses of its Workforce Plan and its Private Finance Initiative 2 proposal, since these two areas have been the focus of NHS Improvement’s and PricewaterhouseCooper’s attention.

The hospitals Trust’s workforce plan is inadequate in the following respects

It has next to nothing on a community services workforce plan.

Key assumptions of the workforce plan are questionable:

  • There is no evidence that cutting 105 hospital beds is feasible (which would account for 150 Whole Time Equivalent job losses, or 22% of the total.)
  • The reviewed skills mix/ 768 new lower-qualified professional roles are unlikely to provide good quality, safe patient care.
  • Job evaluation, say nurses we have spoken to, is likely to destroy everything that epitomises nursing – that is, to provide all nursing care from basic care upwards. To nurse the whole person, whatever their needs.
  • Increased use of voluntary work and community involvement in both hospitals is part of the workforce plan
  • It includes significant workforce changes based on new West Yorkshire and Harrogate Sustainability and Transformation Plan schemes that have not been consulted on and have not been scrutinised by Councillors.

Workforce plan and implications

Monitor and PwC have told the Trust to tackle the high workforce spending required by the two District General Hospitals (and also to deal with the massive PFI costs), by turning one District General Hospital into a planned care hospital and the other into an acute and emergency hospital, while “optimising the utilisation” of the Trust’s PFI and non-PFI estate.(Full Business Case, p95)

The hospitals Trust’s Full Business Case obediently mis-attributes the cause of their staff recruitment and retention problems to the fact that the Trust runs 2 District General Hospitals each with a 24/7 Type 1 A&E.

Rather than tackling the disease of under-funding, stealth privatisation and a total lack of effective national workforce strategy that that the government has infected the NHS with, their workforce plan is about treating the symptoms.

By workforce “challenges”, they mean they haven’t got enough staff, they have problems with recruitment and retention and they are spending A LOT on agency staff and have been told to cut that drastically starting this year.

A similar reconfiguration in Mid Yorks has not stopped a “haemorrhage” of consultants

As well as cutting the equivalent of 479 full time staff over next 10 years, through natural turnover, the Workforce Plan states that recruitment and retention will be improved by dismantling the two District General Hospitals and replacing them with one small planned care hospital with outpatients and urgent care centre and one acute and emergency hospital.

They say this will make CHFT a more attractive place for doctors to work.

But this has not been the case at Pinderfields Hospital iin Wakefield, where the Mid Yorks Trust is a few years ahead of Calderdale and Huddersfield  in a similar reconfiguration; it is now “haemorrhaging” consultants, in the words of N Kirklees Support the NHS deputation to Calderdale and Kirklees Joint Health Scrutiny Committee at the July 21st 2017 meeting.

Drugs bill more than doubles while workforce spending flatlines

Other cost cutting measures – including “delivery of skill mix” – in other words replacing highly qualified clinicians with new grades of less qualified staff – mean that workforce spending goes down year on year for the next 10 years and by 2042 is only slightly higher than it is now. (In contrast, the drugs bill more than doubles over the same period.)

Are they pulling figures out of a hat?

Cutting 479 full time equivalent staff is a lot less than the 966 Whole Time Equivalent staff reduction modelled in the hospital Trust’s 5 year strategic plan and presented in the public consultation – which does make you wonder if they are just pulling figures out of a hat. Because what has happened to change the number of necessary staff, between now and the preparation of the 5 Year Strategic Plan last year?

The Full Business Case says the hospitals will be able to cut 479 whole time equivalent staff (ie full time jobs) because these measures would make it possible:

  • service reconfiguration and redesign;
  • recruitment and retention;
  • new professional roles;
  • job evaluation;
  • staff utilisation and productivity.
    (Full Business Case pages 9 & 72)

We unpick these assumptions in the next lot of Full Business Case BS reports, which we are sending to the Independent Review Panel and Calderdale and Kirklees Joint Health Scrutiny Committee – links coming soon.

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