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Another week brings another change in rhetoric on staffing

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The past months have seen the subject of safe staffing levels very much in the limelight following a series of subtle and less subtle messages from NHS regulators.


First of all, we had the new regulator NHS Improvement seemingly setting out a robust approach which was at odds with its stated intention of being more supportive than its predecessors.

As part of its approach to exerting control over health service finances, it named 63 trusts as having over-recruited staff. It noted all of them had seen above-inflation growth in their pay bills since 2014 and there was the suggestion they might face fines.

”That so many managers were prepared to speak out publically against NHS Improvement clearly showed the level of feeling”

Trust leaders hit back, with some arguing that the regulator had got its methodology wrong and others saying they would not compromise on safety just to save money. That so many managers were prepared to speak out publically against NHS Improvement clearly showed the level of feeling.

Now it seems the regulator may have rowed back a bit since its initial headline-grabbing stance.

The boss of the new body, Jim Mackey, said the naming of trusts with high pay bill growth was “intended to start a discussion” and the organisations were “not being targeted for cuts to their workforce”.

In a statement described as clarifying the regulator’s position, Mr Mackey added that it was “incorrect to suggest that providers will be penalised financially over pay growth”, and it would be “unworkable and unsafe” to suggest that £356m of excess spending should come from pay bills alone.

”So, did people get the wrong end of the stick?”

He promised to work with trusts and fellow regulator the Care Quality Commission “to identify where savings can be made without compromising patient safety”.

So, did people get the wrong end of the stick from NHS Improvement’s initial announcement about 63 trusts? Is its latest statement actually the real message it had been wanting to deliver all along?

Or was it a tough statement of intent designed as a start point for negotiations with trusts, or perhaps a more politically motivated way of getting some headlines? At this point we don’t know – or at least no one is saying – but this week’s softening of the NHS Improvement line is welcome.

Talking of the CQC, it also introduced a new tone on safe staffing in an apparent effort to clarify its position.

In a statement issued on Wednesday about Yeovil District Hospital Foundation Trust, the regulator said it was up to the organisation how it tackled understaffing found by inspectors in the emergency department and intensive care unit.

“It is for the board of the trust to determine whether this is best achieved through additional recruitment, or it can be achieved through changes to the existing model of care,” said CQC deputy chief inspector of hospitals Professor Ted Baker.

Professor Baker subsequently said the emphasis on the trust’s freedom to decide how to tackle staffing issues was intentional and was to clarify the CQC’s position on staffing.

“The CQC is often characterised as telling people they have to recruit more staff”

Professor Ted Baker, CQC

“We felt the need to clarify that we are not trying to take away the autonomy of organisations and just dictate crude staffing levels based on arbitrary standards,” he said.

“The CQC is often characterised as telling people they have to recruit more staff and that is a simplistic representation of our view,” he added.

Has the CQC come under pressure from ministers or other agencies to stop telling trusts they must boost their staff levels? The regulator claims not. Personally, I am slightly suspicious.

”Personally, I am slightly suspicious”

Not least because service redesign usually takes time to implement and, in this particular case, doesn’t seem an obvious fit with solving shortages in critical care or emergency departments.

So, to summarise, we have one regulator calling on trusts to look at their pay bills to make savings and while another is highlighting that trusts can ensure safe staffing levels through service redesign rather than recruitment.

The coincidence adds up to something a bit fishy in my book. I sense a distinct movement in the halls of power towards a focus on workforce reductions to make savings. Normally, we only hear political statements calling for cuts to backroom staff and managers, but this may well signal something wider.

Of course, I realise that the NHS financial position is parlous and that workforce is its biggest cost. But please let us not forget the hard lessons on staffing learnt from Mid Staffs and the Francis report, where monetary priorities were put ahead of patient safety.

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