NHS
trusts are faced with growing unrest among their doctors and consultants as
morale dips and many hinted they would consider early retirement as a way out.
HR, although feeling hamstrung by external factors, is facing up to the
challenge with a raft of programmes. Kathy Watson reports
For
most HR managers the revelation that their staff are on the point of mutiny
would be a call to action. But for managers in NHS trusts, it is very
different.Â
At
the end of last month HR professionals were presented with a raft of surveys in
medical publications charting doctors’ complaints. Three surveys delivered
similar messages.
First,
the Hospital Consultants and Specialists Association found that 62 per cent of
respondents said they are prepared to work to rule in pursuit of their new
contract conditions. They also delivered a depressing picture of their attempts
to alter their patterns of work in order to alleviate current stresses.
Hard
on its heels came a similarly bleak set of findings from the Medical Sickness
Society which found that more than half the doctors and dentists it surveyed
plan to take early retirement. At the other end of the career spectrum nearly a
quarter of those younger than 30 said they are considering a change of career.
The
Sunday Times also published research showing morale has fallen dramatically
among the doctors it surveyed over four years. So what do personnel directors
and managers in NHS trusts intend to do to improve the lot of hospital doctors
and consultants?
Although
they are prepared to look for solutions they feel that their hands are tied by
external factors.
The
NHS is undergoing a prolonged period of change, they say. Along with education,
healthcare provision has become a key performance indicator for the Government.
So almost every facet is being revamped, not by the providers but by the
Government in consultation with them.
As
the first fruits of that work, last December new contracts were introduced for
junior doctors to restrict their horrendously long hours. It is taking time for
the new system to bed down and for doctors to be reassured that they will not
lose valuable training as a result of the cut in their hours.
The
health service is launching a huge recruitment drive which will result in a
further 12,000 consultants, 59,600 nurses and 3,000 GPs by 2009. Also,
consultants are in tough negotiations with the Government over a new contract
of employment. It is long overdue – their current one has been in operation
since 1979.
In
tandem with this upheaval, the public’s trust in healthcare professionals has
been dented by a series of recent scandals and allegations of malpractice. As a
result, the Government is proposing to revalidate consultants’ skills on a
formal and regular basis, probably from next April.
It
is no wonder then that in the midst of this turmoil some hospital doctors want
out, claim the personnel managers. But they believe they are doing as much as
they can to help most of their staff cope.
Andrew
Kelly, director of HR for Sussex Weald and Downs NHS Trust, cites as an example
its annual staff survey, the latest of which is being processed but which has
until now indicated few signs of dissent.
In
addition, the trust has gained accreditation from the Government for its
handling of new doctors’ contracts. The trust has increased its number of
consultants, thereby spreading the workload and, in line with government
guidance, is producing job plans and reviews for each one. It also holds
regular team briefings.
Kelly
believes the stresses are caused primarily by external factors. He said,
"Changes in new doctors’ and consultants’ contracts and revalidation is
giving cause for concern. But we can work with the medical staff and overcome
any fears using clinical guidance and supporting continuing professional
development."
Mike
Griffin, HR director of Kings College Hospital NHS Trust, believes the apparent
bad news should be viewed in the context of "manoeuvring" by both
sides during the current contract negotiations. He points out that early
retirement is not the vote of no-confidence it might appear in other
professions, as it profits consultants financially to take their pension and
then return to work.
But
he concedes life is tough for his staff. "All consultants are faced with
managing an almost insatiable demand. There is a much higher degree of
regulation and accountability and for the older doctors it is difficult to come
to terms with."
He
believes HR’s major contribution has been the introduction of effective
appraisal schemes that create opportunities for new training and development.
They have been triggered at Kings College by a forum that meets regularly led
by one of the younger consultants. Thus far it has resulted in a development
programme for new consultants to help cope with stress during the transition
from their old jobs to the greater autonomy that consultancy brings. They have
also identified time management and work planning as training needs.
Griffin
points out that the old established annual appraisal process has become much
more rigorous. Now clinical directors are closely involved in discussing and
appraising consultants’ workloads particularly because of the time management
challenges consultants face at Kings between their teaching and medical duties.
Several
personnel directors cite the British Medical Association as a key adviser on
their committees that cover conditions of work for doctors. Roger Faulkner of
University Hospital, Coventry and Warwickshire NHS Trust is one of them. His
team offers occupational health services, stress counselling and
family-friendly policies. He sees little evidence of unhappiness among his
staff and turnover levels are not huge.
Coincidentally,
on the day we talked he was saying farewell to one of his consultants now aged
65. The man had taken retirement at 60 but then returned to the hospital with a
slightly reduced workload when he realised he would need to earn extra for his
pension.
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The
head of personnel for Basildon and Thurrock General Hospital NHS Trust, Gary
Theobald, echoes the view that the findings on poor staff morale is not a
reflection of his trust’s situation. In response to the vast changes under way,
he believes consultation with the staff and the BMA is essential.
"You
have to ensure people feel involved," he said. "Clinical governance
will not work without them."
