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The NHS - the good and bad right now
Working in the NHS
Member Name: dave27
Working in the NHS
Date: 16/11/01, updated on 16/11/01 (2535 review reads)
Advantages: Can't think of any
Disadvantages: Pay, Instability
If you're aspiring to be a Big Time Charlie management type, the answer is easy ... Don't even think about it.
On the other hand, those of you who are considering taking up nursing as a career, you've never had better prospects.
I can speak from first hand experience as I work as a Finance Director for a Trust in the North West. I've been there five years now, after doing the rest of my time in the private sector.
Let's consider the management side first...
When the Labour party came to power in 1997, there were high hopes for it and its vision of changing the face of Britain and improving the public services. There was a lot wrong with the NHS in those days, and genuinely, 18 years of Tory mis-rule and the imposition of the internal market, setting Trust against Trust and producing winners and losers, but always harmful competition and rivalry, left it in a sorry state, divided, directionless and creaking at the seams.
Labour, with Frank Dobson holding the Health portfolio back then, were full of good ideas and enthusiasm and quickly hit on the clever idea of giving power to the front line troops, to ask doctors and nurses to run the show. It would obviously be a popular move and in theory was a great idea.
The reality has been a bit more difficult. Let me explain...
Until recently, NHS organisation had been along these lines. The Department of Health and the NHS Executive were at the centre of the NHS, setting policy and putting out the directives of the government. The Executive was based in eight Regional Offices around the country and had the job of overseeing the whole operation. The Health Authorities, between 100 and 200 of them, were given annual commissioning budgets to buy services from Trusts, who were set up to provide services. All wel
l and good, and effective enough.
However, the problem which the government had spotted was that the faceless bureaucrats, the bean counters in the Executive and the Health Authorities held all the power, clogged the system up and did not really understand services. Things had to change.
Labour's big idea was to form new organisations, called Primary Care Trusts, who would be controlled by doctors and nurses, who would both commission and provide services. It was argued that putting the power in the hands of the clinicians, better, more clinically appropriate investment would be carried out. All well and good.
As always, the devil was in the detail and as thinking went on, Labour saw that they couldn't just change one part of the system, they had to reorganise the lot and switch responsibilities around. Now, as we sit in October 2001, the NHS is going through the most radical period of organisational change in years.
During the next 18 months, there is not a single organisation within the NHS, and therefore not a single member of staff, who will remain unaffected. The eight Regional Offices are being replaced by four Health and Social Services departments and much of their power will be devolved down to newly formed Strategic Health Authorities. The 200 Health Authorities are to be replaced by 30 Strategic Health Authorities, with much of the power of the former Health Authorities being devolved to the Primary Care Trusts.
Most existing Trusts are being reorganised around specialisms and there is a fever of change and constant fear going around as a huge vacuum of decision-making has developed.
Now the net result of all this is the utmost uncertainty, where there is not a manager within the service who isn't worrying about his future - everyone is going to have to apply for their own jobs, in effect. That's not good for morale or the service because everyone is too busy
gazing deeply into their navels to even think about patients.
It also means of course that there are going to be precious few chances for outsiders to get a look in for the next 18 months, so I'd seriously give it a miss if I were you.
It's a completely different story for nurses, however, and there has been an alarmingly huge recruitment crisis within the NHS for years which is coming home to roost in a big way. A qualified nurse these days can go to literally any town in the country in the knowledge that there will be someone begging her to signup, and paying well over the odds to do so. Forget all the propaganda - nurses have never been better placed to get a slice of the action.
Added to that, the government are making all sorts of other changes to give nurses more power. There is an ever growing band of so called 'supernurses', consultant nurses coming into place.
My own Trust has got a new development planned which provides and extra 38 beds and we're desperately seeking a whole tranche of nurses, 60 of them. But can we get them, can we coco?
We're struggling to get anywhere near the sort of numbers we're talking about and estimate that it is going to take at least 18 months, as long as the construction process itself, before we can get the necessary numbers, AT A PUSH! If we can't get enough nurses, the whole project is at risk, and recruitment has been identified as the major concern.
The guy handling the recruitment told me in no uncertain terms that anyone who has got a bit about them and is a qualified nurse can determine exactly where they want to work.
It may not be everybody's cup of tea, and there's no way I would want to do it, but nursing is unquestionably an area of opportunity at present.