In 2008, John Riddington Young and co-authors gave an amusing description of the disturbing consequences of letting grocers redesign the health service (p66). Those who suffer under NHS mangers will be aware of their common lack of relevant qualification. Although the present NHS management structures arose from the reports of grocers, these managers would not last long in supermarkets. Patients will also have noticed a service that increasingly underperforms supermarkets’.
The NHS way has long been to promote the incompetent to a higher position. Productive posts are declared redundant the incumbent obliged to apply for a management position for which they are poorly skilled. Sometimes the “redundant” post is eventually re-advertised. Sometimes the post was not redundant at all and work requiring great skill is done worse than before. Abundant training courses perpetuate widely-accepted but poor management practices. Job plans and appraisals ensure the indoctrination is consumed.
Much of this is driven by silly accreditation schemes like CPA and Investors In People. Managers like the comfort of benchmarking their operations against peers of similarly limited vision. This ensures the safety of mediocrity. Accreditation marks are goods of ostentation that seem less selfish than the premium cars and watches.
Perhaps it’s just down to personalities, but Dr Riddington Young’s management nous gives confidence that military doctors would not have produced the inflexibility of the naval officers’ ISO management standards. Unfortunately he did not get as far as criticising pathology accreditation in the book.
Now let us consider the plans for the future scientific workforce whose work will fall victim to accreditation by CPA and UKAS.
Professor Sue Hill was appointed Chief Scientific Officer in October 2002. She has been much more visible in the management of change than her predecessors. Busy NHS staff, many of them also members of “hard-working families”, have no time to read the lengthy websites and policy documents that have flooded incontinently from the government of that time. Maybe those families could have worked less hard and achieved more if they had been allowed to without the gush of government-engineered “change”.
A key task she was appointed to implement was reform of the careers of thousands of NHS scientists. The programme is called Modernising Scientific Careers (MSC). It sounds like it came from the same minds that gave us Modernising Medical Careers. Pathology staff are involved in over 70% of diagnoses and treatments. Scientific workers provide critical services much more widely than in laboratories and are employed across many NHS disciplines in engineering, physical, physiological and life sciences. They range in grade from entry level staff receiving specimens to Consultant Clinical Scientists that are Fellows of the Royal College of Pathologists, have long held equivalent status with Medical Consultants in pathology, and may be heads of departments and clinical directors. The various scientific roles are all now to be described as Healthcare Scientist.
A large number of NHS scientists are Biomedical Scientists (BMSs) who have great expertise in performing laboratory tests. Their skills scored well in AfC and consequently they have become too expensive to maintain the level of staffing that they once did. Many took up employment during service expansions around 40 years ago. The experience of this age cohort will soon be gone from the service and the loss is producing a decline in real quality, although accreditation continues to assure the quality of whatever is inspectable. Despite the tightness of the accreditation bodies’ control, there will always be scope for bad things to happen in the real world beyond the virtual reality that records create.
Trainee medical staff had their lives royally messed about by the MMC/MTAS fiasco. Senior medical staff significantly improved their salaries by sacrificing independence in the new Consultant Contract. Most other NHS staff made modest improvements in their salary as a result of the complex, equality-driven Agenda For Change which has taken years to bring close to completion. It has made some staff too expensive. The accompanying, tortuous and unworkable Knowledge and Skills Framework (KSF, now simplified) relates competence to pay progression. It was accepted as an alternative to productivity measurement; the new pay regime was designed in partnership between management and trade unions. This leaves the unions in a poor position to criticise problems in the developing system. The gains of AfC are now being rolled back. The workforce is to be supposedly better educated and less well rewarded. The motto is “Doing more with less.”
Unfortunately, medical and non-medical staff have not conferred much on what has been happening in these complex and verbose plans. Both have omitted to look for the common guiding themes.
The planned effects of reprofiling the workforce are shown in this graph from p20 of Modernising Scientific Careers: The UK Way Forward:
The thinking behind this had earlier been described in Pathology: Towards A Competence Based Workforce A Report of the Pathology Profiling Project. This document provides an insight into the design of a cheaper workforce according to signed-off “competences” rather than education, professionalism and broader abilities. It is an exercise in long-term planning and control that is likely to be quickly outflanked by events that are not individually predictable. However the government has said in a press release:
“…the Department will be adopting the following ideas, suggested by the public through the Spending Challenge process: …
- We will increase the use of highly qualified clinical scientists in the NHS to free up doctors to focus on the work that only they can do, as part of the Modernising Scientific Careers programme. This programme will save the NHS in excess of £250 million per year.”
Did “the public” really suggest that one? The public knows nothing of Clinical Scientists and neither do many doctors. Pathologists will be doing more work in clinics and wards if this comes to pass. The Federation for Healthcare Science (FHCS) was formed by the government in 2002 as an overarching body for the professional organisations representing healthcare scientists. The government did not want to have to deal with the large number of representative bodies.
Many Clinical Scientists confused the FHCS with a body they had opted to join, the Federation of Clinical Scientists, to represent them in industrial relations. This was not surprising since it appeared to be simply a change to the professional description of Healthcare Scientist that had been notified. In fact it was a very different organisation; a government one arguably portraying itself as a voluntary membership body. Like a questionnaire, this was designed to direct opinion rather than to measure it. This is how the government speaks to scientists while pretending there is a conversation. It has a non-government email address. It even sounds like a representative body:
|About the Federation for Healthcare Science|
|Strength in Numbers The Federation was formed in 2002 as an overarching body for the professional organisations representing healthcare scientists. The government recognises healthcare scientists as vital to the delivery of its NHS Plan for England but the public is often unaware of the contribution they make to the services provided by the NHS. The Federation will provide a collective voice for science in the health service to the government, other health care professionals and to members of the public.Aims of the Federation for Healthcare Science
1 Enhance the profile of healthcare science and those professions working within it. Emphasise the roles performed relating to patient care, quality, clinical governance and health improvement.
2 Shape and influence policy at local and national level on science in healthcare.
3 Establish links with other national bodies and groups relevant to science in healthcare.
4 Ensure there is an effective national forum for the exchange of information and good practice in healthcare science. Support and resource networks in support of healthcare science groups & professions at local & national level.
5 Provide support for emerging and changing healthcare science disciplines and professional bodies.
6 Develop and promote the need for and development of research capacity in healthcare science to support evidence-based practice and the development of new techniques for patient benefit.
7 Contribute to workforce planning, including recruitment and retention issues within healthcare science.
8 Advise on and respond to new technology and scientific developments and initiatives in healthcare science, and advise on the implications for health services.
The three sections of the Federation
The forty plus professions, groups and disciplines within healthcare science are grouped into three main sections, based primarily on the underlying branch of science from which they originate. The three branches are:
Representation The Federation has representatives on a range of policy-making and professional groups. These representatives provide input to the development of policy and also provide information to the Federation on progress in different areas of endeavour.
Member organisations Links to the websites of individual member organisations can be found by going to the links page. These are the appropriate contact points to find out more about particular professions and their activities.
Contacting the Federation Telephone: (+44) (0)20 7833 5807 Fax: (+44) (0)20 7436 4946 Email: email@example.com
Federation for Healthcare Science (FHCS): general presentation Contains workforce information on healthcare scientists and information on the Federation including its roles and aims.
FHCS Consultation FHCS responses to consultations on external initiatives and policy.
New recruitment scheme for Healthcare Scientists
The new scheme for the recruitment into Master’s level healthcare scientist training posts in England will start in the New Year for the September 2011 intake of Scientist Training Programme (STP) trainees. The new scheme will help to ensure consistency across the country. There will be a single national timetable for recruitment, national guidelines for the conduct of selection interviews, and assessment centres to ensure all candidates are treated fairly and equally. Science graduates will apply for the training posts through the NHS Jobs website, with shortlisting and selection processes organised and conducted by local Trusts working in established scientific networks. New networks will be supported through grants to run assessment centres. The new national healthcare scientist trainee recruitment scheme will be managed on behalf of all SHAs by South Central SHA. It replaces the previous scheme, co-ordinated by Northgate Arinso Ltd.
Details of all training posts will be available on the NHS Jobs website http://www.jobs.nhs.uk/ Further details of the scheme and a list of all the posts will be found on NHS Careers website http://www.nhscareers.nhs.uk/. Details will be on the websites in January 2011.
The details of MSC are described in documents including those below: Modernising Scientific Careers – Department of Health links
It’s different in Scotland: Safe, Effective and Accurate: An Action Plan For Healthcare Science in NHSS Scotland
And in Northern Ireland – an integrated Health & Social Care Service: Modernising Scientific Careers – A Healthcare Development Plan for Northern Ireland
National Occupational Standards are closely tied in to these programmes for managing staff by certified competences. Despite these plans for a high quality workforce, increased regulation of each practitioner and accreditation inspection keep coming. The current government needs to re-evaluate the plans of the previous government because they have the potential to create havoc in the delivery of healthcare.
An important change in the delivery of pathology services is their integration into “Blood Sciences”. This is driven largely by companies that have created analysers able to run tests from multiple pathology disciplines. It is leading to pathology services increasingly managed by the companies that manufacture the analysers and reagents. Some lobby politicians and use their instruments to provide private testing services without clinical interpretation. Anomalous results will simply need to be repeated by a GP as they may suffer similar limitations to home testing kits.
So what is the educational and management picture that is coming together?
It is central to the new “Modernised” NHS workers that they will have their skills proven, not by education, professionalism and empathic care, but by Outcome Based Education schemes assuring competence, by bureaucratic revalidation, and by quality accreditation.