The ever rolling aftermath of the credit crunch – a new angle every day – makes horizon scanning a full time job. For those who only have time for a quick look up from the grindstone, I list the main trouble spots, as I see them, and some suggestions on how you, as a manager, might respond.
First up is the stupid economy. We are going to take a beating for the banks. The NHS Confederation claims £8bn-£10bn in real terms will be lopped off the service over three years from 2011. Enough said.
Closely related on the strife list is the recession hardened public. All our problems need to be viewed through the prism of public mood. This is a changing and volatile factor, which all players, including unions, must consider with care. Would anyone like to predict confidently how the public might respond to another funding crisis, another high profile quality failure or industrial unrest over terms and conditions nationally or procurement plans locally?
In the midst of a recession, the multi-year pay settlements have proved a windfall deal for staff, resisted only by a handful of politically motivated thinkers. But the financial conditions for public sector pay in the next three years are nothing if not dire. Throw in political attacks on Agenda for Change, medical pay and public sector fatcats and there is scope for trouble aplenty.
The nuclear issue is pensions. Whatever the party or parties in power, there will be a battle royal for the future of defined benefit pension schemes in the public sector. Whenever I am asked what might make my own members – senior managers all – strike, my only answer is: pensions. The arguments against the race to the bottom, urged on us by the Taxpayers’ Alliance, are good, rational and compelling. Strongly worded emails to Money Box are not going to do it. This will be a straightforward fist fight, which the unions will take all the way.
By the way, a million quid buys a public sector pension of about £35,000 a year, a couple of weeks’ money for Fred the Shred.
Next, job cuts. Serious estimates suggest up to 350,000 jobs will be axed across the public sector in the next five years, with its quota demanded of healthcare. Large scale job losses are the most destabilising threat we face. The turnaround regime for the deficits of 2006 – some trusts considered 10 per cent staff cuts – and the more managed bloodshed of Commissioning a Patient-led NHS look like a dress rehearsal. But we did learn a few things.
Managers and staff alike, used to expansion, were ill equipped to deal with contraction. Unions and employers, snug in each others’ arms, dreaming of Agenda for Change, had a bucket of ice cold water dumped on them: partnership working really creaked under the strain of the crisis. Good, experienced people were lost, and our abysmal record for having black and minority ethnic people in top jobs became – if possible – even more abysmal.
Finally, and maddeningly, the management of change is becoming more controversial. People sense the financial crisis starts to give permission for radical answers, off the radar even a year ago. “All bets are off!” For example, the heat is rising on the next stage review’s transforming community services programme, with unions mistrustful of the procurement policies of primary care trusts, strategic health authorities and the Department of Health.
There is much talk of hidden – or not so hidden – privatisation agendas on the union side; the need to break up monopoly provision on the commissioner side. The debate is fast becoming old style, national and ideological: the antithesis of our hopes for local determination, partnership working and building quality for individuals and local communities. It looks as though we will see a corresponding rise in local and bitter conflicts between employers and staff.
People in the palaces of the mighty need to consider the right response to this list of troubles, but assuming they cock it up, as from experience you have every right to expect, how do you fancy managing your team and services through this lot? The following might help.
Stay positive. Counter-intuitive it might seem but optimism is as good a response as any. Most people come to work in the NHS because they have a vocation for caring: that won’t change. So leading all staff and services towards quality is still your mission, even more important in tougher times, and most of your colleagues will still want to come with you.
Show courage over the things that matter. For example, are you going to see race equality deprioritised yet further or partnership working jettisoned as the storm rages around you?
Be kind to yourself. This might run against your gut instincts but you are going to come under horrible pressure. Think of the nightmare faced by a finance manager: “Strip out more costs, make it balance, make it do more”.
Find ways to cope, including pushing back at bullying and unrealistic demands. Steer your career onwards. Demand fairness and dignity in reorganisations. Resist the attempted robbery of your pension.
Finally, be visible. Now is not the time for managers to hide away. Stick together with other managers, and argue for the importance of good management in quality healthcare.
