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Workforce: Finance is crushing everything at the moment

Mon 28 Nov 2016

MiP Conference 2016: Four experts on the NHS workforce discuss the challenges facing the NHS and how we can make it a better place to work.

The myriad pressures the NHS face at the moment can overshadow some of the major challenges in the workplace for managers and staff – things like bullying, ensuring fair terms and conditions for staff, and dealing with employment disputes.

Dr Madeline Carter, a senior research associate at Newcastle University, stressed the importance of tackling bullying as an organisational issue rather than focusing purely on individuals’ actions.

Effective organisations had top management who “walked the walk” and engaged with staff, she said. One Carter’s pieces of work had led to ten recommendations for organisational actions to reduce bullying, including the need for a proactive approach, but also advocating helping individuals to increase their insight into their behaviour and its impact on others. “Managers shape culture,” she said. “They are really critical.” She suggested job descriptions could include references to managers’ role in managing and creating culture within an organisation.

Victoria Phillips, head of employment rights at Thompsons Solicitors, and a frequent columnist for MiP’s Healthcare Manager magazine, said there was a real problem with delays in investigations into areas such as bullying allegations.

“What we are increasingly seeing in the public sector is that investigations are being taken out of the line managers’ responsibility and being given to someone independent,” she said. “I’m not sure how appropriate it is to have someone who is external dealing with a relatively low level issue.”

She suggested the NHS struggled to know what to do in some cases. But when investigations took a long time and led to delays in tackling an issue, it contributed to a feeling that people were being treated badly.

Some MiP members may also have been affected by changes in employment tribunal fees which have been seen as discouraging many workers from taking their employers to tribunal, she said.

Philipps said that the number of cases going to tribunal had plummeted, even in the NHS where many applicants were likely to be supported by their unions. This means “workers have nominal rights but no way of getting justice,” she said.

She saw Brexit as a looming challenge with the potential to affect much workplace legislation – such as the European Working Time Directive (EWTD) and regulations on fixed-term employment. “All of these rights will go when the European Act is repealed,” she said. “What will be left in their place? There is a real challenge that is going to be faced by both managers and workers. It’s very important for managers to start that dialogue with trade unions and get their collective view on how some of these issues will be resolved.”

Philipps added that many employment rights were based on European law – including TUPE – and the government would need to decide how to approach them. “The challenge it seems to me is which of these rights do they care most about to find Parliamentary time to protect.” She speculated that rights under TUPE and the EWTD could be lost.

Jon Skewes, director for policy, employment relations and communications at the Royal College of Midwives, said the most important underlying pressure was the level of funding for health and social care which meant finance was “crushing everything” at the moment.

There was a particular issue with pay, he said, where the government has said public sector pay should be kept down for several more years. This year, Agenda for Change staff got a 1% rise but inflation is expected to rise sharply next year, while the previous Chancellor George Osborne had declared his intention to keep rises to a maximum of 1% until 2019.

Mr Skewes said unions were calling for the NHS Pay Review Body to award 1% rises above the rate of inflation – so 1.9%, based on the 0.9% inflation recorded in July.

But pay was not the only issue. “We know midwives and many other groups are suffering intensification of work,” caused by rising demand and long-term staff shortages – which could impact on patient safety.

Staff have also found organisations less willing to consider flexible working arrangements, he said. Flexible working had been important to employers in the mid 2000s (when the NHS was desperate to attract staff) but now he was seeing many more staff working 12-13 hour shifts, which would suit some but not others.

Sheree Axon, NHS England’s director of organisational change, explained some of the work her directorate was doing on supporting women in the workplace. 400 women had been through one of its programmes, and there was a thriving women’s network aimed at personal development, professional development and helping women in a system where there was increasing fragmentation. Trade unions were supporting the network, she said.

Axon said the programme helped women to think about different “chapters” in their lives. “We all have a contribution to make. We have a fantastic voice and we don’t want to be overlooked,” she said.


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