Sunday, March 29, 2009

NHS bosses award themselves inflation-busting 7.5pc rises (but nurses get just 1.9pc)

The socialist version of Wall St.?

Top NHS managers awarded themselves inflation-busting pay rises last year, as private sector staff faced a pay freeze. Average pay for trust chief executives soared by 7.5 per cent in just one year to £142,450, while nurses are having to make do with just 1.9 per cent. And this was despite guidance from the Department of Health that raises for senior managers should be no higher than 1.3 per cent.

The best-paid hospital boss is on £230,000 - enough to pay for more than ten nurses, while two saw their pay rise by more than 30 per cent. Since Labour came to power, Health Service chief executive pay has almost doubled (up 98 per cent).

The shocking details of pay hikes given to senior bureaucrats in the NHS between 2007 and 2008 comes a day after it was revealed that the number of managers has soared quicker than the number of nurses. There are now 39,900 managers in the NHS - up 9.4 per cent in one year. But there are 6,000 fewer GPs and 15,00 fewer midwives than managers. Meanwhile the number of health visitors and nursing assistants also fell.

Michael Summers, of the Patients Association, said: 'The news keeps getting worse. Yesterday we found out there are an ever increasing number of managers and today we find out their pay is climbing. The NHS needs pay increases for nurses, not managers.'

Conservative health spokesman Stephen O'Brien said: 'Why is it that NHS bosses think it is acceptable to award themselves generous perks and inflation-busting pay rises while hard-working nurses are being forced to take what is effectively a pay cut?' 'Labour needs to think again whether now is really an appropriate time for them to be playing fast and loose with taxpayers' money.'

LibDem health spokesman Norman Lamb said: 'Those at the top who have benefited in the past have got to lead from the front. There has to be a sharing of the pain.'

The salaries were revealed in the NHS Boardroom Pay report from research group Incomes Data Services. Average chief executive pay is £142,450, up from £132,500 the year before and £72,000 in 1997. Elite foundation trust chief executives earn even more - £157,000 on average. Other directors on NHS trust boards have seen their pay go up by 6.4 per cent. Finance directors earned £102,850 on average, while medical directors were on £165,000.

The report also found that pay increases in England were much higher than in Scotland or Wales. The highest paid chief executive was Robert Naylor at University College Hospital trust in London. His pay soared to £230,000 - a rise of 30 per cent in a year. Other high earners were the chief executives of the Heart of England trust's Birmingham hospital and Newcastle upon Tyne hospital, on £227,500 and £222,500 respectively. The biggest rise was seen at the Airedale trust in West Yorkshire, where chief executive Adam Cairns' pay soared 33 per cent to £137,000.

Steve Tatton, editor of the report, said: 'The earnings of NHS trust directors are continuing to move ahead at a faster pace than the rest of the economy. 'In the current climate the remuneration of NHS directors, like any top executives working in the public sector, is subject to intense public scrutiny, particularly when unease about the widening gap between senior executives and the rest of the workforce is growing in both the public and private sector.'


Australia: Fraud and loathing in disastrous NSW public hospitals

Patients sent to imaginary beds and a doctor who complained about it gets persecuted!

ON APRIL 28, 2006, Shellharbour Hospital boss, Michael Brodnik, distributed an email. A decision had been made, he wrote, to set up a new unit within the emergency department. "The unit will be … four beds, conceptually down the right hand wall of ED but using the concept of 'virtual beds'," he told colleagues. Patients who arrived at emergency and needed admission would be assigned a virtual bed if no official in-patient bed was available, remaining physically in emergency. Brodnik said he had no control over the change, reassuring staff: "It really is a paper exercise."

The rationale was to get patients off the emergency department's books within eight hours of arrival - a watershed imposed by government as a so-called "key performance indicator" or KPI, amid political pressure over backed-up hospitals and ambulances unable to offload patients.

At Shellharbour Hospital, an outpost serving the cookie-cutter sprawl that straggles down the coast from Wollongong, that target was hard to achieve, because some patients had to be transferred for diagnostic tests.

By May, Shellharbour was still processing emergency patients too slowly, and emails were flying. The head of the hospital's emergency department, Dr Simon Leslie, sent a measured one to Sue Browbank, Brodnik's boss: "We are being asked to run our health service on the basis of the need to treat one statistic," he wrote. "Doctors have not been ignorant or uncaring of the need to manage our resources appropriately … but are driven firstly by patient care and community needs."

For a while, Leslie continued a vocal opposition to the imaginary beds. The directive to reclassify patients "according to any objective look at it was fraudulent", he told the Herald last week. "It required staff in my emergency department to write down records that were incorrect." Later he tired of battling the fait accompli and settled back to running front-line health care in the hard-to-staff hospital.

That could have been the end of it, but then Peter Garling, SC, came to town. On April 14 last year, at one of the inquiry's 34 public hearings, "Dr Leslie told me the 'virtual ward' was a fiction to compensate for the fact that Shellharbour Hospital does not have a short stay unit," Garling recounted in his report. Leslie's evidence resulted - finally - in the ward's abrupt termination, though this, as he had previously observed to Browbank, was, "easy because it doesn't actually exist".

Three weeks later, Browbank informed Leslie of the appointment of a Southern Hospitals Network Director of Emergency Medicine - which, according to Garling's later deconstruction, "both technically and in reality … effected the abolition of Dr Leslie's position". Leslie was ordered to stop calling himself director of the emergency department and told he could instead apply for a part-time position. "How is it possible," he asked a human resources manager, "to remove me from the role for which I have a contract and in which I have been acknowledged and satisfactorily functioning for over two years?"

The vaporisation of his job and claim it had never really existed were normal practice during "amalgamations and clinical reviews," the manager soothingly responded. "In many cases roles and responsibilities have changed, staff displaced and new position descriptions written."

Leslie's was a story Garling could not resist. A microcosm of the poisonous malaise he had observed on a statewide road-trip to 61 public hospitals, it comprised four elements the senior counsel had noticed repeatedly: a bottleneck between emergency and in-patient beds; inflexible performance criteria imposed from on high, then middle-management sleights-of-hand to meet those demands; and a yawning gulf of alienation between clinicians and administrators.

So when Leslie updated the inquiry on the personal fallout from his testimony, Garling in late September 2008 ordered five people as well as Leslie to four gruelling days of extra hearings, devoted to the doctor's treatment. They included Debora Picone - in 2006, chief executive of the South Eastern Sydney Illawarra Area Health Service, but elevated in 2007 to director general of NSW Health.

That won Leslie no respite. On the contrary, shortly after Garling's summonses landed on managers' desks, Leslie was cut out of meetings and told to hand back his pager and vacate his office - though ultimately he did not do so, successfully arguing both were essential to his work.

In her sworn evidence, Browbank acknowledged Leslie's job description was signed by a doctor expressly delegated to work out his role and title. Yet she maintained the position could not exist, because the doctor had no authority to create it. Garling rejected the semantic contortion. Browbank's stance "flies in the face of the obvious facts revealed by the evidence and is wholly untenable," he concluded. Because Leslie's treatment was "unreasonable, repeated, unwelcome, unsolicited, offensive, intimidating, humiliating and threatening," Garling wrote, "I find it amounted to bullying and harassment in accordance with NSW Health's own guidelines."

Leslie is an unlikely poster boy for victimhood. Affable and easygoing, it is hard to imagine him having the sleep disruptions and obsessive thoughts he says beset him at the time. He simply carried on going in to work. "At heart," said the 52-year-old, "I'm a doctor who likes to look after patients."

Doctors who like to look after patients are the backbone of the health system, but are massively disenfranchised. Re-engaging them would be the most critical step in reforming NSW Health, Garling said, proposing a Clinical Innovation and Enhancement Agency - under which clinicians would determine protocols for patient care. As well, he proposes an independent Bureau of Health Information to monitor hospital performance, freeing doctors like Leslie from political pressure to fudge the loathed KPIs.

The toughest challenge is how to make hospitals gentler. "The workplace culture in NSW public hospitals is characterised by lack of respect and trust, absence of empathy and compassion, inability to celebrate the success of others, failure to communicate, and a lack of collaboration," was Garling's damning verdict after his journey to the heart of the health system. Its anti-bullying policy had failed, dissent was quashed and persecution was rife.

Garling recommends making individual employees - all 118,000 of them - more directly responsible for their behaviour, reorienting the system away from blame towards constructive criticism and strengthening complaints procedures.

Last July, Leslie lodged a formal complaint about his treatment. Eight months later he has not been told how it will be resolved. Terry Clout, the area health service's chief executive, told the Herald he was seeking more information and would consider "any actions that may be required". He declined to comment further, citing, "procedural fairness" in the "personnel matter".

Leslie said the delay was "a process to wear me down". He understands deliberations will not privilege Garling's account of events - despite the evidence the commissioner collected under unmatched statutory powers.

Perhaps that is unsurprising. Garling said Leslie's situation went unresolved because Shellharbour managers "did not demonstrate … the slightest knowledge of what constituted bullying and unacceptable behaviour".

When is a bed not a bed? Leslie has paid a price for trying to reconcile the internal logic of NSW Health's storytelling with empirical reality, and no one has ever apologised. He will now take his case to the NSW Industrial Relations Commission. If Leslie - with the inquiry's weight behind him - cannot bring NSW Health managers to account, possibly nobody can. "Mr Garling's put a fairly heavy burden on me," he said. "I feel an obligation not to let that go to waste."


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