NHS staff cuts go back to front

The NHS has been told to find £20bn in annual efficiency savings by 2014, towards which it is expected that jobs will be mainly be lost in administration, facilities and other back office functions. Unsurprisingly, this has brought criticism. Dr Hamish Meldrum, in a June 2010 British Medical Association (BMA) press release on the survey of doctors, said: "Even changes to backroom functions or administrative processes have consequences for frontline staff that, in many cases, may have to pick up the work themselves; this means less time for patients." Less time available for treating patients, as a result of having to carry out additional non-medical functions, does not bode well for the nation's health. Furthermore, early trends also seem to point to a minor loss of medical jobs, which is likely to make the situation worse. There was a 0.1% decrease in headcount in July 2010 – or 1,385 posts – when compared to the previous month, which had itself seen a decrease of 817 posts, according to the provisional monthly figures of NHS hospital and community health service staff in England (excluding primary care staff) published by the NHS Information Centre (NHS IC). The numbers for July are 0.7% (7,785) higher than in September 2009 – but monthly figures show staff numbers peaking in March 2010, after which the numbers started to decrease (see graph above). So, contrary to initial expectations, are frontline jobs at the NHS also disappearing? Regional details show that more people left the NHS (total excluding bank, locums and trainee doctors) than joined it in most of England between May and June 2010: the exceptions are London and the south east coast strategic health authority areas, which saw more people join than leave. BMA researchers say this could be due to differences in the numbers of junior doctors finishing training and taking up consultant posts. Financial concerns could be another reason, in view of available local hospital recruitment budgets. Looking for locums Additionally, statistics show hospital practitioners and clinical assistants (both locum and non-locum) facing the largest decline with a percentage decrease of seven to 11 times greater than in the other categories. However, analysts at the BMA believe this might be due to employers replacing these posts with standard speciality doctor posts that adhere to the national Staff and Associate Specialist contract agreed to in 2008. The Department of Health says that although the percentage decrease for this segment appears high, it is in fact a small staff group, comprising generally of practising GPs who spend only a tiny fraction of their working time within the hospital environment. Overall, the trend seems to be one of trusts depending on locums to take care of short term needs, coupled with a slow move towards limiting the overall non-locum workforce. The use of a locum workforce in itself is not a cause of immediate worry as temporary staff often have to tick more boxes than the permanent staff employed in the same departments. Locums are already employed in short-staffed departments to increase output and hit their targets. However, it does mean that employment patterns within the NHS might undergo a change. Union membership appears to be rising, as employees try to manage the risk of job losses. Union Unison says that August this year has produced the strongest recruitment rate in seven years, although it is still in the process of evaluating the risk of job losses on a regional basis. So how seriously are these changing trends and measures affecting patient care within the NHS? Immediate and short-term service delivery is likely to remain largely unaffected. NHS hospital managers seem to be trying to control the impact of rationalisation within hospitals and it should some months before the effects start to be more visible. By then, if the planned move towards primary care trust dissolution and GP reform has been initiated, it will impact referral systems, forecasts of expected patients based on alignment with PCTs and other long term service delivery planning forecasts. This is likely to create imbalances in the short run and will definitely impact staff needs. The service feedbacks in relation to staff numbers will then tell another interesting story. Kavitha Ravikumar is an independent consultant who has worked for several years on healthcare issues