In May this year, my own Primary Care Trust, Hastings and Rother, suddenly appeared on a "sin" list in the recently departed News of the World as having one of the worst waiting lists for vital tests, including cancer scans, in the country. The waiting list had apparently escalated by 41,733%. In April 2010, there were only 3 people in Hastings and Rother waiting over six weeks for a scan, by April 2011, there were 1,255 (it is now down to 44 and still falling).
As the MP for the area I immediately asked the Chief Executive for a meeting and an explanation. The answer, was: overtime. The newly appointed Chief Executive had banned overtime in Radiology. He had done this when he realised that some radiologists were earning their salary again in over-time charges. Some of these salaries can be as high as £100k a year, and he needs to save £5m per annum locally on the current annual budget. These are therefore significant sums. In order to "improve working practices" he had banned it. Waiting lists grew faster than Jack's beanstalk. Subsequently, when both sides had shown their muscle, limited overtime was introduced (at less cost) and waiting lists have been coming down ever since.
The NHS pays huge sums in overtime. It is referred to as Waiting List Initiative work (WLI), which highlights the political sensitivity of these payments. Waiting Lists are the equivalent of the patients' heart beat to politicians. If they go up, the NHS is failing and if they fall all is well. But the cost of keeping those waiting lists down has been bad management practices of vast over-time payments. Of course we all want waiting lists to be kept down, no one wants a long wait for an important appointment, and it is in the NHS Constitution that all patients should be seen within 18 weeks of referral by a doctor. But reducing waiting lists by throwing money at expensive overt-time contracts is costly and inefficient.
In very few areas of public or private sector employment are overtime payments made to well-paid employees or to management. The expectation is that individuals in senior jobs will devote the time needed to fulfil the responsibilities of the role – even if that means staying late. Over-time for MPs anyone? The current arrangement across the NHS is that each Trust negotiates its own overtime payments. Stories circulate of consultants all over the country making more than £100k a year in overtime payments. The typical rate is about £600 for four hours overtime, so it adds up quickly.
Poor planning and lack of accountability for public funds has been the root cause of these costs. But what's the solution?
As in so many other aspects of management, the private sector leads the way. In the current economic environment businesses are taking a more rigorous approach to reducing overtime costs sytematically while maintaining customer service. During the last Labour Government techniques of management were lost along the way as health chiefs chased targets and took their eye off costs.
In any organisation, staff overtime can be a symptom of a poorly thought-through process. The NHS is no exception. The answer is to rework the process – and not to be afraid to think radically. First, are the right tasks being done by the right level of people? If expensive consultants are being paid to catch up on paperwork after hours, think about employing PAs or part-time assistants. It sounds counterintuitive, but hiring more or different personnel can result in a lower overall wage bill. Second, tackle the remuneration and bonus approach to align performance during normal hours with the rewards offered to staff. For instance, if employees are saving important tasks until late in the day, managers can get bounced into paying overtime. Third, refresh scheduling to see if existing staff would consider something other than the standard 9 to 5. This combined with adding new staff working normal hours could cut overtime without compromising service to patients.
One thing's for sure, a manager's knee jerk reaction to cut costs fast with a hiring freeze and an overtime ban, more often than not puts at risk the quality end service. In the private sector, this is recognised. Why not the NHS.