HCSA

The Hospital Consultants and Specialists Association (HCSA) is a trade union that represents the interests of senior hospital and medical staff

Whistleblowing: managing vexatious complaints

By Stephen Campion - 7th January 2012 4:30 pm

I like David Drew’s idea of presenting a whistleblower with an award where concerns have been properly upheld. But I am not sure I agree with him that the numbers of vexatious or malicious allegations are rare.

In my experience, they are becoming far too prevalent but even if we don’t know the numbers the ruination of just one consultant career is one too many. Let me give one true example (trust me, I am not a doctor) where the HCSA is actively involved. This is not unique and neither is it an exaggerated description. It goes like this…

In late 2011 two consultants were reported by a ‘whistleblower’ to have engaged in private practice in NHS time. Both were immediately excluded (suspended) pending referral to the NHS Counter Fraud Squad. No cursory or initial investigation was undertaken by the trust; the allegation of fraud was considered far too serious for that - immediate exclusion was implemented. Contact with colleagues was forbidden for fear of interfering with ‘witnesses’.

Three months later, yes three months, the NHS Counter Fraud Squad found no reason to pursue criminal proceedings and the two consultants allowed to return to work.

The reputation of both has been seriously damaged, their health has suffered as a result of stress; the scars of such an ordeal will take a long time to heal. Tell them that exclusion was a ‘neutral’ act - and they will say that is not how it felt to them. They are angry and rightly so.

And the ‘whistleblower’? Anonymous, unaccountable and probably sleeping easy at night - unlike the innocent victims of such malicious behaviour. It will take more than a telephone hotline; the culture needs to change. Receptive to legitimate concerns, certainly. But equally it must be unforgiving of the vexatious complainant. That is not whistleblowing - but can the NHS recognise the difference? Not in my first-hand and very real experience.

Malicious whistleblowing is destroying consultant careers - and so is the lack of any realistic accountability of the perpetrators.

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Brand NHS: How to get a head in advertising…

By Stephen Campion - 16th December 2011 2:06 pm

As the countdown to Christmas continues, so too do appalling TV and newspaper advertisements. Some (well most frankly) make me vow never to buy the product because the adverts are so awful. One or two are quite good, although who on earth would want to buy perfume or aftershave based on the sexy whisper of the manufacturer’s name? I still can’t tell whether she is asking me to buy Don Giovanni or Armani - but who cares? Most adverts are downright dreadful.

So I had this “I’m sorry I haven’t a clue” moment. How about using one advertisement to advertise someone else’s product? And to make it fun the product had to be NHS related (or loosely so!). Here’s my top eight:

1. “Go Compare” to advertise Dr Foster’s Hospital League Tables

2. “Believe in Better” to feature the health secretary peering down on those unfortunate patients foolish enough to subscribe to expensive NHS TV channels, let alone watch him

3. “Every little Helps” to promote NHS pay and pension propaganda

4. “We’re the 4th emergency service” to encourage use of GP out-of-hours cooperative’s (well adverts must be taken with a pinch of salt)

5. “We take care of you” offering a warm welcome at Circle’s Hinchingbrooke Hospital

6. “Never knowingly undersold” offering PFI schemes at knockdown prices

7. “Can’t believe it’s not butter” for the Care Quality Commission, as it tries to work out what it really is

8. “Better by design” as affordable hospitals are built

Have a go yourself to while away those idle moments between mother-in-law’s arrival and her ever extending date of departure. My most treasured advertisement though is “Famous Grouse” and in wishing you all a Happy Christmas, prosperous New Year and all the joys of the festive season I leave it to you to select the grouse of your choice. There are, and will continue to be, many to choose from!

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Same solution applies to debt crisis and NHS

By Stephen Campion - 14th November 2011 11:33 am

If you read this to the end, you may very quickly take the view that I am no economist. And you would be right. But watching the events unfold within the Eurozone you might also question whether those who claim to be economists are themselves capable of resolving the world’s financial, crisis.

Even they cannot agree, and I am not persuaded that the politicians have all, or any, of the answers. I am increasingly concerned that actually the world crisis is so great that it is beyond the wit of man to deal with them. Surely there comes a time when it behoves our leaders (and indeed ourselves) to admit defeat, draw a line under the sand and move on. The loss in the short-term may be outweighed by longer term stability and financial growth.

So, my economic theory goes something like this; for convenience I have called it the Campion Cancellation of Debt Hypothesis. It is best explained this way: Campion owes the editor of HospitalDr £100. But that same editor owes Campion £100 also. The accumulated debt on the balance sheet is therefore £200. Now if each agree not to repay the other then the amount of debt in circulation reduces to zero. But if the editor is owed £120 the accumulated debt amounts to £220. If that cannot be repaid then the editor gets nothing, interest forces the debt to accumulate and eventually spirals out of control. So the wise thing to do is for the editor to settle for something rather than nothing i.e. £100. Result - a debt free balance sheet.

Sure there will be winners and losers but lending money as a last resort to those who have no realistic prospect of repaying the debt is the economics of the mad house. It matters not how many noughts you put on the end (I had not heard of “Zillions” before, except perhaps in the context of inflation of Zimbabwean proportions) the principle must be sound.

When a position is reached that human intervention appears unable to resolve, the answer is to stop and start again. Continuation of economic and political interventions that serve only to make things worse seem to me a model for disaster and economic failure.

But the beauty of my cancellation of debt hypothesis is that it works equally well for the constant changes to the health service as well. It works for any situation that appears incapable of being resolved. Stop - and start again! Nobel Prize nominations can be sent to me c/o HospitalDr!

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Pensions: HCSA says “no” to strike action for now…

By Stephen Campion - 31st October 2011 12:46 pm

At a meeting of its ruling council held on 21 October, the Hospital Consultants and Specialists Association (HCSA) considered whether to hold a members’ ballot to take industrial action on 30 November over the government’s pension reforms.

It did so in the context of government proposals that will require hospital consultants to work longer before being able to access their pension, pay more in pension contributions, and receive considerably less than promised when they joined the scheme. The impact of the pension proposals will be felt by all hospital consultants with the newly appointed - and consultants of tomorrow - being the most significantly affected.

President of Council, Dr Umesh Udeshi, consultant radiologist in Worcester recognised the unfairness of what is being proposed. He reminded delegates that the damaging implications would be particularly felt by the lower paid but essential staff of the NHS whilst also having a disproportionate and damaging effect on consultants who had worked hard throughout their careers.

He commented: “The unfair pension proposals will have a negative impact for all NHS staff irrespective of salary, job, or length of service. It must be right that, as senior members of the NHS team, we do what we can to defend everyone who has invested in the NHS Pension scheme who now stand to lose a great deal if these changes go ahead.”

The HCSA Council took the view that as the association was party to the continuing discussions with Government it would not be appropriate to take industrial action on 30 November.

HCSA met with the health secretary on 18 October and continues in negotiations with government. It agreed to reconsider this option if government refused to hold meaningful negotiations around the contributions to the scheme, the pension change from final salary to career average and the unfairness of reneging on a pension package agreed only three years ago.

This is all the more unfair, as the NHS pension scheme is in surplus at present by some £2 billion per annum and the Treasury is taking this surplus and using it for general purposes, not investing it for future pensioners!

The HCSA wants to be responsible but the facts are that NHS consultants are in the middle of a three year pay freeze, already contribute a higher proportion of their salaries to their pensions than lower paid staff, and will pay higher taxes both on their incomes and their pensions when they receive them.

Consultants will be particularly disadvantaged by a career average based pension - it takes 19 years of completed service to reach the top of the salary scale, so the career average is lower than groups whose salary reaches the top of the scale much quicker.

Udeshi continued: “We are doing our fair share! It seems the government just keeps coming back for more as they know that we will not advocate any industrial action which puts our patients at risk. We are certainly not ruling out the possibility of industrial action in the future.

“It would be a tragic state of affairs if senior hospital doctors were forced down that route, but unless or until the government understands the very real damage created by these pension reforms I can see the day when doctors will indeed join their NHS colleagues of all disciplines in an unprecedented show of protest.”

Whilst not taking industrial action on 30 November, the HCSA will be organising a number of local events and will work with local trade union branches to provide effective HCSA support on this the day of protest.

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Tories get a grip on language skills of doctors

By Stephen Campion - 6th October 2011 9:36 am

Thank goodness the party conference season is almost over. I actually enjoy watching the cut and thrust of politics but the amateur politician appearing on stage introducing some composite motion no one really gives a toss about makes me cringe with embarrassment.

True there have been some notable exceptions in history. A 16-year-old William Hague in the Margaret Thatcher era is one such example, as indeed was my late step-father who silenced the audience by claiming that he did not want to reduce the Selective Employment Tax - only then to bring rapturous applause by raising his oratory to a high “I want to abolish it altogether.” Hands up who remembers the Selective Employment Tax?!

This year seems to me to have pretty lame and tame. No Neil Kinnock lambasting the Councils for delivering redundancy notices by taxi, no Michael Heseltine wooing the Tory faithful, and certainly no David Steel preparing the Liberals for government. What we got was pale by comparison.

But I fret not! I am content that our ministers and opposition shadows have our best interests at heart. I am encouraged that it is proposed that our doctors should be able to speak English. That’s quite a difficult policy to sell but shows this government is up to making hard and difficult choices.

I am impressed with the economic argument that we should not live off credit cards (why didn’t someone tell that to Gordon Brown or debt ridden university students). As for human rights it is pleasing to know that cats in the UK will not be abandoned by their Eastern European owners facing deportation.

In these recessionary times there is a case to be had for all political parties to reduce their spending on such junketing. Given the level of debate I reckon there are plenty of other reasons to curtail this expense!

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Temperature rises over NHS pension proposals

By Stephen Campion - 23rd August 2011 5:09 pm

I am honoured that one reader of Hospital Dr has suggested that by emulating Lady Godiva I might encourage the government to amend its plans for pension reform. I am not quite sure what would be the more unappealing - my appearance in a batman outfit on the balcony of Buckingham Palace (as proposed by the editor of this illustrious website) or stripping off and riding naked on the back of a white horse into the sunset.

There’s a pun in there somewhere about working in my members interests - but let’s not go there! I am however quite prepared to protest over the unfairness of the pension reforms as they affect senior hospital staff. So whilst I have not (recently at any rate) visited a fancy dress shop or been sized for a one-piece, skin-coloured, body stocking, I have instead spent time assessing the mood of HCSA members. Through our online survey I was genuinely distressed to hear how angry many of the responses have been.

Let me give you a few examples from consultants:

“I am prepared to go on strike and hand in an undated letter of resignation. This is theft - pure and simple.”

“The current NHS pension scheme is in surplus and self-financing. Hospital consultants will be particularly disadvantaged.”

“I am very, very angry that I and many others will be penalised for having listened to repeated government exhortations to provide and save for my old age only to find my financial planning shot away.”

“These changes represent a breach of promise on government’s own calculator persuading me to change to the ‘new’ scheme in 2008.”

And so they go on in similar vein. Whilst I cannot pledge to take my clothes off by way of protest I will certainly do whatever I can to get one fundamental message across.

It’s this: senior hospital doctors will be particularly badly hit when it comes to pension reform. They are enduring a pay freeze (and therefore basic pension contributions) for three years, have seen an additional 10% tax burden and £1k a year rise in National Insurance. They now face the prospect of paying up to 6% more in pension contributions in return for substantially less pension income on retirement.

Unlike GP’s and other health workers whose earnings rise rapidly in the early stage of their careers, hospital doctors cannot reach the top of their salary scale until they have been in post for a considerable time - in the case of a consultant, for at least 19 years. A pension therefore based on career average earnings has a distorting and disproportionate impact - one that is clearly unfair and inequitable.

I will be making these, and other points, to all the politicians at their party conferences. But as I write this I am becoming increasingly angry at the unfairness of what is being proposed. So perhaps I just might change my mind and do a ‘Lady Godiva’. Anyone care to join me?

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Pension: is it fair consultants should pay more?

By Stephen Campion - 29th July 2011 1:48 pm

I am struggling to equate the political direction over NHS pensions with any semblance of fairness.

True, hospital consultants are in a difficult position. Consultants are typically included amongst those described as ‘high earners’. But let’s take a look at the facts. After 12 to 15 years of training they begin a consultant career on £74,500 a year. It is only after 19 years that they reach the top of the scale at £100,400.

Relative to other professional classes this does not seem highly paid to me. The final salary figure could be higher were it not for the fact that their pay has been frozen for two years; take home pay has been further reduced by hefty increases in tax, National Insurance contributions and (guess what) pension contributions.

Estimates coming from the Treasury suggest that under Danny Alexander’s fair deal pension reform, consultants can expect to pay a further £3,600 in pension contributions every year and work longer to reap benefits far less than those promised when they joined the scheme.

Is this really fair? The government line is that pensions for those less well paid should be protected. In other words they should be subsidised by those earning more. This differential philosophy is akin to saying that those who earn less should therefore pay less for a gallon of petrol, a loaf of bread, a motor vehicle and its vehicle excise duty. These cost the same irrespective of income. So what’s the difference between any of these and a pension?

I do not disagree with Hamish Meldrum, chair of BMA council, who argued recently on the Today Programme that this pension reform is a stealth tax. But it is more, much more than that.

Pension contributions are proposed to increase according to salary - but the product being purchased is exactly the same. Simply put, the pension product provides 1/80ths or 1/60ths of salary per year worked. The differential contribution is manifestly unfair - the product is the same; it simply costs more if you are defined as a ‘high earner’.

To make matters worse these high earners only reach the top end of the salary scale towards the end of their careers - career average for them is quite different than career average for those whose salary is flat rate and not subject to threshold increases only once every five years.

The government may well be relying on the public mood, fuelled by misinformation and spin, that it is wrong for ‘high earners’ to reap high rewards at the tax payers’ expense. I think the public is more mature than that. The NHS scheme is in very healthy surplus, it was amended only three years ago in light of actuarial and Treasury forecasts, and passed the tests of fairness.

The public may not understand the finer points - but that will not mean that the public will be blind to the damage these pension reforms will have on their NHS.

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Let him without sin cast the first stone

By Stephen Campion, HCSA chief executive - 15th July 2011 1:40 pm

At least the NHS has been taken off the headlines this week. Clare Gerada’s stinging rebuke of the Prime Minister and his approach to practice boundaries, together with warnings that NHS waiting times are rising, pale into insignificance when compared to the alleged antics of the News Corporation.

I was never one to take a great deal of interest in the News of the World and I am probably in the minority in not having my phone hacked, or at least if it has been the police have yet to tell me.

But I can’t help thinking about the way our Parliamentary democracy has reacted to such a shameful example of wrongdoing. Where were the select committees at the time our elected leaders stole from the taxpayer by way of expense claims? The sense of self-righteous indignation displayed by the MPs questioning the serving and retired police officers, Messrs Yates, Hayman and Clarke, frankly left me reaching for the meclazine before finding a ferry to take me to France - or anywhere to escape the nauseas arrogance of the MPs’ “questioning”.

True, the sound bites were good: “The public will see you as a dodgy geezer,” said Lorraine Fullbrook, the Conservative MP for South Ribble. “More like Clouseau than Columbo,” said chairman Keith Vaz. It is all too easy to fire attacks on those appearing before a select committee, even the more so when protected by parliamentary privilege and in front of the TV cameras.

I just hope that when the Murdochs and Rebekah Brooks appear before the committee they give as much as they get. I am not saying News Corporation is perfect - far from it. But maybe, just maybe, the committee chairman might begin his questioning with the words: “Let him without sin cast the first stone.”

Might be a short hearing!

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Climate is ripe for a perfect storm in the NHS

By Stephen Campion - 29th June 2011 10:14 am

In our response to the NHS ‘listening exercise’, the HCSA warned that the climate is ripe for a perfect storm.

It is all very well reforming the NHS - most commentators agree that reform is necessary - but even the most ardent supporter of the government’s plans must surely see that today’s problems must take priority over tomorrow’s NHS.

Like the tragedy in Staffordshire, the NHS is in real danger of losing sight of the ball. The experiences reported about the financial crisis in Leicester are not unique.

Many trusts are openly saying that they can’t pay the bills and are resorting to draconian measures to balance the books. At the same time NHS staff remain under a pay freeze, redundancies are becoming the norm and staff are being asked to accept higher pension contributions in return for a lower pension income. Morale is low; and goodwill rapidly destroyed as the NHS is forced to manage a financial crisis not of the staff’s making.

Where does patient care stand in this mess? Many treatments are being put on hold or restricted. Care of the elderly is regularly reported as being sub-standard. Waiting times are lengthening; tensions within the NHS increasing.

Reform can only be built upon a solid platform and I fear that the sinking sands will inevitably lead to structural collapse. Raiding surplus pension funds to bail out the business is Maxwellian, dangerous and ill-conceived. How often are we told: “Staff are the greatest NHS asset?” Well now is the time for politicians to put their support for the NHS to the test.

The perfect storm is not a cheap sound bite. Until or unless NHS staff are valued, respected and treated fairly, the storm clouds will loom large.

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Future Forum comes up with the right advice

By Stephen Campion - 14th June 2011 11:00 am

I was personally pleased that the Future Forum - set up to advise the government on its struggling Health and Social Care Bill - acknowledged many of the arguments put forward by the HCSA. The main headlines I guess concern the recommendations on the clarity of the Secretary of State’s duties, the suggested changes to the role of Monitor, and the need for hospital doctors to be part of the commissioning arrangements.

Professor Field was right also to recognise our concerns about the current low morale within the NHS staff; he was right to say that undue delay would lead only to further retirements and loss of quality staff, yes even managers. On the issue of competition within the NHS I am pleased that Prof Field recognised that competition has to be part of an integrated healthcare model. I am only surprised that some people thought this a radical concept - there is nothing particularly new or novel about private sector involvement with the NHS.

The direction of travel (a phrase I suspect that will become increasingly and frustratingly as naff as ‘blue sky thinking’, ‘moving forward’ and ‘picking the low hanging fruit’) is one that most seasoned commentators appear to agree is right.

What made me despair was the level of political debate. For Labour, the BBC quotes shadow health secretary John Healey as calling the Future Forum report a “demolition job on the Tory-led government’s misjudgements and mishandling of the NHS”. For the Liberals, Nick Clegg is reported to claim he has won 11 out of 13 arguments. Oh, please!

I was impressed by what Prof Field and his team have produced in such a short period of time. He has indicated support for the basic principles behind the Bill and offered practical solutions for the government to consider. I just hope this doesn’t get bogged down in political rhetoric about who scored how many points or who made the biggest U-turn.

The NHS is far too important for that. Call me naïve if you like, but I think I heard Steve Field say exactly the same thing. I hope that neither of us will be disappointed.

Read an at-a-glance guide to the recommendations.

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