I have to admit I have something of a soft spot for the Aberdeen Royal Infirmary (ARI), and not just because both my sisters worked there. My affection comes, like many who have an affiliation for any place, from personal experience, and the ARI is where my mum spent the last few days of her life before being cruelly taken from us two months ago.
There are no words, or at least no adequate words, to express my eternal gratitude for the care and dignity Mum received from the staff in Ward 114, and from the amazing Irish nurse Danielle who almost certainly would say she was just doing her job – but for us it was so much more than that – as she was with us throughout those last few heart-breaking days.
Obviously, Mum was not the only patient in the ward, and other families must have been going through the same trauma. I’m certain each and every one of them would have been comforted by the highly dedicated, professional, and compassionate team there for them in their time of need too.
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Which is why, when the ARI hit the news twice last week, my ears pricked up and I paid more attention than normal to yet another health story.
Last Friday saw what was reported as an assault close the A&E department for over two hours. Now, as the case is currently live, that limits what can be said about it, but one thing is certain – that level of disruption and stress caused by incidents like these do nothing to help the overburdened staff trying to help an often ungrateful public, placing demands on the service often through their own (alcohol-fuelled) stupidity.
Two days earlier, an altogether duller topic dominated the news, as independent auditors (consultants to you and me) filed a report suggesting an additional £26M could be saved by NHS Grampian (NHSG) – on top of the £40M already identified by the health board – as it sought to address a £93M deficit.
(Image: PA)
My reactions to consultant/auditor reports verge on Pavlovian at the best of times, and this polemic was no different. The first rule of consultancy is GET MORE WORK, and happily this tome maintains that proud tradition. Running to some 138 pages – as clearly the fees demand more than a pamphlet to be justified – the report on the deficit states: “Upon initial assessment of NHSG’s work on the drivers of the deficit, we identified that this was not in line with what we would typically expect from analysis of the drivers of the deficit for an NHS organisation. We recommend that SG and NHSG consider undertaking a full and complete analysis of the drivers of the deficit.”
You have to hand it to these consultants – that’s a lot of words to say ‘we don’t know the actual cause, but if you want to pay us some more, we can have another crack at finding out’. Despite that, and with the full blessing of the government, the report made some assumptions which pretty much came down to the health board having too many folk on the payroll.
Predictably, the Sword of Damocles report was welcomed by the health board, who without a word of irony suggested its content would be considered to help improve the patient experience, clinical care, and staff wellbeing. The Health Secretary, Neil Gray, was equally effusive – he had to be, I suppose, as he paid for it – and claimed the report was an important part of driving improvements and the board should improve capacity and drive real, sustainable change.
Now, I’m not one of these ‘pour endless pots of money into the NHS’ purists, as I see the damage that causes to the wider public sector – and I can count. But I do get more than a smidgen miffed at the veneration of what are essentially bean counters when it comes to determining what our public services should look like.
Clearly, the cost of sustaining public services is a huge issue. Real-world economics demand hard choices, and those invariably leave some of the wider population disappointed. But the promotion of auditors as the all-seeing oracles on how our services should be structured is verging on the insane.
You see, this is a script I know well. Audit Scotland spent years lambasting the finances of our police service and as the chasing of savings became all-consuming for those at the top, the decline in service was stark as a result. Saving money is, however, a very profitable business. It inevitably demands more consultancy – remember that first rule! – as well as scores of new six-figure salaried executives to oversee the cuts to the actual workers and service.
And lest the tedious public start to question the decline, the expansion in comms professionals will be there to sell them that things are actually improving, as the results of a gerrymandered survey clearly show.
NHS Grampian is now on an inevitable slide, as “rightsizing” the workforce is identified as the primary method of saving money. As an aside, whoever coined that term deserves to have the bare soles of their feet flayed with a rubber hose and then hope that when they got to A&E the nurse who would treat them hadn’t been replaced by a change manager.
I’m sure counting beans is a noble profession, but stay in your lane – or if you’re tempted to stray out of it, at least make sure you point your pencils in the right direction. Never once have I heard an auditor identify the impossibility of managing the impacts of headline-grabbing but unsustainable government policies, nor of the real consequences of cutting service and people to match the budget. Ultimately, they simply act as prophets of doom and a deflective shield for those who lack the courage to be honest in the first place.
We all know what happened to our police service, and now well over a decade and four Chief Constables later, its current head Jo Farrell is sounding very loud alarm bells indeed. I sincerely hope NHSG breaks the mould of cutting workers while growing managers, and that communities in the North East are able to be treated by more people like Danielle – as frankly, the world needs more like her. If the cost of that is fewer bean counters – we all win.
Calum Steele is a former General Secretary of the Scottish Police Federation, and former general secretary of the International Council of Police Representative Associations. He remains an advisor to both.