Front page of Saturday’s edition of The Times outlines a new proposal to link patient satisfaction to NHS budget payments by allowing punters to give feedback on services received.
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Will Wes Streeting be setting up a new Check A&E Trade or a Hospital Trip Adviser type website where patients will be able to post reviews after appointments? I do hope so as I can’t wait to read other people’s comments on their experiences with the No Hope Service.
Performance related pay has been the mainstay of financial services for decades so I applaud this radical proposal to create a meritocracy in delivering healthcare. Those who provide the best service should be amply rewarded and those who don’t should be put on a Performance Improvement Plan with further sanctions imposed if targets are still not met.
However, my experiences of working in PRP (Peformance Related Pay) environments is both positive and negative. As an employee motivated by the thought of an extra couple of thousand quid in my pay packet at year end, I always strived to give 120% and go ‘above and beyond’ to use the bank’s own corporate jargon. My January pay packet was always a fat wallet making all those 12-hour days very worthwhile but not so for those at the bottom of the heap.
PRP breeds resentment. Those who can’t or won’t step up to the plate get de-motivated, resentful and even less inclined to meet targets. Performance Improvement Plans often do little to change the status quo.
As an ex-manager, I remember the annual PRP process as a vicious bun-fight. Departmental heads locked in an airtight room screaming at each other as they vie for a slice of the PRP pie for their staff. Oh yes, there’s only a finite budget allocated for staff reward schemes usually divided into Top, Middle and Bottom buckets into which all staff are categorised. The bucket you end up in determines your annual bonus so you’ve got to hope your manager has the loudest voice.
Assessing performance against PRP criteria is an exhausting and divisive process. It’s hard to remain objective and not let your own personal feelings or judgements come to the fore when ranking members of your own team making it even harder to come up with a Top, Middle or Bottom list. Can you imagine how difficult it would be to fairly assess one hospital against another?
In life there’s always winners or losers. What criteria will the Government use to rank NHS trusts in terms of performance and what reward will this be linked to? Will they award a fixed amount for every positive patient review? Or will rewards be skewed by politics such as levelling up agendas? How will they deal with negative reviews? And what if all the best performing hospitals were in the South, would they get larger budgets than those in the allegedly deprived North? There are a million questions to be answered.
Rather than implement a standalone performance related pay system linked to patient feedback, the Government would do better to implement process changes to weed out all those needless bureaucratic institutionalised ways of working followed religiously by the NHS. The current health bible needs to be ripped up and re-written so it is a thinner tome. To reduce waiting lists what is needed are quicker patient pathways to effective treatments not that meandering A to B route via C, D and E in order to get the drugs or interventions needed.
Carrot and stick as a means of improving the NHS, cutting waiting lists and achieving excellence in service delivery sounds great from a patient’s perspective but how this will work in practice remains to be seen.
Performance related pay has been the mainstay of financial services for decades so I applaud this radical proposal to create a meritocracy in delivering healthcare. Those who provide the best service should be amply rewarded and those who don’t should be put on a Performance Improvement Plan with further sanctions imposed if targets are still not met.
However, my experiences of working in PRP (Peformance Related Pay) environments is both positive and negative. As an employee motivated by the thought of an extra couple of thousand quid in my pay packet at year end, I always strived to give 120% and go ‘above and beyond’ to use the bank’s own corporate jargon. My January pay packet was always a fat wallet making all those 12-hour days very worthwhile but not so for those at the bottom of the heap.
PRP breeds resentment. Those who can’t or won’t step up to the plate get de-motivated, resentful and even less inclined to meet targets. Performance Improvement Plans often do little to change the status quo.
As an ex-manager, I remember the annual PRP process as a vicious bun-fight. Departmental heads locked in an airtight room screaming at each other as they vie for a slice of the PRP pie for their staff. Oh yes, there’s only a finite budget allocated for staff reward schemes usually divided into Top, Middle and Bottom buckets into which all staff are categorised. The bucket you end up in determines your annual bonus so you’ve got to hope your manager has the loudest voice.
Assessing performance against PRP criteria is an exhausting and divisive process. It’s hard to remain objective and not let your own personal feelings or judgements come to the fore when ranking members of your own team making it even harder to come up with a Top, Middle or Bottom list. Can you imagine how difficult it would be to fairly assess one hospital against another?
In life there’s always winners or losers. What criteria will the Government use to rank NHS trusts in terms of performance and what reward will this be linked to? Will they award a fixed amount for every positive patient review? Or will rewards be skewed by politics such as levelling up agendas? How will they deal with negative reviews? And what if all the best performing hospitals were in the South, would they get larger budgets than those in the allegedly deprived North? There are a million questions to be answered.
Rather than implement a standalone performance related pay system linked to patient feedback, the Government would do better to implement process changes to weed out all those needless bureaucratic institutionalised ways of working followed religiously by the NHS. The current health bible needs to be ripped up and re-written so it is a thinner tome. To reduce waiting lists what is needed are quicker patient pathways to effective treatments not that meandering A to B route via C, D and E in order to get the drugs or interventions needed.
Carrot and stick as a means of improving the NHS, cutting waiting lists and achieving excellence in service delivery sounds great from a patient’s perspective but how this will work in practice remains to be seen.
In principle this idea could make poor performers buck up particularly if budgets are at risk but to be sure there’ll be squealers who’ll cry foul at these proposed changes.
My 5 star review will be given when my ongoing neck problem has been properly sorted but as the NHS have washed their hands of me claiming there is nothing more that can be done then for now its a big fat 0 on the scoreboard.
