By Kim Hoque, Simon Davis and Michael HumphreysThis article looks at the government’s aim of using the reward of ‘earned autonomy’ and Foundation Trust status as an incentive to improve performance in the NHS. It examines the issue by investigating the extent to which members of an NHS Trust’s senior management team perceive themselves as autonomous, the factors most likely to hinder their ability to operate autonomously, and the extent to which managers want greater autonomy. In the event, autonomy was largely restricted by extensive centrally dictated targets. Entrenched professional interests and a lack of managerial skills on the part of clinician managers suggested limitations on the extent to which autonomy can be realistically devolved. Additionally, there was little belief among managers that greater autonomy would enable healthcare services to be delivered more effectively.
Two-thirds of hospital consultants who have switched to the recently introduced contract say they are satisfied with their new terms and conditions. Interim results from a survey by the British Medical Association also show that six out of ten consultants had transferred to the new contract even though some hospital trusts were still dragging their heels.The survey found that just over a quarter of consultants intended to transfer to the contract and 13 per cent said they would either stay on the old contract or had not yet made up their minds. More than half of the full-time consultants who have moved onto the new contract reported that they were doing 12 programmed activities, or PAs, where one PA is usually equivalent to four hours of work. Almost two-thirds of those doctors believe that fairly reflected their workload. The survey also found 85 per cent of consultants have on-call responsibilities, three quarters of them on the most intensive on call band – Category A.
Government crime reduction strategies are in danger of targeting the usual suspects rather than those who cause the most harm or who pose the greatest risk, according to a new discussion paper from the think-tank the Crime and Society Foundation today.The paper, ‘Crime, persistent offenders and the justice gap’, says many of those who commit hidden crimes such as domestic violence, sexual assaults and crimes against children do not come to the attention of the authorities and so are likely to be ignored by the government’s strategy. It also argues that government spin on crime figures is misleading and counterproductive.