Ambulance crew sick days reduced:
AMBULANCE crews are receiving extra care and support in a bid to cut the service’s absence rate. Evening Telegraph
Monday, 23 April 2012
Judge calls for urgent action to prevent care home thefts by staff
Judge calls for urgent action to prevent care home thefts by staff:
A JUDGE has called for urgent action to be taken to stop vulnerable people in Northamptonshire being swindled out of thousands of pounds of cash by greedy care home workers. Northampton Chronicle & Echo
A JUDGE has called for urgent action to be taken to stop vulnerable people in Northamptonshire being swindled out of thousands of pounds of cash by greedy care home workers. Northampton Chronicle & Echo
Undercover filming shows Alzheimer's sufferer being repeatedly beaten
Undercover filming shows Alzheimer's sufferer being repeatedly beaten:
Footage of an Alzheimer's sufferer being repeatedly beaten by a member of staff at a care home will be screened tonight. The Independent
Footage of an Alzheimer's sufferer being repeatedly beaten by a member of staff at a care home will be screened tonight. The Independent
The big ideas
The big ideas: In the latest issue of Public Service Review: Health and Social Care, NHS and Commissioning Board Authority Chief Executive Sir David Nicholson, calls for a system to get the best out of the world-class talent to be found in the National Health Service.
Read the article.
Watchdog accused in care home row
Watchdog accused in care home row: The Care Quality Commission is being criticised for failing to take sufficient action after undercover filming showed an 80-year-old woman being slapped by a care worker. BBC News
CCGs adopting 'worst of PCT habits', warns GPC
CCGs adopting 'worst of PCT habits', warns GPC: Clinical commissioning groups (CCGs) are excluding LMCs from the development of their constitutions and risk morphing into 'the worst of PCTs', GP leaders have warned. GP Online
QOF could link to patient benefits and ignore GP workload
QOF could link to patient benefits and ignore GP workload: Primary care could be made more efficient if QOF points were linked to patient benefits rather than GP workload, research by a member of the NICE QOF team suggests. GP Online
Health and social care influenza pandemic preparedness and response
Health and social care influenza pandemic preparedness and response:
This guidance is intended to support local preparedness and response planning in England during the transition period through to 2013. The key changes in the strategy learned from the 2009 pandemic are: develop improved plans for the initial response to a new pandemic; ensure a response that is proportionate to a range of scenarios; allow for differences in the rate and pattern of spread of the disease across the country and internationally; and develop improved plans for managing the end of an influenza pandemic.
This guidance is intended to support local preparedness and response planning in England during the transition period through to 2013. The key changes in the strategy learned from the 2009 pandemic are: develop improved plans for the initial response to a new pandemic; ensure a response that is proportionate to a range of scenarios; allow for differences in the rate and pattern of spread of the disease across the country and internationally; and develop improved plans for managing the end of an influenza pandemic.
Dementia and end of life care: implications for people with sensory loss
Dementia and end of life care: implications for people with sensory loss:
This report summarises the issues discussed during a half-day seminar held in February 2012, organised by the Social Care Institute for Excellence, ARUP and the Thomas Pocklington Trust.
This report summarises the issues discussed during a half-day seminar held in February 2012, organised by the Social Care Institute for Excellence, ARUP and the Thomas Pocklington Trust.
Andrew Lansley backs lower pay for NHS staff in poorer areas
Andrew Lansley backs lower pay for NHS staff in poorer areas:
Health secretary risks new political storm by supporting proposals that unions say will worsen the north-south divide
Andrew Lansley, the health secretary, is threatening another controversial revolution in the NHS by proposing that its staff be paid less if they work in poorer parts of the country.
The cabinet minister is backing a plan for regional pay, which would mean that nurses, midwives, hospital porters, cleaners and paramedics would earn less if they work in the north or the Midlands rather than in the south of England. Official documents reveal that the only exemption backed by the Department of Health would be for highly paid managers working in new bodies established to deliver Lansley's controversial NHS reform programme, widely criticised as a privatisation of the health service.
The department, according to a submission to the NHS pay review body, believes special arrangements would be necessary for this new cohort of executives to "attract and retain high-calibre leaders and staff responsible for transforming delivery".
The revelation was seized upon by the government's critics on Saturday night as fresh evidence that the coalition is out of touch with the British public.
Health unions accused the health secretary of seeking to drive down wages in the provinces with the crippling consequence of creating an ever deeper north-south economic divide. They said women would be particularly badly hit by the proposals.
The policy is also likely to reignite disputes within the coalition over Lansley's handling of the NHS, with one senior Liberal Democrat attacking the proposal as "divisive and ideological" and warning that regional pay in the NHS was a "red-line issue" for Lib Dem MPs.
John Pugh MP, the co-chairman of the Lib Dem parliamentary policy committee on health and social care, said: "Not content with cementing the divisions between the north and south, Andrew's proposals harden the divisions between the well-paid and the rest. This demonstrates his continuing, unfortunate talent for alienating the people he needs to rely on most: NHS staff.
"Regional pay proposals and the blinkered ideology that underpins it remains a red line for many Lib Dem MPs and risk provoking an enduring, embittering standoff within the coalition which will profit no one."
Lansley's recommendation was made in response to the call by the chancellor, George Osborne, in his recent budget for the public sector to be "more responsive to local pay rates" to help the private sector grow in economically depressed parts of the UK.
Osborne argued that public sector pay should mimic the private sector and be more reflective of local economic conditions. In written evidence to the independent NHS pay review board, Lansley's department agrees that there is a prima facie case for regional pay in the NHS, described in the document as "market-facing pay".
The document suggests setting a national basic pay rate at a "minimum level necessary" and paying additional supplements in particular geographical zones. It says: "Current rates of pay in the NHS do vary geographically, but significantly less so than the pay of comparable staff in the private sector. The introduction of more sensitive market-facing pay would therefore enable more efficient and effective use of NHS funds." It further argues that "where the NHS pay premium is relatively high there is the potential for private sector enterprise to be crowded out with adverse impact on the prospects for local economic growth."
The document says the department favours a "measured approach, at least initially", and recommends the "introduction of one, or perhaps two, additional zones of geographical pay differentiation." It adds: "These could then be assessed and the evidence base on market-facing pay further developed to permit the consideration of the case for introducing further additional zones in the future."
The pay row is set to escalate when the shadow health secretary, Andy Burnham MP, addresses the Unison health conference in Brighton this week. Burnham said: "National pay is part of what underpins a truly national health service. Labour will defend it, as it is fair to staff, helps control costs and brings stability to the system.
"It is often harder to work on the NHS front line in more deprived parts of the country and yet this government wants to pay those staff less and reinforce the north-south divide. It will infuriate NHS staff to see senior managers arguing for one rule for themselves, and another for staff. They are seeking to insulate themselves from these changes, while driving down pay for thousands of front-line staff across the country."
Christina McAnea, the head of health at Unison, the largest health union, which will present its evidence on regional pay on Monday at its health conference, said: "The Department of Health's evidence on regional pay is built on sand. For a government that says it wants to cut paperwork, introducing regional pay would be a massively expensive, bureaucratic nightmare, designed to cause huge disruption and conflict.
"Regional pay would cause skills shortages in so-called low-cost areas, with nurses, midwives and specialised staff being hard to recruit and retain, hitting the care of patients.
"The government want to introduce a market ethos into the NHS but most private companies abandoned regional pay scales years ago as divisive and unworkable."
The Department of Health said: "Our evidence shows how more market-facing pay could help employers make better use of the NHS pay bill. It makes clear that there is a compelling case for implementing market facing pay for all Agenda for Change staff in England, whether they fulfil a support role, work in administration or work on the front line, such as nurses and other clinical staff. The principle of equal pay applies to all staff across the entire country.
"Any recommendations must be implemented in a way that is simple, effective and safe. National organisations like Health Education England are however in the very early stages of development.
"We have therefore invited the NHS pay review body to consider how, in the absence of detailed evidence about the appropriate job markets, their recommendations on market-facing pay might affect recruitment and retention, including the implications for equal pay in these particular organisations." The Guardian
Andrew Lansley, the health secretary, is threatening another controversial revolution in the NHS by proposing that its staff be paid less if they work in poorer parts of the country.
The cabinet minister is backing a plan for regional pay, which would mean that nurses, midwives, hospital porters, cleaners and paramedics would earn less if they work in the north or the Midlands rather than in the south of England. Official documents reveal that the only exemption backed by the Department of Health would be for highly paid managers working in new bodies established to deliver Lansley's controversial NHS reform programme, widely criticised as a privatisation of the health service.
The department, according to a submission to the NHS pay review body, believes special arrangements would be necessary for this new cohort of executives to "attract and retain high-calibre leaders and staff responsible for transforming delivery".
The revelation was seized upon by the government's critics on Saturday night as fresh evidence that the coalition is out of touch with the British public.
Health unions accused the health secretary of seeking to drive down wages in the provinces with the crippling consequence of creating an ever deeper north-south economic divide. They said women would be particularly badly hit by the proposals.
The policy is also likely to reignite disputes within the coalition over Lansley's handling of the NHS, with one senior Liberal Democrat attacking the proposal as "divisive and ideological" and warning that regional pay in the NHS was a "red-line issue" for Lib Dem MPs.
John Pugh MP, the co-chairman of the Lib Dem parliamentary policy committee on health and social care, said: "Not content with cementing the divisions between the north and south, Andrew's proposals harden the divisions between the well-paid and the rest. This demonstrates his continuing, unfortunate talent for alienating the people he needs to rely on most: NHS staff.
"Regional pay proposals and the blinkered ideology that underpins it remains a red line for many Lib Dem MPs and risk provoking an enduring, embittering standoff within the coalition which will profit no one."
Lansley's recommendation was made in response to the call by the chancellor, George Osborne, in his recent budget for the public sector to be "more responsive to local pay rates" to help the private sector grow in economically depressed parts of the UK.
Osborne argued that public sector pay should mimic the private sector and be more reflective of local economic conditions. In written evidence to the independent NHS pay review board, Lansley's department agrees that there is a prima facie case for regional pay in the NHS, described in the document as "market-facing pay".
The document suggests setting a national basic pay rate at a "minimum level necessary" and paying additional supplements in particular geographical zones. It says: "Current rates of pay in the NHS do vary geographically, but significantly less so than the pay of comparable staff in the private sector. The introduction of more sensitive market-facing pay would therefore enable more efficient and effective use of NHS funds." It further argues that "where the NHS pay premium is relatively high there is the potential for private sector enterprise to be crowded out with adverse impact on the prospects for local economic growth."
The document says the department favours a "measured approach, at least initially", and recommends the "introduction of one, or perhaps two, additional zones of geographical pay differentiation." It adds: "These could then be assessed and the evidence base on market-facing pay further developed to permit the consideration of the case for introducing further additional zones in the future."
The pay row is set to escalate when the shadow health secretary, Andy Burnham MP, addresses the Unison health conference in Brighton this week. Burnham said: "National pay is part of what underpins a truly national health service. Labour will defend it, as it is fair to staff, helps control costs and brings stability to the system.
"It is often harder to work on the NHS front line in more deprived parts of the country and yet this government wants to pay those staff less and reinforce the north-south divide. It will infuriate NHS staff to see senior managers arguing for one rule for themselves, and another for staff. They are seeking to insulate themselves from these changes, while driving down pay for thousands of front-line staff across the country."
Christina McAnea, the head of health at Unison, the largest health union, which will present its evidence on regional pay on Monday at its health conference, said: "The Department of Health's evidence on regional pay is built on sand. For a government that says it wants to cut paperwork, introducing regional pay would be a massively expensive, bureaucratic nightmare, designed to cause huge disruption and conflict.
"Regional pay would cause skills shortages in so-called low-cost areas, with nurses, midwives and specialised staff being hard to recruit and retain, hitting the care of patients.
"The government want to introduce a market ethos into the NHS but most private companies abandoned regional pay scales years ago as divisive and unworkable."
The Department of Health said: "Our evidence shows how more market-facing pay could help employers make better use of the NHS pay bill. It makes clear that there is a compelling case for implementing market facing pay for all Agenda for Change staff in England, whether they fulfil a support role, work in administration or work on the front line, such as nurses and other clinical staff. The principle of equal pay applies to all staff across the entire country.
"Any recommendations must be implemented in a way that is simple, effective and safe. National organisations like Health Education England are however in the very early stages of development.
"We have therefore invited the NHS pay review body to consider how, in the absence of detailed evidence about the appropriate job markets, their recommendations on market-facing pay might affect recruitment and retention, including the implications for equal pay in these particular organisations." The Guardian
Patients with rare illnesses 'losing out' in NHS drug allocation lottery
Patients with rare illnesses 'losing out' in NHS drug allocation lottery:
Health experts fear new national framework governing allocation of drugs could hit some more than others
People with rare diseases are failing to receive vital medical treatment because their illnesses are not recognised in guidelines that govern the distribution of NHS-approved drugs.
Health experts who fear that a new framework governing drug allocation that comes into force next year could see some people lose out.
Anglea Tyermans, 38, who has arteriovenous malformations (AVMs), an extremely rare cardiovascular defect that affects less than 1% of the population, fears she will die if she does not receive a course of injections approved by Nice, the clinical body that oversees drug allocation on behalf of the NHS.
Her primary care trust in West Sussex will not pay the £15,000 for her to have the one-off treatment, which her lawyers say will arrest her illness. Experts appointed by West Sussex PCT said "further research" was required.
Rare Disease UK, an alliance of organisations that support people with uncommon illnesess, estimates there are more than 6,000 rare diseases that will affect 1 in 17 people in the UK.
A new commissioning board next year will oversee the allocation of medicines to end the "postcode lottery" that sees some patients deprived of a drug because of where they live.
But Alastair Kent, chair of Rare Disease UK, warned economising could have an impact on how the board determines future allocations of drugs.
Kent said: "The rhetoric is about everybody achieving better healthcare but for the rhetoric to meet the reality is a huge ask." The Guardian
People with rare diseases are failing to receive vital medical treatment because their illnesses are not recognised in guidelines that govern the distribution of NHS-approved drugs.
Health experts who fear that a new framework governing drug allocation that comes into force next year could see some people lose out.
Anglea Tyermans, 38, who has arteriovenous malformations (AVMs), an extremely rare cardiovascular defect that affects less than 1% of the population, fears she will die if she does not receive a course of injections approved by Nice, the clinical body that oversees drug allocation on behalf of the NHS.
Her primary care trust in West Sussex will not pay the £15,000 for her to have the one-off treatment, which her lawyers say will arrest her illness. Experts appointed by West Sussex PCT said "further research" was required.
Rare Disease UK, an alliance of organisations that support people with uncommon illnesess, estimates there are more than 6,000 rare diseases that will affect 1 in 17 people in the UK.
A new commissioning board next year will oversee the allocation of medicines to end the "postcode lottery" that sees some patients deprived of a drug because of where they live.
But Alastair Kent, chair of Rare Disease UK, warned economising could have an impact on how the board determines future allocations of drugs.
Kent said: "The rhetoric is about everybody achieving better healthcare but for the rhetoric to meet the reality is a huge ask." The Guardian
Medics filmed 'offering female circumcision'
Medics filmed 'offering female circumcision':
Up to 100,000 women in Britain have been "circumcised", with medics across the country offering to carry out illegal genital mutilations on girls as young as 10, it was reported yesterday. The Independent
Up to 100,000 women in Britain have been "circumcised", with medics across the country offering to carry out illegal genital mutilations on girls as young as 10, it was reported yesterday. The Independent
Friday, 20 April 2012
Integrated care pilots reveal mixed results | Nick Goodwin
Integrated care pilots reveal mixed results | Nick Goodwin: Have the Department of Health's integrated care pilots driven improvements in the quality and cost effectiveness of patient care? (Blog, 19 Apr 2012) Kings Fund
Early implementers sought to test long term conditions year of care funding model
Early implementers sought to test long term conditions year of care funding model:
Early implementers are being invited to apply to test a potential new way of funding long term conditions care. The LTC year of care funding model will be tested by six early implementer sites and prescribes a set approach for the purpose of national evaluation.
The model is described in Quality, Innovation, Productivity and Prevention long term conditions which is published today along side an application form and supporting guidance for those interested in becoming early implementers.
The deadline for applications is Friday 25 May 2012.
QIPP long term conditions is aimed at health and social care commissioners and providers who are implementing integrated LTC care services to improve outcomes and people’s experience. The funding model has been developed through the QIPP LTC work stream to support health and social care teams in integrating care in a more sustainable way by aligning funding with people’s needs.
The model, which is is not mandated, has been developed using evidence and best practice and will be formally tested by the early implementer sites. The model will evolve over time with this testing phase informing future developments. Department of Health
Early implementers are being invited to apply to test a potential new way of funding long term conditions care. The LTC year of care funding model will be tested by six early implementer sites and prescribes a set approach for the purpose of national evaluation.
The model is described in Quality, Innovation, Productivity and Prevention long term conditions which is published today along side an application form and supporting guidance for those interested in becoming early implementers.
The deadline for applications is Friday 25 May 2012.
QIPP long term conditions is aimed at health and social care commissioners and providers who are implementing integrated LTC care services to improve outcomes and people’s experience. The funding model has been developed through the QIPP LTC work stream to support health and social care teams in integrating care in a more sustainable way by aligning funding with people’s needs.
The model, which is is not mandated, has been developed using evidence and best practice and will be formally tested by the early implementer sites. The model will evolve over time with this testing phase informing future developments. Department of Health
The week: issue 244
The week: issue 244:
On the agenda this week: the Secretary of State launches a consultation on standardised packaging of tobacco products, foreign doctors to prove they can speak English before practising in England under new government proposals, and the Prime Minister announces a call to action for frontline nurses to share best practice with colleagues across the NHS. Department of Health
Download ‘the week’ issue 244 13 – 19 April 2012 (RTF 546KB)
On the agenda this week: the Secretary of State launches a consultation on standardised packaging of tobacco products, foreign doctors to prove they can speak English before practising in England under new government proposals, and the Prime Minister announces a call to action for frontline nurses to share best practice with colleagues across the NHS. Department of Health
Download ‘the week’ issue 244 13 – 19 April 2012 (RTF 546KB)
Home births more 'cost effective'
Home births more 'cost effective': Research by a team at the University of Oxford has indicated that planned births at home and in midwifery units are more cost-effective than giving birth in hospital.
Writing in the British Medical Journal, where they compared costs and outcomes for mother and baby of giving birth in different locations, they said this was particularly the case for women who had given birth before.
They focussed on 60,0... Healthcare Today
Writing in the British Medical Journal, where they compared costs and outcomes for mother and baby of giving birth in different locations, they said this was particularly the case for women who had given birth before.
They focussed on 60,0... Healthcare Today
NHS needs to integrate mental and physical health services for better care and impressive savings
NHS needs to integrate mental and physical health services for better care and impressive savings: A new report from the NHS Confederation Mental Health Network makes the case for combining mental and physical healthcare. NHS Confederation
From vision to action: making patient-centred care a reality
From vision to action: making patient-centred care a reality:
The Richmond Group, an alliance of leading health and social care charities, is calling on the Government to ensure patients are central to the delivery of care in the redesigned NHS in England. This report sets out what the group would like to change to put patients at the heart of the NHS.
The Richmond Group, an alliance of leading health and social care charities, is calling on the Government to ensure patients are central to the delivery of care in the redesigned NHS in England. This report sets out what the group would like to change to put patients at the heart of the NHS.
NHS waiting times rise 6%
NHS waiting times rise 6%: New research from the Patients Association has revealed that waiting times are getting longer for common surgical procedures.
It has warned of increasingly long delays for the most common forms of surgery in NHS hospitals, despite Prime Minister David Cameron’s election pledge to cut waiting times.
Latest figures show that waiting times rose by 6% for eight types of surgery between 2010 and 2011. The ... Healthcare Today
Read the full report here
It has warned of increasingly long delays for the most common forms of surgery in NHS hospitals, despite Prime Minister David Cameron’s election pledge to cut waiting times.
Latest figures show that waiting times rose by 6% for eight types of surgery between 2010 and 2011. The ... Healthcare Today
Read the full report here
Spending cuts biggest challenge for health service leaders
Spending cuts biggest challenge for health service leaders:
Our survey found that the impact of cuts is as big a challenge for the NHS as implementing the Health and Social Care Act
The impact of spending cuts is as big a challenge for the NHS as implementing the Health and Social Care Act, say healthcare leaders.
An exclusive Guardian healthcare network survey asked members what they think are the main concerns facing the health sector; 64% said implementing efficiency savings, 62% said the impact of the Health and Social Care Act, and 35% said planned NHS reforms.
Other responses included the increasing demands placed on the health service by demographic changes - citing both the ageing population and an ageing workforce. One member wrote the biggest challenge was "becoming more cost efficient while maintaining and improving quality"; and another cited unco-ordinated thinking and planning.
The issues of spending cuts and the government reforms are recurring themes throughout the survey, with many members blaming them for the aspects they like least about their jobs, and also fearing the effect they will have in the year ahead.
Our survey was launched before the health and social care bill gained royal assent to become the Health and Social Care Act, and asked members whether they personally supported the proposed reforms - 68% said no, 11% said yes, and 21% were unsure.
One member branded the bill "unworkable", another commented "this bill could well be Cameron's 'poll tax'", and a third said: "The NHS remains a political toy and is bounced on a whim from minister to minister."
Members were also asked whether they think there should be more private sector involvement in the health service - 56% said no, 27% said yes and 18% were unsure.
And the questionnaire - completed by more than 500 healthcare network members - also asked whether healthcare leaders think there should be more integration of health, social care and housing services. Some 89% said yes, while 5% said no and 6% were unsure.
The research revealed a very strong sense of public service among healthcare network members, with a large proportion saying the chance to help people, care for patients and improve others' lives was the most enjoyable aspect of their job. Many also cited patient contact, while the variety of their role and the challenges of delivering care were also repeatedly mentioned.
When asked what they liked least about their jobs, many members said they felt uncertain about their future - whether due to government policy, NHS funding or job insecurity. A number mentioned that politics - at a local and a national level - were having a negative impact on their work, and many felt that paperwork, meetings and administration (one member cited "death by email") were the least enjoyable aspects of their work. Other members cited workloads, staff shortages, work place pressure and poor morale.
Most members (73%) think their jobs will become more difficult in the year ahead - and cuts and reorganisations were again mentioned by many.
One member said: "We are fighting to understand the new NHS structures, in 12 months we will still be trying to understand them and delivering in a changing landscape."
Another commented: "There is a huge amount of work to do, and in some instances there is a lack of focus, vision and lack of support. With uncertain financial times, and in the challenging political climate. Things are very tough."
But 25% think their role will stay the same over the next 12 months - and 3% believe it will get easier.
The research is the second in a series of quarterly questionnaires sent to healthcare network members and promoted via Twitter and Facebook. The first questionnaire also found that spending cuts are the biggest challenge facing NHS leaders.
Watch out for further opportunities to contribute to healthcare network research later in the year, and in the meantime please add your comments on the issues discussed in this piece below. Guardian Professional.
The impact of spending cuts is as big a challenge for the NHS as implementing the Health and Social Care Act, say healthcare leaders.
An exclusive Guardian healthcare network survey asked members what they think are the main concerns facing the health sector; 64% said implementing efficiency savings, 62% said the impact of the Health and Social Care Act, and 35% said planned NHS reforms.
Other responses included the increasing demands placed on the health service by demographic changes - citing both the ageing population and an ageing workforce. One member wrote the biggest challenge was "becoming more cost efficient while maintaining and improving quality"; and another cited unco-ordinated thinking and planning.
The issues of spending cuts and the government reforms are recurring themes throughout the survey, with many members blaming them for the aspects they like least about their jobs, and also fearing the effect they will have in the year ahead.
Our survey was launched before the health and social care bill gained royal assent to become the Health and Social Care Act, and asked members whether they personally supported the proposed reforms - 68% said no, 11% said yes, and 21% were unsure.
One member branded the bill "unworkable", another commented "this bill could well be Cameron's 'poll tax'", and a third said: "The NHS remains a political toy and is bounced on a whim from minister to minister."
Members were also asked whether they think there should be more private sector involvement in the health service - 56% said no, 27% said yes and 18% were unsure.
And the questionnaire - completed by more than 500 healthcare network members - also asked whether healthcare leaders think there should be more integration of health, social care and housing services. Some 89% said yes, while 5% said no and 6% were unsure.
The research revealed a very strong sense of public service among healthcare network members, with a large proportion saying the chance to help people, care for patients and improve others' lives was the most enjoyable aspect of their job. Many also cited patient contact, while the variety of their role and the challenges of delivering care were also repeatedly mentioned.
When asked what they liked least about their jobs, many members said they felt uncertain about their future - whether due to government policy, NHS funding or job insecurity. A number mentioned that politics - at a local and a national level - were having a negative impact on their work, and many felt that paperwork, meetings and administration (one member cited "death by email") were the least enjoyable aspects of their work. Other members cited workloads, staff shortages, work place pressure and poor morale.
Most members (73%) think their jobs will become more difficult in the year ahead - and cuts and reorganisations were again mentioned by many.
One member said: "We are fighting to understand the new NHS structures, in 12 months we will still be trying to understand them and delivering in a changing landscape."
Another commented: "There is a huge amount of work to do, and in some instances there is a lack of focus, vision and lack of support. With uncertain financial times, and in the challenging political climate. Things are very tough."
But 25% think their role will stay the same over the next 12 months - and 3% believe it will get easier.
The research is the second in a series of quarterly questionnaires sent to healthcare network members and promoted via Twitter and Facebook. The first questionnaire also found that spending cuts are the biggest challenge facing NHS leaders.
Watch out for further opportunities to contribute to healthcare network research later in the year, and in the meantime please add your comments on the issues discussed in this piece below. Guardian Professional.
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