EBME Forums Forums Management Professional Issues Agenda For Change agenda for change

Aintree is one of the 'Early Implementes' of the system with a remit to
pilot the system and they have already begun implementing this new system.

The following is a report on how Agenda For Change is proceeding at Aintree.
This was the picture as of 6th August 2003:
- Aintree aimed to have completed the matching/evaluations within six months
but it looks now as if that might not be possible

- There is an assumption from some specialist nurses that their jobs are
specialised but it is possibile that some could end up being put on a lower
band because it seems that they aren’t as specialised as they believe. I
understand that a similar picture is emerging amongst Medical Secretaries
- They are now estimating that 50% of staff will be matched to a national
profiles whilst 50% will need local evaluation. The local evaluation figure
could be higher in Trusts where more specialised work is done. Each
evaluation takes approximately 9 hours to complete
- As of 6th August, they had nearly completed all nursing jobs, have been
working on A&C jobs and are about to start on Radiography.
- Pathology/Pharmacy, I understand, have yet to be started.
- It looks as though many ‘D’ and ‘E’ grade nurses are likely to be on the
same band which is causing concerns around erosion of differentials. This
picture could be reflected in other professional groups.
- They aime to start paying some staff groups using the new pay system in
September but do need to sort out some central funding issues first
- They now feel that the whole process will cost more than originally
anticipated
- Because annual leave will be calculated on the basis of hours rather than
days it is becoming complicated to manage
- They feel there will be problems staffing certain Bank Holidays,
particularly over Christmas, because of the way out of hours are calculated
and have referred this matter to the Department of Health for advice
- The Knowledge & Skills Framework, which is the tool used for staff
development, will begin to be piloted in the Trust across about 100 staff.

Interesting. Is there anyone from Aintree willing to comment.

The silence from the first wave sites is deafening..........or is this just my natural sceptisism ?

The reason no information is appearing from the early implimentors is because we know as much as you do ie sod all!,but one thing we have heard from the union is that a national profile for mto's is comming out in approx two weeks.Maybe this will shed some light on where medical engineering technicians will be graded.

Agenda for change
As someone who runs a Clinical Engineering Service and has spent some considerable time working on this whole subject I would like to take the time to put to bed these Chinese wispers so let me offer the following:
1] Just may be the reasion no one from any early implementer site has said anything is that there has been nothing to say! What would you all really have uninformed comment spreading panic & discent or the truth!
2] AfC is about the Scientfic Profession as a whole something which currently runs to some 60 odd identified disciplines it is not just about mending the odd patient monitor. Sorting this out takes time. it also not just about how much you get paid, Itis about the whole life package, the terms under which you work, the skills you need and how to ensure you get them. Remember to this Rome was not built in day. Look at Clinical Engineering itself up to 5 MTO levels some of these with specfic responsibilities etc.
3] Currently there are no nationally identifed job profiles for any Medical Technical Officer role which is where the majority but not all of us fit.
4] Where matching etc has taken place this has been primarily at the management level of the service with matches to the relevent works officer profile, clinical scientist profiles or to the professional manager profiles.
5] My own trust quite rightly is holding back evaluation of Techinical Scientfic roles until national profiles become available.
6] What is happening on these you may ask - the answer is quite a lot work has been undertaken by those of us in this field at the early implementers to generate meaningful profiles and hopefully the results of this will be available shortly. Again we have had to address many issues in doing this such as should we write for today or tomorrow and in compling these great efforts have been mad to ensure that they are meaningful, honest and above directly relevent
7] It seems to me that you all are taking the rather dim view that this whole process will end in doom and gloom. This was my view at the start however now Iam of the opinion that the reverse is true this is an excellent chance to grasp the nettle and set about raising your profile, professional status personal competancy.
8] Yes there may be some winners and losers however this as Darwin wrote is called evolution.

I think it's creditable that those involved in this process of change should comment - even though it's a bit late in the day for discussions, feedback and reassurance RE: AfC and NOS. However I'm going to be controversial as ever and add that it's easy to put forward intelligent-sounding views, especially when you're involved in the process and have a grasp of what's actually going on.

Apparently there are Chinese w(h)ispers or rumours floating about but as Darwin commented "Unfortunately this is what happens when those Apes involved in a process not keep the Chimpanzees informed about possible changes that may affect them - they are left to speculate in this case, twiddling their prehensile thumbs, during bouts of monitor-mending".

Irritation is also being expressed in a majority of individuals that show concern - those who may be affected by the decisions of the minority, who do not represent them as a whole. Of course we are concerned for our future prospects. Hmmm, not very reassuring when one discusses “winners and losers” and implies that we should look to the the “bigger-picture” is it? "Trust me - I'm a professional Technical Manager - or at least that's what I want to be after AfC". Say no more.

This aside; I think the point about people's concern about this agenda has been missed - a process of discussion and feedback is not useless, even if it is just as a means of reassuring the monitor mending Chimpanzees of this world.

Does the minority involved in AfC, think their involvement, input and views towards implementing AfC or NOS, whatever, is representative of the views of the Technician workforce as a whole? I don't think so – nobody has ever asked my views or those of my colleagues at any stage of the process. Not even a Questionnaire. They don't have a clue about the price of bananas do they?

I tried to get information from various sources but it was not forthcoming; information has been scant to say the least - I even contacted Sue Hill on a couple of occasions concerning AfC and Occupational Standards and received promises of information but nothing was forthcoming. I am certain that others tried too.

If others involved in the AfC process had as high a profile as Professor Hill then perhaps I could have also contacted them for reassurance and to be told just as much a long time ago rather than having to wait so long to be enlightened in such a seemingly patronising manner.

Well said RL, surely if you are an "early implementer" you should have something to implement.

Maybe it should have been introduced as "early not quite ready because we haven't done the work yet" sites.

Doesn't role off the tongue I know as the "buzz" phrase but sums up what has had happened.

I hope when the "blurb" comes out it reads better than some other previous postings, you never know maybe a chimpanzee at Papworth had broke the spell-checker.

Must go and get the Chimps to stare at some monitors, maybe through evolution with an infinite number of Chimps and an infinite number of monitors, one of them will evolve into a Clinical Engineer, just after he writes the complete works of Shakespeare.

It doesn't look good if someone who "runs a clinical engineering service" thinks that an EBME engineer "mends the odd monitor" now and again - and then takes that misconception to the job profiling panel !

The view amongst our senior Divisional Managers is that they couldn't run their service without the EBME Department. They openly express the view that our technical input into the daily clinical routine is invaluable.

I wonder if they hold the same opinion in other Trusts about some Clinical Engineering Services - or even if they really know who they are or what they do ?

But then that's the advantage of working at the sharp end - mending patient monitors.

Ok, lets explore some more issues.

Referances made to monitors or evolution in my previous posting are not intended as derogatory the intent was to try to place things in context.

From this please consider the following. There is the very good idea of attempting to implement a just and fair pay scheme, everyone would agree that there is a lot of inequality in the current pay scheme across all the NHS professions. Whilst this is a good idea the question is "is it possible?" Answer -the only way to find out is much the same as we do in our profession - conduct some tests.
This is what Early AfC implementation is about trying this concept and seeing if it works.
This means that it is a continual learning process. Views generated at the start of this process may not be those held now.
It has to be accepted that this is a vast set of tests to perform, if the NHS had waited for "test specficications" for every dotted "i" and crossed "t" then this process would never have got underway. This is the reasion why at the moment there are no nationally agreed clinical engineering profiles.

Next let us consider how services are provided. Some are provided by Estates based services, Some by Medical Physics based services and some by engineering staff who are not in eiether. This means some services are headed by Works Officers, Some by Clinical Engineers and some by Technologists (I use the current terms here and the term Clinical Engineer is that as held by those with CEng registration. Again these issues have to be taken into account when job matching or evaluating.

Then it has to be remembered that this exercise is not about evaluating the individual but the job content against 16 identified criteria. However before this can be done clear understanding has to be inplace regarding the exact job content (here we soon found out that across our whole scientfic staff posts people where doing far more than their orginal job descriptions said they did) and again this takes time to work out and record. There are for example core tasks done at every grade the depth, responsibility, and resources needed or use will differ from grade to grade. Again this has to be clearly worked out. Before any job matching or evaluation can take place.

Remember this process is happening for every staff group within the early implementers. I can not speak for every trust but certainly here whilst the Scientific staff group per se is large it is only in 3rd place when compared to Nursing, and Ancillery staff groups. As such this means we have had to take our turn.

Also job matching and evaluation (if needed) is done by a pannel of the orgnisations own staff not outside these take time to train and again slows the process down.

So I hope you can see that there is no deliberate attempt to misinform, it is simply that at the moment as I say there is not really anything to say.

Finally whlist we are "all" taking the view that this is definately going to happen don't overlook the fact the voting on this issue at the moment has been just to as I say agree to try this process out. Before any National Roll Out there needs to be another Union vote to accept the package.

If any of you have any major burning issues on this subject then e-mail me I am happy to discuss our experiances to date.

Paul, my burning issue with AfC is whether I am to be compromised (yet again) by a system that has a tendency to destroy any good-will that exists with it's staff and demoralises them by allowing possibly non-representative groups of volunteers to steer badly thought-through processes and schemes, on the fly, for whatever reasons I can only imagine. You mention the status and equivalence of Clinical Engineers, Works Officers and Technologists and in particular the CEng qualification......??

Well we all have to have aspirations but mine are set a little lower – will I take a reduction in salary and have negligible future prospects after all this? I hope not. If CEng and equivalent status that is what drives you through the AfC process then fair-enough but the majority of us in EBME are monitor menders. Of course I am suggesting that you may be out of touch with the masses. A just and fair pay scheme for individuals in our position is going to be very difficult to achieve for at least three reasons:

1. There is a high demand for technical staff and it's difficult to recruit and retain them - this has already been recognised; that's why there is the inclusion of a temporary (albeit 7 years), discretionary, recruitment and retention premium applied as and when seen fit by the local assessment panel. This means that in areas where there is a skills shortage, that technicians doing the same job (or at least have the same job profile) as their colleagues working in areas with less demand, that they may be paid more for being on the same grade i.e. be paid the R&R premium. Fair? More like a skills-postcode-lottery to me.

2. The fact that there will be local assessment of the similar job profiles will mean that its likely there will be discrepancies between the grades that some individuals achieve at one location to what an individual achieves at another. It is just a fact of life that rules (whether they be the law of the jungle i.e. evolution or not) will be interpreted and applied differently by different groups of assessors - perhaps under the influence of local pressures e.g. financial position of the Trust. Despite all the training and software packages under the Sun.

3. With all the good will in the world, some Technologists may lose out because they work in small departments providing limited services. The job-roles will be assessed commensurate with the level of the limited EBME services that exist in some hospitals and may ensure that the associated grading puts Technicians onto a lower-salaried band than they were on before. The catch may be that the services at that location will never be improved so there will never be the opportunity to progress. Not until there is a mass-exodus will R&R premia be applied, I reckon. No one just hands-out premiums for no reason - I think even R&R premium will be assessed locally - by that time the experienced staff may have already gone, to the higher paid jobs, if possible.

Just my spin on it all you understand, not Chinese Whispers or anything like that. My burning issues, if you like.

Before AfC or NOS there may also be a tendency that staff currently performing certain duties, tasks or responsibilities will be relieved of these if there is the possibility of others, in the position to do so, to claim these in order to boost their own status in the scheme. e.g. training roles, relieving other staff of tasks and responsibilities such as quality systems, etc, etc. Hence by striving to remove the inequality between professions AfC may well enhance inequalities and infighting within the same profession. This may really be the Evolution you suggest (survival of the fittest).

As for being a vast set of tests to perform – surely the group of experts involved in AfC are not trying to apply the system to job-roles that they know nothing about are they? If you are working within Clinical Engineering or equipment maintenance surely you have been involved, with your peers, in your chosen field and not “dabbling” with other job-roles? This seems inefficient to me if that's the case but I'm really only interested in the progress towards the job-profiles of Clinical Technologists because I'm an Engineering Technician, not a Clinical Biochemist or a Respiratory Measurements Technologist. The wider picture is irrelevant to a monitor-mender like I am and a luxury since my time is not my own during working hours.

As I see it the problem that the NHS has is that it's never been clear what kind of a service is required from Clinical Engineering and how this is to be achieved i.e. no thought-out plan (looks like this is set to continue judging from your posts). So how can job-roles be assessed in the “wider picture” if they vary so much from location to location? No consistency or standardisation in job roles so how will you maintain consistency and standardisation in the AfC and NOS? Perhaps NOS should have been introduced before AfC, once the NHS management had decided what it wanted from it's employees – after deciding what sort of services it wanted to provide, of course. Oh and telling us about it and avoiding leaving "filling in the gaps" to groups of volunteers, perhaps, Oops, I am being controversial again.