Annex A > Chapter 5 - Regional, District and Trust Management > Management structures throughout the period in question > Staffing and contracts of employment
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Staffing and contracts of employment
152 The Personnel/Human Resources Department of B&WDHA [185] was responsible for producing and reviewing job descriptions and the criteria for appointments, as well as for training regimes and patterns of deployment. [186]
153 Increases in staffing took place in response to the planning requirements of the SWRHA/B&WDHA Project Team and on the basis of advice from the existing medical staff of the District. For the DHA, advice on medical staffing for planning purposes came from the DMO, Dr Baker.
154 Clinicians would raise the need to replace an outgoing consultant or for the appointment of additional staff via the clinical groups and advisory committees. A job description would then be prepared with advice from the relevant Royal College, incorporating contractual requirements as laid down by the DoH. They would then be submitted to the DHA, which would approve the appointments through its Annual Programme processes. [187] The standard of a candidate would be ascertained by examining their qualifications, then a shortlist would be produced of those who were to be interviewed. Formal appointments advisory committees, which included clinical representatives and representation by the relevant Royal College, conducted the interviews.
155 Control of the number of medical staff posts overall was exercised by the DHSS/DoH via the RHAs. Approval for new and replacement posts had to be sought from the regional manpower committees. [188]
156 The Regional Manpower Committee was an advisory committee of the SWRHA. The RMO advised the Regional Manpower Committee on national and regional medical manpower planning requirements. The Committee had to pre-approve any appointments, bearing in mind DHSS/DoH manpower planning requirements, before forwarding the prospective appointment to the Central Committee of the DHSS for its approval. [189]
157 Criteria and procedures for appointments of consultants were laid down by HC(82)10 [190] and HC(90)19. [191] These Health Circulars advised on the composition and procedures of the Advisory Appointments Committee, which made recommendations to the DHAs for the appointment of consultant staff. Dr Baker explained that the DHA could accept or reject these recommendations, but they were usually accepted. [192]
158 As B&WDHA was a teaching district, it recruited consultant medical staff and held their contracts of employment. In non-teaching districts, the SWRHA held the contracts of employment. The role of the DHA therefore embraced ensuring competent staff were recruited and that there was sufficient provision within the contract of employment to maintain the standard of service, for example by training and study leave requirements.
159 With regard to who held the contracts of the consultants at the hospitals, Miss Hawkins explained that the RHA would not be able to suspend a consultant directly:
`We held the contracts for all consultants except those in the Teaching Authority. They [the Teaching Authority] held theirs, so that was why we would have to have had the dialogue with the Chairman, the Vice-Chairman, even the DHA itself with the RHA to tell them of the problems, to involve them and to get them to suspend operations.' [193]
160 Senior registrars were employed by the SWRHA. Responsibility for their appointment lay with the Regional Committee in Specialist Training (RCST), which applied the criteria and procedures set out in HC(82)10. [194] The RCST was also an advisory committee of the SWRHA, reporting through, and accountable to, the RMO and his staff. The Medical Post-Graduate Dean was appointed to the RCST jointly by the SWRHA and the University, in order to take account of the national and regional policy for medical education and training. Dr Baker explained that the RCST was supported by a number of specialty sub-committees; for example, the Sub-Committee for Medical Specialties covered training in cardiology and the Sub-Committee for Surgery covered training in cardiac surgery. [195]
161 Dr Baker explained that responsibility for the appointment of registrars lay with the DHA between 1984 and April 1989. Thereafter it was transferred to the SWRHA and the RCST, following advice from the DoH. [196] Senior house officer (SHO) posts were subject to a nationally-imposed ceiling and their numbers were regulated by the RCST. This ceiling was lifted by 1995, and SHO posts became the responsibility of the Regional Task Force on Junior Doctors' Hours, chaired by the RMO and advised by the Post-Graduate Dean. [197]
162 The Advisory Appointments Committee assessed the experience of consultants at the time of appointment. Once they were appointed, their training was self-regulating. They were entitled to 30 days' study leave over a three-year period, with expenses paid from a budget held by the DHA. In addition, sabbatical leave could be taken. This was unpaid, although grants were available from various awarding bodies and other sources. [198]
163 Although as a teaching authority the DHA drew up and held the contracts for the consultants, it did not scrutinise the continuing training or study of the consultants employed. Ms Charlwood told the Inquiry:
`A standard form of consultant's contract allowed study leave. Job programmes identified time for research and audit, when the latter became an expectation. The [District] Health Authority supported professional self-regulation and development through funding and overall regulation of study and professional leave allocations. Since training and retraining was an individual professional responsibility guided by professional bodies, no Health Authority system supervised training/study or the resulting competencies of individuals.
`After recruitment, the maintaining and monitoring of standards and competence at B&WDHA level was by exception only, in terms of reports of inappropriate professional conduct. The work performance of consultants was largely self-regulated, with oversight by Directors of Clinical Divisions and operational managers. Infrequently, problems, usually about untoward behaviour or attendance, were referred to the District Medical Officer and/or the clinical representatives on the Health Authority.' [199]
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Footnotes
[185] Mr Ian Stone was District Personnel Manager 1982-1985, then District Manpower Manager 1986-1991; from 1 April 1991 he became Director of Personnel at UBHT
[186] WIT 0074 0012 Dr Baker
[187] WIT 0038 0025 Ms Charlwood
[188] WIT 0074 0012 Dr Baker; T36 p.42; T30 p.47-9
[189] WIT 0074 0013 Dr Baker
[190] HAA 0164 0375 - 0384 ; Health Circular HC(82)10
[191] HAA 0164 0385 - 0387 ; Health Circular HC(90)19
[192] WIT 0074 0012 Dr Baker
[194] HAA 0164 0375 - 0384 ; Health Circular HC(82)10
[195] WIT 0074 0013 Dr Baker
[196] HAA 0164 0393; Executive Letter EL(89)P88
[197] WIT 0074 0014 Dr Baker
[198] WIT 0074 0014 Dr Baker
[199] WIT 0038 0025 Ms Charlwood