If anyone thought that with Winter over, the crisis in hospitals would be over too, they will find that Spring has brought a batch of new problems - aimed especially, it seems, at workforce managers. These are making staff at Great Western Hospitals distinctly 'unhappy.'
The government imposed pay increase of one per cent for the coming year for about 1.3 million NHS staff - the seventh year running for one per cent rises or frozen pay levels - has not been well received. For some nurses, midwives and radiographers this will amount to less than £5 extra a week - with inflation at 2.3 per cent, food prices rising even faster and more inflation rises expected.
Oonagh Fitzgerald, GWH's Director of HR, told Thursday's (April 6) Board Meeting that the impact on staff had been 'very negative': "Staff are very unhappy. Pension contributions have been increased - net take home pay has gone down. It has not helped staff morale. We have a very unhappy workforce."
She added that staff unions planned to hold a meeting this coming Monday ((April 10). This blow has come soon after a staff survey showed that three quarters of respondents are enthusiastic about the work they do.
Commenting on the survey, chief executive Nerissa Vaughan told the Board: "Of course, the results also highlighted areas where we need to make improvements, such as our staffing levels, which is no surprise to me and recruitment and retention remains one of our key priorities."
On top of this there is the 'IR35' controversy. New IR35 regulations, which come into effect today, force 'off-payroll' workers to pay the same level of tax as full-time staff - making employers pay their tax and national insurance. This will affect locum doctors and agency nurses.
Elsewhere in the NHS, this has led to locum doctors demanding pay increases and threatening not to come to work. Lincoln Hospital nearly had to close its A&E department this week because locum consultants refused to do shifts due to the new tax rules.
A connected area for concern is GWH's continued spending on agency nurses. It was noted that 73 per cent of NHS hospital trusts have successfully reduced their agency spend and over half of these have cut these costs by more than a quarter.
GWH currently has a vacancy rate of seven per cent - that's equivalent to 330 full time posts. And they have to be filled from the hospital's own staff bank, with locums and with costly agency staff.
In the words of the director of finance, Karen Johnson: "Agency, bank and locums continue to put pressure on the Trust." And, she reported, the cost of overtime payments increased from £123,000 in January to £148,000 in February.
One of the reasons for higher agency costs has been the delay in getting new recruits from overseas up to the required extremely high standards of English - spoken and written.
Chief nurse Hilary Walker explained that having these overseas recruits working has positive results: "We have safer, quality care through their being here." But they cannot do the jobs they were employed to do unless they pass all their exams - so they have to have agency nurse cover.
Nerissa Vaughan knows the seriousness of the agency situation. "I can't'" she told the board, "run a hospital on a £13m annual agency bill."
GWH has run recruitment drives overseas and locally and does everything it can to support retention of staff. And there is a new recruitment drive coming soon - watch this space.