Recruitment and retention of estates and facilities staff in the NHS

Purpose – Agenda for Change is set to be the biggest reform of pay since the National Health Service (NHS) began in 1948. As well as introducing a standardised pay structure; it also aims to improve recruitment, retention and staff morale. Staff groups identified as having recruitment and retention problems include estates/works officers, qualified maintenance crafts persons and qualified maintenance technicians. The object of this research was to investigate recruitment and retention problems for estates and facilities staff currently experienced by Trusts. Design/methodology/approach – Focus groups were used as the primary method of data collection in an attempt to tap into the existing expertise of staff working at strategic and operational supervisory positions in a wide range of Trusts. Findings – Although our findings suggest that the main recruitment and retention issues fall into four main themes: social, financial, environmental and political; recruitment and retention of estates and facilities management staff is a complex problem involving a wide range of issues and these can vary from location to location. Furthermore this should also be seen as a series of issues that varies across employment groups including: domestic/housekeeping, trades, managers/officers and facilities directors, which need to be distinguished. Practical implications – There is a continuing need to raise the profile of estates and facilities management staff in the NHS to those levels enjoyed by Human Resource (HR) and Financial Management. Furthermore perceptions surrounding both recruitment and retention issues and the nature of work within estates and facilities management staff in the NHS can lead to a negative and self-perpetuating “cycle of failure” where there is an assumption of loss of control. However, there are some initiatives being undertaken that suggest it is possible to concentrate on internal matters such as more appropriate and flexible recruitment processes, improved support services for staff and greater flexibility within the job and that these can generate “cycles of success”.</p

Leadership conversations: the impact on patient environments

Purpose – The aim of this study is to examine 15 NHS acute trusts in England that achieved high scores at all their hospitals in the first four national Patient Environment audits. No common external explanations were discernible. This paper seeks to examine whether the facilities managers responsible for the Patient Environment displayed a consistent leadership style. Design/methodology/approach – Overall, six of the 15 trusts gave permission for the research to take place and a series of unstructured interviews and observations were arranged with 22 facilities managers in these trusts. Responses were transcribed and categorised through multiple iteration. Findings – The research found common leadership and managerial behaviours, many of which could be identified from other literature. The research also identified managers deliberately devoting energy and time to creating networks of conversations. This creation of networks through managing conversation is behaviour less evident in mainstream leadership literature or in the current Department of Health and NHS leadership models. Practical implications – The findings of this study offer managers (particularly those in FM and managers across NHS) a unique insight into the potential impact of leaders giving an opportunity to re-model thinking on management and leadership and the related managerial development opportunities. It provides the leverage to move facilities management from the role of a commodity or support service, to a position as a true enabler of business. Originality/value – Original research is presented in a previously under-examined area. The paper illuminates how facilities management within trusts achieving high Patient Environment Action Team (PEAT) scores is led.</p

Agenda for Change: views and experiences from estates and facilities staff

Purpose – Agenda for Change is the biggest reform of staff pay in the UK National Health Service NHS) since it began in 1948. As well as introducing a standardised pay structure; it also aims to improve recruitment, retention and staff morale. The aim of this study is to look in-depth at the experiences and opinions of a range of estates and facilities staff surrounding Agenda for Change during the implementation period. Design/methodology/approach – Focus groups were used as the primary method of data collection in an attempt to tap into the views and opinions of staff working at operational positions in a wide range of trusts. Findings – One of the most important and common themes, which reoccurred throughout the focus groups, was the view that the Agenda for Change framework was designed around the needs of nursing staff. Therefore, the framework did not adequately cater for the needs of estates and facilities staff. Specific concerns related to this included; the role or contribution of estates and facilities staff during patient care was not fairly reflected; trade qualifications were not recognised, particularly in comparison to academic qualifications; members of the job matching panels did not have the appropriate knowledge to make decisions surrounding estates and facilities jobs; nurses were more likely to make progress through the bands than estates and facilities staff.</p

An analysis of pupil concerns regarding transition into higher education.

Transitioning to higher education is often a stressful experience, with incoming students facing similar issues year after year. This chapter presents two years of data collection regarding the concerns of Computing secondary school pupils when considering their upcoming transition into the first year of higher education. Over the two-year period, it can be seen that pupils continue to demonstrate concerns regarding topics related to money, jobs and course achievement as opposed to those related to environment or social issues. The consistency between relative areas of concern over the two years is striking, further suggesting that an understanding of these issues might help higher education institutions to better support their incoming students

Methylmercury Exposure and Adverse Cardiovascular Effects in Faroese Whaling Men

Background: Methylmercury (MeHg), a worldwide contaminant found in fish and seafood, has been linked to an increased risk of cardiovascular mortality. Objective: We examined 42 Faroese whaling men (30–70 years of age) to assess possible adverse effects within a wide range of MeHg exposures from consumption of pilot whale meat. Methods: We assessed exposure levels from mercury analysis of toenails and whole blood (obtained at the time of clinical examination), and a hair sample collected 7 years previously. Outcome measures included heart rate variability (HRV), blood pressure (BP), common carotid intima-media thickness (IMT), and brainstem auditory evoked potentials (BAEP). We carried out multiple regression and structural equation model (SEM) analyses to determine the confounder-adjusted effect of mercury exposure. Taking into account correlations among related measures, we categorized exposure and outcomes in groups to derive latent exposure and response variables in SEMs. We used multiple regression analysis to compare the predictive validity of individual exposure biomarkers and the latent exposure variable on individual and latent outcomes. Results: The toenail mercury concentrations varied widely and had a geometric mean of 2.0 μg/g; hair concentrations averaged about 3-fold higher. Mercury exposure was significantly associated with increased BP and IMT. This effect was reflected by SEMs, but mercury in toenails tended to be the best effect predictor. Conclusions: The results support the notion that increased MeHg exposure promotes the development of cardiovascular disease

Restoring Akt1 activity in outgrowth endothelial cells from south asian men rescues vascular reparative potential

Recent data suggest reduced indices of vascular repair in South Asian men, a group at increased risk of cardiovascular events. Outgrowth endothelial cells (OEC) represent an attractive tool to study vascular repair in humans and may offer potential in cell-based repair therapies. We aimed to define and manipulate potential mechanisms of impaired vascular repair in South Asian (SA) men. In vitro and in vivo assays of vascular repair and angiogenesis were performed using OEC derived from SA men and matched European controls, prior defining potentially causal molecular mechanisms. SA OEC exhibited impaired colony formation, migration, and in vitro angiogenesis, associated with decreased expression of the proangiogenic molecules Akt1 and endothelial nitric oxide synthase (eNOS). Transfusion of European OEC into immunodeficient mice after wire-induced femoral artery injury augmented reendothelialization, in contrast with SA OEC and vehicle; SA OEC also failed to promote angiogenesis after induction of hind limb ischemia. Expression of constitutively active Akt1 (E17KAkt), but not green fluorescent protein control, in SA OEC increased in vitro angiogenesis, which was abrogated by a NOS antagonist. Moreover, E17KAkt expressing SA OEC promoted re-endothelialization of wire-injured femoral arteries, and perfusion recovery of ischemic limbs, to a magnitude comparable with nonmanipulated European OEC. Silencing Akt1 in European OEC recapitulated the functional deficits noted in SA OEC. Reduced signaling via the Akt/eNOS axis is causally linked with impaired OEC-mediated vascular repair in South Asian men. These data prove the principle of rescuing marked reparative dysfunction in OEC derived from these men.This work was supported by the British Heart Foundation, London, UK, and the Diabetes Research and Wellness Foundation, Portsmouth, UK

LKB1/AMPK and PKA Control ABCB11 Trafficking and Polarization in Hepatocytes.

Polarization of hepatocytes is manifested by bile canalicular network formation and activation of LKB1 and AMPK, which control cellular energy metabolism. The bile acid, taurocholate, also regulates development of the canalicular network through activation of AMPK. In the present study, we used collagen sandwich hepatocyte cultures from control and liver-specific LKB1 knockout mice to examine the role of LKB1 in trafficking of ABCB11, the canalicular bile acid transporter. In polarized hepatocytes, ABCB11 traffics from Golgi to the apical plasma membrane and endogenously cycles through the rab 11a-myosin Vb recycling endosomal system. LKB1 knockout mice were jaundiced, lost weight and manifested impaired bile canalicular formation and intracellular trafficking of ABCB11, and died within three weeks. Using live cell imaging, fluorescence recovery after photobleaching (FRAP), particle tracking, and biochemistry, we found that LKB1 activity is required for microtubule-dependent trafficking of ABCB11 to the canalicular membrane. In control hepatocytes, ABCB11 trafficking was accelerated by taurocholate and cAMP; however, in LKB1 knockout hepatocytes, ABCB11 trafficking to the apical membrane was greatly reduced and restored only by cAMP, but not taurocholate. cAMP acted through a PKA-mediated pathway which did not activate AMPK. Our studies establish a regulatory role for LKB1 in ABCB11 trafficking to the canalicular membrane, hepatocyte polarization, and canalicular network formation