I've just hear from a friend of mine in London about a Primary Care Trust. The interim managers (external contractors) have suddenly discovered that the local PCT is exceeding its budget. So now they are in panic mode, rapidly trying to slash costs, which if they'd managed them properly in the first place would not be a problem. They are trying to cut costs by reducing the number of nurses and also recruiting lower grade nurses where an essential vacancy occurs. For this particular clinic the funding was supposed to have been ring fenced.
The result is that the senior experienced nurses are voting with their feet and leaving what was a highly skilled and stable team that has taken years to build up. The management response, stopping any temporary staff needed to cover sickness/maternity leave, bullying to get the senior nurses to agree to unrealistic rotas and expecting nurses to work unpaid overtime to fill the gaps. These senior "managers" are paid four times what the nurses are paid. The managers have no clinical skills or experience of nursing.
It is ironic that this particular service attracts payments from other PCT for treating "out of area" patients. The "income" is twice the running cost of the Department. The whole service is funded by external commissioners and there are agreed service levels. If there are not sufficient nurses on site, the public will be turned away and their ailments not treated.
I say - fire the managers and not the nurses! Just another demonstration of the difference between managers and administrators. These people are definitely not managers, but probably can craft excellent powerpoint slide shows.