Craig Ryan

Writer | Reporter | Editor

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  • Fit for work, or not the right fit?

    With one in five working-age Brits out of work and not even looking for a job, ministers are very worried about Britain’s ‘economic inactivity crisis’. People drop out of working life for all sorts of reasons, but the biggest is ill-health — people on long-term sick leave or claiming various state disability or incapacity benefits.

    This costs a lot of money: around £212 billion a year in lost output, welfare payments and NHS costs (that’s 70% of the income tax Brits pay every year) according to official statistics. On top of that, ill-health and sick leave costs employers £85 billion every year.

    And it’s getting worse. 800,000 more people are off work with health problems than before the pandemic and another 600,000 are set to join them by the end of the decade.

    So along comes former John Lewis boss Sir Charlie Mayhew with his independently-produced report for the Department of Work and Pensions, chirpily entitled, Keep Britain Working.

    Economic inactivity is a ‘serious but fixable problem’ says Charlie. ‘We’ve ended up in a situation that no one wants, that is neither sustainable nor necessary.’

    He proposes a new partnership between government, employers, trade unions and the NHS to develop a ‘healthy working lifecycle’: an agreed set of standards on workplace health and disability across the UK. There are a whole raft of other measures including changing the benefits system to encourage people back to work and reform of the UK’s ludicrous ‘fit note’ system, which has never really worked since it replaced ‘sick notes’ in 2010.

    The report doesn’t set targets, but in his intro bit Charlie talks about raising the UK’s employment rate to the average (80%) for advanced Western economies — that means adding another two million people to the UK workforce.

    It’s a thorough and thoughtful piece of work. But my worry is that even if all this does get millions more people looking for work, we’re going to run smack into another problem that could be just as hard to solve.

    Where are these two million jobs coming from?

    Many, probably most, people on long-term sick or disability will be older, experienced workers. You only have to spend five minutes on the socials to see that these workers are really struggling to find work. Linked In is full of people of a certain age (around mine) who talk about little else.

    If you’re looking for harder evidence, try here on employment rates, here on older-worker unemployment or here on age discrimination. Or just ask anyone over 50 who’s looking for work.

    The rush to replace human beings with AI, which is still accelerating even as evidence of the technology’s limitations and costliness proliferates, isn’t going to help either. AI — or more accurately expectations about AI — is cutting a swathe through exactly the kind of office-based, information gathering and processing jobs most likely to be suitable for people coming back from long-term sick.

    How can we expect people recovering from mental or physical health problems to see themselves as ‘fit for work’ if employers tell them over and over again that they’re not — that they’re too old, too experienced or ‘not the right fit’ for the jobs available? Endless rejections by an AI bot or, worse still, being continually ghosted after putting a lot of effort into applying for jobs isn’t going to do a whole lot of good for your mental health.

    Maybe it was outside Charlie’s remit, but the report doesn’t seem to deal with this at all. Incentivising employers to invest in workplace health and ‘return-to-work’ plans for sick workers is great, but it won’t help much if there are no jobs for people to go back to.

    Tackling the supply side of this problem but ignoring the demand side will just create more ‘statistical’ unemployment and lead to more misery. Unless we do something as a society to create more jobs — real jobs for human beings, not machines — we’re just setting up people to fail.

  • The overpaid ‘shelf-stackers’ giving City chiefs a headache

    Photo by Vitaly Gariev on Unsplash

    Today’s Financial Times(£) reports “City executives” wetting their pants about the UK’s minimum wage (£12.20 an hour), which is apparently getting too close for comfort to the meagre starting salaries finance and professional service firms pay their graduate recruits:

    Several chief executives have voiced their fears about the impact on recruitment if the minimum wage reaches pay levels for graduate positions in traditional white-collar jobs. 

    “Why would young people take on £45,000 of student debt if they can earn the same stacking shelves?” asked one.

    Well, one reason might be that working in professional services in a comfortable office in “the City1” is a lot more pleasant and interesting than stacking shelves, wiping bums or flipping burgers. Another might be that graduates working in the City can look forward to professional training, promotion, much higher salaries and even better jobs in the near future — nice things rarely on offer to people doing minimum wage jobs.

    When I left university, I was offered a job with a management consultancy firm. The salary was £16k — very decent at the time, but not exceptional. I didn’t really want to be a management consultant, so I took a job at the House of Commons instead, which seemed much more interesting and exciting, although the salary was about a grand lower.

    That was in 1991. That £16k is worth £40,400 of today’s money2, well above today’s median graduate starting salary in “finance and professional services” (£33k according to the FT) and miles above the minimum wage (around £25k for someone working a demanding 40-hour week). Graduate salaries have not even kept pace with inflation, let alone with wages overall, as the FT story acknowledges:

    While pay for senior ranks at the Big Four accounting firms has soared, junior staff are paid much less as a result of the firms’ “pyramid” structures, with thousands of young workers hired each year but only a small number making it to a senior level.

    It didn’t seem to occur to any of the executives who spoke to the FT that their firms might consider paying graduates more than people doing jobs they clearly look down their noses at. But none presented any evidence that they were actually struggling to recruit graduates, or losing talented young people to the irresistible allure of working in Tesco or one of Amazon’s warehouses. So why all the whingeing?

    The answer, I think, comes further down in the story:

    City executives say they are increasingly trying to ensure young staff do not work long hours — traditionally a matter of course for new starters gaining experience — to avoid falling foul of minimum wage rules...

    Some employers who spoke to the FT voiced fears they would end up being “named and shamed” by the government for inadvertently paying below the minimum wage.

    So there you have it. The real worry is not problems recruiting graduates or “social mobility”, but that by forcing graduates to work long hours (a “matter of course”, according to the FT), City firms might get done under the minimum wage laws for not paying them enough on an hourly basis.

    Of course, City firms could easily pay their over-worked graduates a bit more, perhaps by taking some of the froth off the salaries of people higher-up that “pyramid” — you know, the sort of people who get to grumble to the FT about how hard it is being a “City executive”.

    But no, to keep on dumping on their own junior staff, they’re now trying to enlist the government in dumping on the poorest working people in the country by holding down the minimum wage. I guess that’s the kind of stellar leadership they’re so well paid for.

    1. For readers outside the UK, “the City” is shorthand for the big, prestigious financial, commercial and legal firms in the UK, which often (but not always) have their headquarters in the square mile of the City of London. ↩︎
    2. Adjusted by cumulative CPI inflation between 1991 and 2025 using the Bank of England’s Inflation Calculator ↩︎

  • Out now: Winter 2024-25 issue of Healthcare Manager

    The latest issue of Healthcare Manager, the quarterly magazine for managers in the NHS and social care, is out now.

    This one turned into a bit of a ‘reform special’, with the fallout from the Darzi review into the state of the NHS (there’s a very good summary of Lord Darzi’s findings from the NHS Confederation here), and lots of rather bitty statements from ministers on how they might reform the NHS and what might be in the forthcoming ten year plan.

    Cover of Healthcare Manager 62, Winter 2024-25, featuring photo of Ed Garratt.

    So in this issue we look at what the Darzi review means for managers, how the ten year plan needs to be different from previous failed reform plans and at the government’s rather sketchy plans for professional regulation of NHS managers.

    Our main interview is with Ed Garratt, chief executive of the Suffolk and North East Essex Integrated Care Board (ICBs are the bodies that plan and fund NHS services in your local area). As well as running one of England’s most successful ICBs, Ed leads a whole bunch of task forces and pilot projects that may play a big role in the government’s reforms. What he has to say about the need for compassion and kindness in leadership, investing for the future and doing things differently in the NHS is well worth a read.

    I hope you enjoy this issue. The digital edition is free for everyone to download and read. 

    I’ve been editor of Healthcare Manager since 2016 and have worked on the title since it was launched in 2009. If you want to know more about the magazine or work with us on a story, please drop me a line.

  • Healthcare Manager — 2024 Election Special

    The election special edition of Healthcare Manager is out now.

    Election coverage is difficult. There’s a lot of noise to cut through but very little light shed on the big issues. We’ve tried to look at this election from our readers’ perspective, as people trying to manage health and care services in the most difficult environment since World War II. We’ve set out what we see as the business the next government – red or blue – needs to get done in the NHS. We’ve looked at what the experts say about six big issues – waiting lists, workforce, social care, reform, buildings and technology – and what Labour and the Tories are offering. And we’ve examined four (there are many more) looming trouble spots that you won’t hear much about in the campaign.

    We also have an interview with GP, comedian and health campaigner Dr Phil Hammond, some tips on how to restart your career after redundancy and some frank advice on what to do if you’re being discriminated against at work.

    I hope you enjoy it. The digital edition is free for everyone to download and read. 

    If you would like to know more about Healthcare Manager magazine or work with us on a story, please drop me a line.

  • Healthcare Manager magazine

    I’ve been editor of Healthcare Manager since 2016, having worked on the title as a consultant editor since it was launched in 2009.

    The magazine is published by Managers in Partnership (MiP), the union set up by Unison and the FDA to represent senior managers in the NHS and social care. We publish four issues a year, offering a mix of news reports, analysis, in-depth features and advice on professional, employment and trade union issues.

    As editor, I plan and commission content for each issue (as well as the MiP website), research stuff that might interest our readers and sub-edit all copy, as well as contributing news reports and features myself. I work with MiP staff to make sure the union’s priorities are covered and help staff to produce content themselves.

    I also manage the work of our freelance contributors and photographers, and control expenditure on the magazine within the overall budget set by my bosses at MiP.

    Design, layout and production is handled by my colleague James Sparling through our company, Lexographic. I work closely with James to finalise the covers and inside pages of the magazine, including writing headlines and captions, selecting images and signing-off of the pages for print.

    We also liaise with the printers and distributors to ensure everything runs smoothly and the magazine gets published on time and on budget.

    If you would like to know more about Healthcare Manager magazine or work with us on a story, please drop me a line.

    Download sample copies of Healthcare Manager

    You can always download the latest issue free from the MiP website.

    HCM 44 Winter 2019-20 Cover
    HCM44 Winter 2019-20
    HCM43 Autumn 2019

  • From ground zero to net zero

    Published in Healthcare Manager 56, Summer 2023

    Decarbonising healthcare will take everything we’ve got and affect everyone working in the NHS. But well-meaning national strategies are struggling to have much impact on the ground. I spoke to pioneering surgeon Aneel Bhangu about the barriers to change and ask why NHS staff and unions aren’t more involved in meeting our greatest long-term challenge.

    Read the web version
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  • When work can be your lifeline

    Published in Healthcare Manager 55, Spring 2023

    Domestic violence and abuse blights the lives thousands of NHS staff every year, and the problem has only got worse since the start of the pandemic. But work can be an important refuge and source of strength for people experiencing abuse, and good support from managers and employers can be a lifeline.

    Read the web version
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  • The last report?

    Published in Healthcare Manager 53, Autumn 2022

    The annual deliberations of the NHS Pay Review body have been a fixture of industrial relations in the NHS for nearly 40 years. But declining trust among staff, high inflation and a marked failure to tackle spiralling staff shortages have put the NHS pay system under severe strain, writes Craig Ryan. Has the review body run out of road? And what could take its place?

    Read the web version
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  • A few words for my dad…

    My dad, Don Ryan, was a World War II veteran, London fireman, electrician, DIY superhero and the best dad anyone could wish for. He would have been 100 today. To mark his centenary, here’s the eulogy I wrote and read at his funeral in 2009.

    I would like to thank you all for being here today. At times like this, words are cheap. But they’re all we have. Words are my trade, and Dad loved words too. He was a big crossword man, scrabble too, and he had a particular fondness for puns – the cheesier the better. And he loved to regale us with obscure London slang – though I think he made some of it up.

    A few words, then, for my Dad.

    He had a long and happy life but it wasn’t always an easy life. Poverty, the great depression, and then war, made for a difficult start. 

    A few weeks ago, I went to look for the house in West Norwood where Dad was born. It’s gone, of course, the site is now the Lambeth Council municipal dump. Dad laughed when I told him. ‘I’m not surprised,’ he said. ‘It was already falling down when I lived there.’

    When Dad was born there was no TV to watch, no radio to listen to. Money was still made of silver and, as Dad would no doubt say, tea was still made of tea. No one had ever heard an electric guitar, put milk in a fridge or seen the West Indies play test cricket. 

    In his lifetime, Dad saw four monarchs and 17 prime ministers. And I don’t think he was greatly impressed with any of them.

    Dad wasn’t famous, but his was a big life, an important life. He was a modest man; he didn’t ask for any special recognition. ‘I was a bit of a coward, to be honest,’ he would say about some incident in the war. He never even bothered to collect his war medals and he wasn’t interested in ceremonies or reunions. He was quite happy to talk about the war, but his life was more than just that war. 

    He knew war is a ridiculous situation in which to place human beings, and if you couldn’t laugh at war, see it for what it was, it would take over the rest of your life.

    But let’s not forget Dad saw things that none of us can even imagine. 

    Near the end of the war, Dad was with the Royal Armoured Corps advancing into Germany, when the Nazis sent batallions of old men and kids – some as young as 12 – to fight them. 

    The old men, no fools, surrendered en masse. The kids, pathetically brave, did not. The British troops refused to fire on them. They had to use heavy artillery from behind the lines, so the gunners couldn’t see whom they were shelling. 

    Dad thought he’d seen everything.

    And then came the horror of the Belsen concentration camp – which he could hardly bear to talk about even sixty years later – where the survivors were so traumatized and hysterical that they had to be locked up again by the British troops who had liberated them.

    Nothing in our lives can compare to those experiences. 

    Dad also played a small part in the Cold War. In fact, I sometimes think Dad might have started the Cold War himself. 

    In late 1945, he was stationed in Helmstedt, running a railway station right on the border between the British and Soviet zones of occupied Germany. The Russians were blocking an important convoy from Berlin, so Dad went across the frontier to see the Soviet Commissar at Marienborn, to try to persuade him to let the train through. 

    ‘Nyet, Comrade,’ said the Commissar. 

    Dad went off and came back with his interpreter, a six-foot-six guardsman nicknamed ‘Lemon’. He waited on the platform while Lemon went into the office to speak to the Commissar. After few minutes of shouting, the Commissar crashed through the plate glass window and landed on the platform on his backside, pursued by Lemon, who stood over him, abusing his paternity in Russian. 

    The Soviets let the train through – grudgingly – but it’s probably a good thing for all of us that Dad’s methods of diplomacy weren’t used more widely in the decades that followed.

    In the 1970s, Dad crossed the Iron Curtain again to work in Eastern Europe. He would spend weeks on end in such mysterious places as Moscow, Prague and Sofia. Some Russian engineers even visited our house in Frimley, accompanied by their KGB minder. 

    In the paranoid atmosphere of the 1970s, this led some of my schoolfriends to think that Dad was a Soviet spy. We were Labour anyway, so it wasn’t hard to make that leap in some people’s minds. When the Bulgarian dissident Georgi Markov was murdered with a poisoned umbrella on Waterloo Bridge in 1978, one of my friends asked me – quite earnestly – if Dad had anything to do with it. 

    The funny thing was, and this says something about the tragicomedy of the Cold War, no one seemed that bothered. I never told anyone Dad was a spy. But I didn’t deny it either.

    Dad was many things in his life. But being a husband, father, and a good friend, was what he excelled at and enjoyed most. 

    It’s been a difficult couple of weeks, but I can never think about Dad for long without smiling.

    The ridiculous sideburns he sported during the 1970s. The Denis Healey eyebrows he always refused to trim. The glint in the Eric Morcambe glasses askew on his face. His Shirley Temple fancy dress outfit that made him look like Miss Piggy.

    However you picture him, I’m sure what you’ll remember most is his good humour, his optimism, his warmth and his sheer humanity. 

    The way he always saw the good side of things and the best side in people. 

    How he took things as they came, and people as they were.

    And how his remarkable life was so rumbustious and full of fun.

    But let’s not be sad for more than a few moments when we think of Dad.

    When he died, I felt that everything associated with Dad was already falling indelibly into the past.

    He meant, quite literally, the world to me.

    But the past never leaves us, and neither do the memories of those we love. The past is always part of the present, and our lost loved ones become part of who we are, now and for the rest of our lives. 

    We began with words and I’ll end with one word.

    This is something I was reading the night before Dad died. It’s from the novel Underworld, by the great American writer – Dad’s namesake – Don DeLillo. And it’s somehow become associated in my mind with Dad’s life and with my own. So I’d like to share it with you.

    You glance out the window for a moment…and you try to imagine the word on the screen becoming a thing in the world, taking all its meaning, its sense of serenities and contentments out into the streets somehow, its whisper of reconciliation, a word extending itself forever outwards, the tone of repose, the tone of hail and farewell…a word that spreads a longing through the raw sprawl of the city and out across the dreaming bourns and orchards to the solitary hills.

    Peace.

    Don DeLillo, Underworld (1997), p827

    Thank you for listening and may peace be with you.

  • Timebanking UK website

    Through my company Lexographic, I’m working with Timebanking UK to design and develop a brand new website, which we hope will go live in August 2020.

    Timebanking UK (TBUK) is the national charity that supports time banks across the UK and promotes the concept of time banking itself. The new website will provide a wealth of resources on timebanking for general readers, time banks, sponsors and funding organisations. Available resources will include videos, infographics and case studies of people whose lives have been transformed by timebanking.

    My job is to advise Timebanking UK staff on content, develop and maintain the content plan, edit all copy and to generally keep the project on track. Design and technical stuff is mainly handled by my business partner, James, working with TBUK staff.

    We are planning to begin a second phase of development in Autumn 2020, once the new site has gone live. This will involve a dedicated area for member time banks, a discussion forum and online booking for training and events.

    While working with Timebanking UK, I became interested in the potential of timebanking to build stronger communities and tackle social isolation, loneliness, poverty and mental ill-health. In 2019, I accepted an invitation from Timebanking UK to become a trustee of the charity.

    To find out more about timebanking and TBUK, visit the charity’s old website (and you may get some idea why we’re replacing it).