Clare Chapman: happiness is a warm NHS workplace

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The NHS has loyal staff and their development must rank high among employers' own local commitments, says the Department of Health's director general of workforce

You cannot squeeze high quality work out of low quality workplaces. Quality workplaces are good for both staff and patients - and are essential to meet the productivity challenge.

But while many staff in the NHS tell us they are committed, trained and honoured, there are still too many variations across the country. Thousands of staff working for both commissioners and providers confirm that while they love their job they feel the system can often get in the way of doing the right things for patients and communities.

At the NHS Employers conference this week, I explained why I think it is essential for us all to take bold steps to put this right.

Improvements must come from local action. Inspiring leaders, engaged staff and involved communities are critical if the high standards that exist in the best organisations are to be available to all who deliver NHS services.

The big workforce themes set out in the next stage review and the draft NHS constitution will help create the conditions for this. Indeed, Workforce Foundation chief executive Will Hutton wrote just a few weeks ago in HSJ that no British enterprise has gone as far as us with our workforce commitments.

The timing is right for another leap forward in the improvement of workplaces. The NHS has seen investment in new and refurbished facilities, the largest expansion of doctors, nurses and other clinicians for a generation, significant changes in workforce contracts and increased attention to improving working lives with professions and social partners. This investment now enables us to transform our working practices in the interests of high quality care. We know quality is best delivered by teams with access to the right information, that are focused on patient pathways and have a shared endeavour to get it right for patients.

Unprecedented commitment

To support regional health economies in what they commit to locally, there are three areas where our national system is being realigned to reward the behaviour sought by the public, patients and staff.

First, the draft NHS constitution includes unprecedented commitment to those delivering services. Its four pledges to staff are properly structured jobs designed around the delivery of care; to provide personal development, training and support; to ensure staff are healthy and safe and to engage staff in decisions that affect them. These pledges will be backed by the full weight of the constitution and we have asked the Healthcare Commission to build the staff survey into its evaluation of trust performance.

I welcome debate around the draft constitution and its values - some of which has taken place in HSJ in recent weeks. Let me be clear at this point. The values have surfaced very much from the bottom up. Thousands of staff and patients have told us what is important to them. Our values are not, as some have suggested, designed to be imposed on local organisations from the centre. Rather, they describe the common traits we expect to be applied across the workforce as organisations and communities interact. We also hope they will support organisations' discussions about their own values.

The second area of alignment can be seen in the commitments to education and training laid out in A High Quality Workforce, published as part of the next stage review. One of the things that distinguish the NHS from most workforces is that 60 per cent of the staff who are with us now will still be with us in 10 years. It is vital that commitment to their development equals the commitment made to a new generation of health service staff.

Finally and crucially, there are the commitments made on leadership. The next stage review reinforced the new approach to accountability based on openness around quality of outcomes and the greater freedom leaders will have to act and be responsive locally.

In response to a recent editorial in HSJ , let me put the record straight - I am not here to line manage the NHS. I am here to understand what matters to the public, patients and staff and ensure we create the conditions where these needs can be delivered.

Lasting change cannot be line managed from the top down. That is why responsibility for delivering on these commitments will sit locally. All health employers will be challenged to interpret the national vision in their own way and to act within this framework to improve the working lives of staff so they can act with confidence to do what they joined to do - make the difference for users of NHS services.