We need a big conversation about workforce

1 October, 2012

What should the party conferences be discussing about the NHS? Dean Royles has some suggestions

The challenges facing public services feature large and it seems everyone has a view about the NHS.

But that shouldn’t be a surprise to us - it is a much loved institution but not perfect by any stretch of the imagination, and the financial challenges facing it are becoming increasingly evident.

‘The size of the challenges means transformation rather than incremental change is the only show in town’

People care about the NHS and want to be heard expressing their view; many also see opportunities, wherever they sit on the political spectrum. The size of the challenges means transformation rather than incremental change is the only show in town. New and radical ways of delivering care, more integration of services and reform of the workforce are just some of the themes.

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This change requires not only significant political will and resilience, but the need for some inspirational leadership and effective management from local NHS executives and clinicians. There will be many ideas proposed and supported at party conferences this year but it seems to me that whatever the party and whatever the debate we will need to look at some key issues for the NHS and its workforce.

Workforce reform

Being more efficient and containing pay costs will be important but only take us so far on the journey. Skill mix, ways of working and extended working days will require new processes and systems and change the way we train and educate staff. We must be more flexible with the national training monies available.

Hypothecated training funds based on how we treated patients years ago need to change. If not, we’re just make the training-rich richer and the training-poor poorer. We need to invest more in support staff, in particular bands 1-4, as these have such an important impact on patient care and the experience they receive.

Support staff

We must stop referring to support staff as untrained staff; it’s offensive to them and undermines the care they give to patients. Not being regulated is not the same as not being trained. Let’s learn from the best of our employers recruiting for values, setting standards, providing structured training and development and ensuring they are well led and supervised.

‘We need to “big up” support staff not undermine their confidence’

These are dedicated, hard-working, committed staff. We need to “big them up” not undermine their confidence by seeing regulation as the be all and end all of care.

Trade union involvement

We have to see trade unions as part of the solution, not the problem. Let’s get away from the polarised debate that portrays all staff as good and all managers bad. Partnership working has served the NHS, patients, staff and employers well. We need to stick with it and lead the way.

Leadership

All the evidence shows us that in other services, strong, engaged leadership has been a key factor in changing patterns of delivery. Taking staff with us is essential and the NHS constitution provides a reasonable framework to: provide staff with well designed jobs; give them the training to be effective; and the support they need to look after their health and wellbeing; as well as involve them in decisions that affect them. It’s what we all want, right?

Focus

While faced with the huge challenge of delivering change, it is essential we maintain a forensic focus on the founding principles and values of the NHS by concentrating on:

respect and dignity
commitment to the quality of care
compassion
improving lives
working together for patients
everyone counts

It’s a topical debate and one likely to take us from the party conference season all the way to the next general election. Where would you start?

Dean Royles is director of NHS Employers

Readers' comments (4)

Lorna Hunter | 1-Oct-2012 6:10 pm
"Inspirational leadership and effective management from local NHS executives and clinicians"

What does that really mean? it's becoming the universal catch all phrase just like "strategy" in the 80's.

We need the "doing" of leading to to happen and take us forward rather than more talk of leadership. The workforce in healthcare services is under huge pressure and we need those in command to step out of their ivory towers to lead and support the changes required. They need to be present with staff groups and authentic in the way they present thmselves. Only then will the workforce want to engage and make the changes happen.
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Sue Johnson | 2-Oct-2012 8:15 pm
Hard to disagree with this content, but what is meant by skill mix? There are many opportunities in the advanced practice/consultant practitioner work force that are blocked by medical practitioners. In fact down bandings and restructuring seem to be removing all the elements of high end skill mix that had been achieved. Constantly pushing work down the ladder without providing a sensible career structure and utilising the skills and knowledge that are available won't contain costs, it will only impact on quality. Allied health professionals, clinical scientists, nurses all have some high flying talented staff, use those talents, focus the training budgets to develop their skills and challenge the doctors to focus on providing those specialist high end skills that patients require. See the workforce as integrated with doctors not seperate andlets pay for the skills to be utilised effectively. Doctors are expensive but essential, i do not want themto be diminished but they need to se themselves as part of the whole team not as seperate or outside the transformation. Go on Dean, prove your money is where your mouth is. Tackle the medical hierarchy to support high quality non medical patient care where possible.
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alyx peters | 3-Oct-2012 3:00 pm
And while we are talking about workforce can we talk about the locum/agency market for healthcare staff. The vast majority of locum doctors and agency nurses are substantive NHS staff, they understand the issues the NHS faces but yet they inist on haggling over their pay rates which does nothing but fuel the off-framework market. Apparently locum doctors are unable to attend an agency office for an interview, the agencies appear to employ whole teams of roaming interviewers to go to the Doctor's own home to carry out the interview and provide mandatory training in their own homes, as you can imagine this is quite a costly and potentially dangerous activity. Framework agencies have already cut their costs to ensure their place on the frameworks but the off-framework market is estimated to be worth twice as much as the on framework market! So could we have a real grown up chat about the whole of NHS staffing please? Framework agencies are trying to work in partnership with their clients, we know how important quality and value for money are!!
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Kirsi Kekki | 4-Oct-2012 10:49 am
Involving the unions to staff development is the key and especially bands 1-4 need to have an access to learning and skills. A good example of union involvement is the upcoming SPF project to increase workplace learning.
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