Streamlining services and funding is important but above all managing staff engagement is now vital to protect jobs and quality of care, says Chris Roebuck

The planned efficiency savings in the NHS demand a renewed focus on quality and efficiency to find cost reductions, drive innovation and create new ways of working. It is only by doing this that the quality of services, patient care and jobs will be protected.

The three main areas are:

  • Operational efficiencyLean process and efficient supply chain.
  • Allocation efficiency Mergers, service configuration and prevention.
  • Changing efficiency through people Performance management, engagement and culture change.

It would be a mistake to view these as discrete process driven components. They are interconnected and people driven. It is people who find efficiencies, innovate and deliver the service. To achieve this they must be engaged though the actions of supportive line managers and by the example of senior management.

Seventy per cent of NHS expenditure relates to people. Research shows that the individual performance of up to 60 per cent of your staff could be increased by 30 per cent if they were fully engaged.

Think of nearly two thirds of your people doing 30 per cent more or better work for the same money in the same time. What impact could that have in mitigating the budget reductions and improving patient care?

Chief executives, directors and HR directors must quickly initiate a local engagement and effectiveness strategy.

If they do not, then each reduction of £1m in budget could result in the loss of 30 posts. This would present both HR and the organisation with significant extra workload that could divert resources from performance and patient care.

All executives should have a basic understanding of skill mix, workforce utilisation, benchmarking, service reconfiguration, lean process, clinical governance, world class supply chain principles, business diagnostics and leadership to enhance delivery of care pathways and improve quality, service and efficiencies in multiprovider, multiple agency environments.

This will create a single aligned leadership team who understand and support each other to deliver a common outcome. Such knowledge can be quickly taught.

Keep it simple, practical, outcome focused and based on common sense - no over complex systems, no over technical language, no assuming your function is better than other people’s. It is about real team working.

Delivering performance uplift is also about leadership at all levels. Every line manager, every person who leads a team or influences people, be they clinicians or managers, must have a clear understanding of what must be done and be able to lead, engage and inspire their people even in difficult times.

They must have the capability to find and deliver cost efficiencies, find and deliver better ways of working though innovation and improve performance and quality through their team.


However, this is not simple to achieve - it requires co-ordination from the top to put the components in place quickly. There is no point waiting for the cuts to bite before taking action. In the months remaining before they do, significant benefit can be gained from preparing people through clear communication and capability building.

Working with the chief executive and other directors, the HR director can focus all the people systems on to the delivery of improved performance and better care.

They can do this by making internal communication clear and timely, getting senior management to set the example, creating a performance culture, developing the skills of line managers, engaging all staff, rewarding examples of excellence, identifying potential leaders with the skills needed to inspire people, changing the organisational structure and ensuring performance is managed effectively day to day and innovation is encouraged.

The NHS is not facing doom and gloom as a result of the recession. Yes, times will be tough but if the preparation starts now and the focus is on what matters - excellent performance from people and inspirational leadership - then the improvements in care and delivery of efficiency follow naturally.

It is about creating a holistic approach within the organisation - not thinking of it as a set of different initiatives run by different people who do different things.