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.

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.


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?


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