Personnel issues are dominated by the implications of the NHS plan. Delegates at AHHRM's annual conference thrashed out the crucial points. Ann McGauran reports from Dublin

Are you overwhelmed by orders and submerged in strategy? Maybe you're worried by the working-time directive and don't know your nurse consultants from your consultant therapists.

For the battered and confused, last week's Association of Healthcare Human Resource Management conference in Dublin was the place to go to soothe frazzled nerves and lift the spirits.

The theme of the conference, introduced by new AHHRM president Karen Bell, was 'fit for purpose in a world of change'. The programme concentrated on organisational development. Who knows, maybe it even sent HR professionals back to work ready to meet the huge management challenges posed by the NHS plan.

That document, still in its mewling infancy and lurking in bulging in-trays, must have been one of the main culprits responsible for the strained 'up all night' look worn by most of the conference delegates.

Ms Bell said that, as HR professionals, the audience were the people who would have to 'arrive at a shared vision' around the plan and find 'new ways of recruiting and maintaining specialist staff '.

Modern medical staff contracts, recruitment of a vast body of extra consultants and nurses, childcare support for staff and new partnerships with social services departments in new primary care trusts were just a selection of a massive list of proposals in the NHS plan requiring substantial HR commitment.

But the body language of delegates said it all.

They shuffled into the lecture theatre and sat around the edges like demoralised schoolchildren.

Surely they weren't trying to avoid eye-to-eye contact with their big boss Hugh Taylor, the NHS Executive's director of HR?

Mr Taylor, who has a prison service management pedigree, told it to them straight. He admitted the NHS plan was 'complex', but systems had to change, and HR was firmly on the 'bottom line', he said.

He talked about the role of the modernisation board and its experts and mentioned the 10 taskforces, including the workforce taskforce.

There were no questions from the floor.

The government has described the NHS plan as the biggest shake-up for the health service since its inception in 1948. But in that light, Mr Taylor's talk did not come across as the 'strategy for the soul' described as necessary by the next speaker, Ron Donovan.

Mr Donovan, an American management consultant, seemed to sense something about the dynamics of this particular group. 'You seem to be getting mixed messages', he said.

'They seem to be saying, 'We want you to adopt these ideas. ' But if you don't - whack! Do you really care how many workforce taskforces there are? What a tongue-twister!' He added: 'Did you feel safe when Mr Taylor asked if there were any questions? I didn't. '

The key to achieving real change was to 'pay attention to the heart', he told the audience. They looked shocked, but intrigued.

The crucial strength of the NHS, Mr Donovan stressed, was its 'absolutely committed workforce'. 'I don't think many of them are in it for the money. They are there because they want to do something for other people, 'he said.

It was all about finding the 'joy of working', he said. How many of them were excited by what they did? The delegates were asked to look into their own hearts - to think what they would say to someone considering joining the NHS. 'Do you tell them to go for it or do you say, 'Maybe the NHS, but not my trust?'' If that was the story, 'You don't need someone else keeping you down, you're doing a fine job of that yourself ', he concluded.

The delegates searched their souls and poured out their woes. 'We want to solve problems, but there is a lack of staff and a lot of things are happening with no connections between them, 'said one. Competing priorities bothered another. 'If you've got a patient on a trolley, you've got to take him off and put him in a bed. But in doing that you've then got to cancel an elective operation. '

Mr Donovan was not a fan of the technique of bringing in 'experts to help us think'. The idea that someone could come in from outside and tell you how to run your trust was 'just not true', he said.

The key was to plant seeds and let change develop organically while promoting risk-taking and asking questions, he said.

Paul Bate, professor of health services management development at Birmingham University health services management centre, suggested that what was needed was a 'very practical vision' and a strong sense of direction provided by 'transforming leadership'.

Trusts would not change 'if you don't change people', he said. Professor Bate, who chairs Birmingham Heartlands and Solihull trust, quoted an example from his own organisation.

The clinical director had been given the job of presenting a re-design of patient processes and was struggling to decide how to convey it to staff.

'He went away and ended up in the hospital's chapel of rest. In the visitors' book was an entry written by a Mr Green, who wrote a moving account of the last couple of days of his father's life. 'You can't treat people like this, ' it said. 'Your hospital has failed my father. '' Professor Bate added: 'He threw the book on the floor and said, ''No more Mr Greens. '' It pulled together a very talented, but difficult group. '

A panel discussion was held on one of the thorniest issues on the HR agenda - how to work with medical leaders to protect patients from doctors who were failing to deliver the required standards.

Chief executive of the British Association of Medical Managers Dr Jenny Simpson said clinical leaders might be trying to be 'guardians of probity', but in reality what they had were 'players on the pitch playing different games according to different rules'.

Part of the manager's difficulty was identifying whether the individual doctor was the problem, or whether the issue lay with their team or the working environment.

Solutions could include a career change, constructive and supportive approaches to assessment, and services for a wide range of issues - not just performance.

HR director of Barts and the London trust Ann Macintyre said she had five to 10 cases at any one time on her desk involving doctors, 'most of which dealt with matters other than clinical competence'. It was 'more a matter of personal conduct', she said.

'One consultant came into a parking space and was asked by a porter not to park there. The consultant replied, 'Fuck you, Paki'' In the past that would have been 'swept under the carpet', Ms Macintyre said. 'But I think there is a real culture change in the NHS. The time has come for us to start looking at these issues. '

In the end the man who was abused accepted a verbal apology, she said. 'I was disappointed he did not want to take it any further. '

Dealing with rude medics obsessed with parking space privileges and drowning under endless initiatives, the HR manager does not have an easy time.

But many of those at the conference will have taken heart from management consultant Ron Donovan's outsider's take on our health service.

It's like a bumble bee, he concluded. If you examined it from a purely technical perspective you would conclude that there was no way it could fly.

As for the health service - 'if you said we will make people work with old buildings and equipment and change government every few years and they will change the focus and direction. . . But if you watch the NHS, it's wonderful'.