The government’s NHS workforce strategy is sidelining trusts and fuelling rows with strategic health authorities, managers have told HSJ.

Health minister Lord Darzi’s next stage review is being criticised for granting SHAs extra workforce planning powers and saying little about non-clinical managers.

Added to “disproportionate” severance pay rules brought in after the scandal surrounding chief executive Rose Gibb’s departure from Maidstone and Tunbridge Wells trust, managers fear they are being disempowered.

University College London Hospitals foundation trust workforce director David Amos said the workforce planning changes were “disappointing and confusing”.

He said: “The message given to the consultation process has been that employers should come together and determine what to do about workforce planning.

“Employers should be put in charge, not just of workforce planning, but spending on education and training. If this new system only gives us a few powers we will be sidelined.”

Darzi’s involvement

HSJ understands Lord Darzi was less closely involved in producing A High Quality Workforce than in the other parts of his review.

The section causing most alarm refers to primary care trusts submitting workforce plans to SHAs, to be merged into a single regional strategy. This seems to contradict a statement elsewhere in the report that “most workforce planning [will be] carried out at a local provider level”. It is thought Lord Darzi inserted this at the eleventh hour.

NHS Employers deputy director Sian Thomas said: “We were expecting SHAs would have a regulatory role and hold local trusts to account but not do the actual work.

“We’d like to see employers in charge of this process. The principle of autonomy applies to payment by results and quality, so why not workforce planning?”

Power struggles

A row broke out at a meeting held between NHS London and trust HR directors in the region last Wednesday, caused by power struggles over the SHA’s workforce strategy, due to be published in September.

A source said: “We were surprised at the approach the SHA was taking. There didn’t seem to be a great deal of opportunities for employers to take a leading role.

“They were clear the resources available for commissioning education needed to be managed in a particular way and they said it was their responsibility.”

Managers have however welcomed the SHAs losing their provider training arms, the introduction of a training tariff and the focus on quality.

Managers in Partnership chief executive Jon Restell said: “We support clinicians being in the driving seat for many changes. But we can see managers not really being part of that script.”

More was needed on black and minority ethnic representation at the top of organisations, he said, while references in the main report to removing poor-performing managers amounted to a “bureaucratic threat”.

Promises to identify and support the top 250 leaders in the NHS ignored problems among middle management, he added.

Central control

His comments come amid wider concerns that the Department of Health could use the 250 leaders programme to exert central control over local health organisations.

The criticism of the workforce strategy has arisen as it emerges that trusts’ decisions to pay off members of staff are routinely being sent to the Treasury for approval.

NHS chief executive David Nicholson wrote to all trusts last November ordering them to submit all severance payments to SHAs. Any “novel or unusual” payments were to go to the Treasury. This followed the£75,000 pay-off handed to Ms Gibb, who presided over a huge C difficile outbreak.

Ms Thomas described the rules as a “disproportionate requirement”.

Mr Restell said payments sent to the Treasury included “very small amounts”, deemed cheaper by trusts than potential legal dispute costs.

He said: “We don’t think employers should be disempowered from making [these] decisions.”

A DH spokesperson said: “Most workforce planning will be carried out at local provider level. PCTs have a role to play as the workforce planning cycle begins with PCT/local authority commissioning plans. SHAs will continue to be responsible for ensuring systems are effective.

“Providers, PCTs and SHAs must work together to ensure service, workforce and finance plans are co-ordinated. The system allows for local flexibility within a clear and consistent framework.”

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