Published: 03/06/2004, Volume II4, No. 5908 Page 12
Implementation is the key word for NHS human resources managers.
Agenda for Change, the consultant contract, the European workingtime directive for junior doctors - big changes that have been years in the making but with deadlines just round the corner.
And unsurprisingly, the strain is beginning to show. Senior HR managers say they feel their peers are fatigued, which was reflected in a relatively low-key atmosphere at the 'HR in the NHS' conference in April.HR managers say the consequences of the downsizing of the Department of Health's HR function, the absorption of workforce development confederations into strategic health authorities and the NHS Confederation's emerging role as an employers' organisation have created extra demands on their time. One director says that as a result of these changes the gap between trusts that perform well on HR and those that perform badly will widen.
The final throes of implementing the consultant contract are dominating managers'minds - not so much the negotiations with consultants but whether funding will be sufficient. All but one of the managers who spoke to HSJ expected their trust to have a deficit.
There is also a frequent criticism that the pace of implementation has put the emphasis on the mechanics of the process. 'I feel the conversations with consultants have not been as meaningful as they could have been, ' says one HR manager. Similar sentiments are expressed about Agenda for Change, where implementation costs are generally thought to be more of a problem than recurring ones.
There is no shortage of culprits for the consultant contract problems, with some managers saying the design 'could have been much better handled at the centre'while others are concerned by a lack of direction from SHAs. One director says he, and others, were caught in a Catch 22 situation in that he was reluctant to make offers to consultants that SHAs might reject on affordability, while being told by SHAs that they could not give an indication of what they could afford without having all trusts' offers in.
Some HR managers say they believe some of the teaching trusts are taking 'too deferential' a position with their consultants, although it is not a view shared by those managers actually working for teaching trusts.One retorts: 'I look at surveys of what trust HR directors are claiming for programmed activities and some can't even fill in the form, they are so confused.'However, there is more agreement on the feeling that HR managers generally are still reticent about engaging with clinical staff. Perhaps not surprisingly, many agree with the sentiment of a medical director heavily involved in negotiations on the contract who describes it as 'perfectly designed to make all sides unhappy'.
Attitudes to the EU working-time directive seem surprisingly relaxed, although not all trusts say they would actually hit 100 per cent compliance by the August deadline; neither were any predicting significant disruption.More concerning was the reduction in training opportunities for doctors - so-called 'cutting time'. This was thought to be an issue which will come increasingly to the fore once the white heat of the August deadline has cooled.
What is missing from many agendas is Improving Working Lives, now dropped as a target this year, and wider issues of being a good employer. 'It is gone off the radar compared to last year and there is a sense that it has been anyway set at quite a low hurdle. Does a nursery with 10 places for under-twos really encourage flexible working?' asks one manager.However, for one HR director from a prospective foundation trust, the new freedoms could potentially put greater focus on this area. A trust with more ability to generate revenue but unable to compete for staff on pay might well learn new respect for some of the 'softer'HR issues, they say.