Mindless retendering

The most cited concern at last week’s HSJ mental health summit was the current workforce difficulties.

Issues around funding or bed capacity, which would have featured five years ago, were no longer centre stage.

The fact workforce came up as the biggest issue for those at the summit will come as no surprise considering the 11.5 per cent decrease in mental health nurses over the past nine years, and an even worse decline for learning disability nursing.

While unease over the workforce centred around the usual — and valid — worries over retention and wellbeing, a few less frequently voiced areas of concern did come up.

Surprisingly, one leader claimed the impact of the Lansley reforms had turned out to be a big driver of poor workforce morale.

To quote them, the impact of the “routine, mindless, repetitive and mechanical” tendering of services on staff is overlooked.

We know retendering of services is a particular gripe for community and mental health providers — readers will remember Claire Murdoch raising the issue not too long ago.

NHS England’s promise to address the Lansley competition problem will be welcomed by most in the provider MH sector.

Leaders also suggested the NHS should think about recruiting the people available rather than holding out for those with the “right” skills.

Could the NHS, for example, take advantage of the workforce which will become available following the pending retail sector crash?

While most would admit seeking “alternative” skills has now become a necessity, some would fairly warn this approach could be a slippery slope to substitution.

A further point of contention appeared to be that those drawing up the contracts for services do not have the insight needed to commission the workforce for those services.

One leader expressed a particular distaste over the current commissioning model, which means “the people who don’t do something and have never done it first hand get to decide how it should be done by people who have spent their lifetimes doing it”.

In one example, another delegate described a situation where commissioners had funded their crisis service with a requirement the trust recruit a chosen number of Band 6 nurses. Adverts were then sent out but no applications were received, yet the requirements could not be adjusted.

Local power

A big question throughout was whether national bodies should be left in charge of workforce plans.

While the brains at the centre will have consulted with local providers for the anticipated People Plan, the numbers are ultimately crunched at a national, rather than local, level.

Pointing out an absurdity in this model, one leader said the NHS is the only industry where the employers (ie. provider trusts) are not the ones who do the workforce planning.

To date, this does not seem to be something which has worked, that leader added.

Even with the local Health Education England regions and sustainability and transformation partnership workforce plans, do providers have any real say in what they need locally?