Jon Restell on the pressing need for a comprehensive workforce strategy for the NHS and what should go into it
Civil servants at the Department of Health have started work on a comprehensive workforce strategy for the NHS. (Let’s hope it covers social care too.) This is very welcome to trade unions like Managers in Partnership, who have been arguing loudly for a workforce strategy for at least three years.
Although first raised by unions, the case for a workforce strategy is now accepted by many NHS leaders and organisations. Simon Stevens has called for a “complete strategy”, arguing that ”our future lies in networks and health systems, not go-it-alone institutions. On too many procurement and workforce issues it has felt the opposite of that.”
The National Audit Office, Health Foundation, Public Accounts Committee, Nuffield Trust, Lord Carter, and the Organisation for Economic Cooperation and Development have all pitched in. But the case for ”a wide-ranging workforce strategy” in each UK country was perhaps best put by the NHS Pay Review Body:
’An effective strategy, linked to each of the countries’ overarching objectives, should identify the people-related implications of the ambitions… explore all aspects relating to the attraction, development and retention of staff and therefore support staff engagement to deliver wider strategic and operational plans.’
So how should we create and deliver such a strategy? Thinking about why no strategy has emerged so far may help us to see the barriers we need to overcome.
The Five Year Forward View did not come with a workforce strategy, although one could be implied by making some workforce assumptions. Some bits of the new Lansley system, Health Education England for example, have specific workforce responsibilities.
A comprehensive national strategy must aim to do the right things in the right place, not to deliver everything nationally
While individual bodies have done useful, important things – such as NHS England’s work on race equality and staff wellbeing – the national system is fragmented. The DH, a puller of many workforce levers itself, should take the lead in bringing everything together.
Local employers also resist national encroachment, often understandably. A comprehensive national strategy must aim to do the right things in the right place, not to deliver everything nationally. Most of the workforce action will and should take place in teams, boards and local systems.
Culture (ie people and the way they do things) eats strategy straight from the pan. So why have strategists ignored workforce and created conditions for their own failure?
For some, workforce is something for someone else to worry about.
Others display magical thinking about new people and new roles. Others again don’t really buy the link between staff engagement and patient care, or between wellbeing and performance. They believe top down and grip gets things done. Some of the time, they are right.
And then there are those who do get it but feel powerless to act, or who abandon change because the workforce consequences look too difficult. For a workforce strategy to work well, these strands of thought need to be addressed.
Employers’ commitment to engaging with representative organisations and trade unions is patchy. Unions run through the NHS like Blackpool through a stick of rock.
The junior doctors’ dispute shows that industrial relations can still make the weather. Dialogue with unions on both policy and delivery is essential.
Then there is the big one: pay restraint has marginalised pay as a policy lever to support changes in productivity and service delivery. The system must push back on pay restraint or, at the very least, prepare for its end.
And what should go into the strategy? The unions are developing their shopping list. Here’s the latest version – in no particular order:
- Making Agenda for Change simpler to explain, understand and operate
- Maintaining the job evaluation system which delivers equal pay for work of equal value
- Putting physical, emotional and mental wellbeing and staff engagement at the heart of healthy, safe and high-performing teams and workplaces.
- Safe staffing levels
- Making the NHS an employer of choice with attractive terms and conditions and excellent people management policies
- Engagement and partnership with unions, locally and nationally
- Effective change management through sound policies agreed jointly by employers and unions
- Equality, diversity and inclusion – recovering the ground lost recently and delivering a just workplace for all our people
- Developing learning and innovating organisations that continuously transform themselves
- A focus on leadership at all levels – one in three NHS staff has supervisory responsibility for someone else
MiP, representing health and care managers, is emphasising three themes.
First, leadership should be part of the workforce strategy, rather than a separate strategy as now. Second, support staff must receive equal care and attention, not least because when you kick the back office the bruise appears on the front line. Finally, partnership between unions, employers, the government and system bodies is essential. It’s the only way to create and deliver a workforce strategy that works for staff and the patients they care for.
Jon Restell is chief executive, Managers in Partnership