Exclusive: Dido Harding: Boards should take culture as seriously as finance

The NHS Improvement chair today published interim proposals from the national review of workforce policy which she has been leading since the beginning of the year, with a full report due after the government spending review expected late this year.

In an interview with HSJ to coincide with the publication of her interim workforce plan Baroness Harding defended the plan’s lack of detail around some key areas such as international nursing recruitment, CPD training and manager regulation, arguing many of these were dependent on the spending review.

Education and training budgets were not part of the long-term funding deal agreed for the NHS last summer, and the service is now pressing the Treasury and other parts of government for a multiyear settlement in the SR.

She said: “Specific commitments that were dependent on the [forthcoming government spending review] spending review were always going to be dependent on the spending review and I don’t think that should be a surprise. That’s why I was asked to complete a final people plan after the spending review.”

Asked if her interim proposals would fix the existing NHS workforce crisis she said: “We have got a lot more work to do before we can say that. We can make really meaningful progress this year, but the actions alone won’t close the gap. We are going to need to invest more in training and developing more nurses and other professions.”

She said the question of new funding from the Treasury was vital, but was “interwoven” with other necessary improvements, and said the NHS “can move the dial meaningfully ourselves and actually that’s the best way to argue why we need to increase funding for training and development and capital investment in the NHS”.

This included improving leadership and the working environment including by reducing bullying, thereby stopping many staff from leaving, she said.

Baroness Harding joined NHSI in 2017, having previously been chief executive of TalkTalk Telecom Group from 2010 to May 2017.

She said the NHS had been relying on the excuse that changing culture took several years, and said: “You can shift from a bullying and rotten culture quite quickly. It’s not acceptable to say it takes too long and it’s too hard.

“If all of the boards in the NHS chose to take culture and people management more seriously and put it on a level footing with financial and operational performance we’d see a huge improvement in culture and outcomes for patients as well.”

She said: “Over the course of the last 20 years the NHS has become increasingly good at financial and operational management and it has not been good at putting people management at the core of the way you run the system both nationally and locally…

“The more we can set out a compelling plan that shows that we will be a world class employer… actually the easier it is for Treasury and government to recognise we need more people working in health and social care and of course that’s going to mean more money to train them. It goes hand in hand, not either or.”

Asked if she was confident the case for investment was understood by the Treasury, the Conservative peer said: “I am pretty confident. It is absolutely self evident we are going to need more people working in health and social care over the next decade. It’s really clear that we need that.”

A spending review is due to take place in the autumn-winter and to cover plans for several years, although with Brexit due for the end of October, and a change of prime minister, it is not certain a full long-term process will take place.

She denied reports that a target to recruit 5,000 international nurses had been removed from earlier drafts of the report – which have seen several leaks to the media – adding there was a “whole raft of numbers” she decided should not be in the plan as they needed more local input to be “aggregated bottom up”.

She added that “directionally it was correct” to say the UK would need to recruit thousands of international nurses.

Asked what the overall number of staff needed to reduce vacancy rates to 5 per cent by 2028 she said there was only a “very high level estimate but I don’t think it stands much external scrutiny at this stage” as more work was needed with local areas.