Mobilising the NHS’s hidden army

Over recent years, a remarkable consensus has formed in NHS policy that the service’s future must be one of planning and providing person-centred care services on a health and care economy-wide basis, delivered by clinically led multidisciplinary teams working together with patients beyond traditional organisational silos.

• Download a PDF of the interim report

These themes inform and illuminate the Five-Year Forward View strategy, and all subsequent major policy initiatives.

It all sounds attractive. Yet although this narrative has developed alongside an aspiration to get clinicians involved in changing care planning and provision, it has tended to include very little or nothing about the contribution and value of the 583,837 non-clinical members of the NHS’s 1,229,371 staff.

The very term “non-clinical” may be part of the problem. Defining any group negatively, as what it is not, is scarcely the best way to think about that group.

The term also suggests that for all the rhetoric about teamworking, there remains a gap and hierearchy between clinical and non-clinical staff every bit as polarising and unhelpful as those between and within the clinical and medical professions (which would be another inquiry altogether).

One very positive outcome of this inquiry would be to find a better descriptive term for these staff than “non-clinical”: we welcome your suggestions hsjinquiry@emap.com.

The invisible half of the NHS workforce

The value of clinical staff in the NHS scarcely needs stating (although junior doctors might currently disagree). Contrastingly, non-clinical staff can seem and definitely feel rather invisible in discussions about workforce, training and policy.

This interim report, based on interviews with sector experts and a half-day workshop, aims to focus attention on the contribution and value of these staff, whose sometimes unseen and often under-recognised work make crucial contributions to the running of services.

As the NHS plans radical changes in provision with the Carter efficiency review, the 44 sustainability and transformation plans and footprints, success regimes, devolution in Manchester, its chances of success will need considered, consistent, credible and sincere engagement with all its staff groups.

If we are to see real change in the NHS, it will mean real change in how all the health and care team – clinicians, medics and non-clinical colleagues – work. It will also mean investing in training and change management capacity: particularly (thought not exclusively) among non-clinical staff.

Forward-thinking clinical staff have long valued all the members of the health and care team, including their non-clinical colleagues: it’s time that everyone else did.

The value of non-clinical staff

This inquiry focuses on non-clinical staff other than those at board level. As such, it will not repeat arguments about the value of managers which HSJ has previously addressed nor address the issue of leadership, again the subject of recent work by HSJ.

Defining any group negatively, as what it is not, is scarcely the best way to think about that group

To exhaustively catalogue the many categories of role under the non-clinical umbrella wouldn’t add huge value. As well as key services provided by cleaners, cooks, porters, gardeners and maintenance colleagues, there are administrators at all levels, switchboard colleagues, IT staff, security staff, as well as those in communications, finance and HR.

There are receptionists, including those in GP practices. And there are the staff who handle arguably the key litmus paper issue of the NHS: car parking. The NHS could not function without these people’s contributions.