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It’s all about the money

The bald facts are these: the NHS needs to make £20bn of efficiency savings by 2015. Workforce costs are around 65-70 per cent of the budget.

“Therefore the logic is that not enough will be achieved in terms of meeting the efficiency challenge without a radical look at how we deploy staff,” says Dean Royles, director of NHS Employers.

All NHS organisations will already be looking at reducing sickness absence and their use of high cost agency staff, he suggests. “These are the here and now things we can do,” he says. “But we also need a more fundamental review of skill mix and deployment and staff usage.”

In the short term, HR managers will need to look at ideas such as seven day working and extending the working day – all measures that could drive up efficiency but will have knock-on effects for staffing.

They will need to think through skill mix changes and which of the two current models might be right for different services: the leaner skill mix with fewer professionals who work in a supporting role or the richer skill mix thought to deliver better outcomes and fewer readmissions. In reality, a combination of both.

Looking longer term, they will need to start thinking now about the impact of moving care closer to home on skill mix, training and education (see below).

Local pay is clearly on the political agenda, but, says Mr Royles: “Chief executives and HR directors know that local pay is not a quick fix. It is just not going to drive down costs quickly enough.”

Rather, local managers are looking for more flexibility in the current system, for example linking incremental progression through pay scales more explicitly to performance.

Staff engagement

Intellectually people across the NHS understand times have changed. But Mr Royles does not believe that making them will necessarily lead to worsening employment relations. “It is important we don’t lose the transparency argument.”

“Some people ask how can you have good staff engagement given the backdrop,” he says. “I would argue that this is exactly when staff engagement becomes even more important.”

The benefits of good staff engagement are already well known: lower sickness absence, higher staff and patient satisfaction, lower patient mortality and higher ratings from regulators.

Now, more than ever, the NHS needs to reap those benefits, says Royles. “This is a time when staff want to be involved and to continue to provide great care and take pride in what they do. They know the challenges the NHS faces and want to play their part”

This was evidenced, he says, by the partnership working between management and trade unions in planning the NHS response to November’s strike over public sector pensions. “It went pretty smoothly. Staff were able to demonstrate, urgent care was provided and the relationship between employers and unions was still intact afterwards.”

His concrete advice to HR managers and workforce leaders is this: be open. “Involve people early in the intellectual debate and challenge that we all face.”

Yes, he realises that HR professionals in the NHS are worried about their jobs too, but says: “One role of leadership is managing change well and leading with confidence. That’s where HR professionals come to the fore.”

Education and training

The changes to education and training proposed by the government and now fleshed out by the NHS Future Forum are profound and would see healthcare employers take the lead in workforce planning and commissioning.

It’s an idea that NHS Employers supports. Mr Royles argues that this is long overdue, regardless of the Health Bill.

“A paradigm has developed that we need to challenge,” he says. “It says that the people who can be trusted when it comes to education and training are the health professionals and that if we, as employers, were involved we would be likely to use the money unwisely.

“My own sense is that employers are passionate about wanting to make sure they have highly trained staff delivering care to patients and it’s disingenuous to suggest otherwise. Employers want to work with the professions on this agenda.”

Caroline Waterfield, deputy head of employment services at NHS Employers, says there are a number of immediate challenges for HR and workforce managers.

“The challenge is on,” she says. “There are deadlines.”

“First of all, make sure you are engaged with your local education and training board. Ask yourself where you need to build the necessary skills and competencies for the job.”

Her sense is that most local workforce leaders are well equipped – but say they need time to do this work properly.

Where LETBs may come unstuck is if the governance structures stifle innovation rather than enable it, she adds. “The LETBs, which are in shadow form at the moment, need a voice through to Health Education England and that is perhaps where NHS Employers can play a key role.”

Care closer to home

The idea of moving care closer to patients is increasingly being promoted, says Gill Bellord, NHS Employers director of employment relations. Acute and community trusts have merged and pressure is coming from commissioners to do things differently.

“So the biggest challenge right now for employers is to be sure that they work with the commissioners to deliver care for patients and to do that they need to be flexible,” she says.

She argues that 2012 will be the year when workforce leaders have this at the top of their agenda. “It has not happened everywhere yet but we know this is a central plank of reform,” she says.

One issue will be to make sure staff skills are not wasted. “Progressive employers are already thinking about what skills they have in their organisations and how they can deploy people differently to fit with new models of service delivery.”

This of course ties in with the changes to training and education, she adds. “It’s no good if we just carry on churning out cohorts of clinicians who can work only in a hospital setting. This has to change.”

Francis inquiry

The other item hoving into view is the Francis inquiry into the failings at Mid Staffordshire Foundation Trust, which is due to report in the spring and is expected to have far reaching ramifications.

“There will no doubt be recommendations around the sort of environment in which staff work,” says Mr Royles. “Are we making it as easy as possible for staff to raise concerns, and giving the leadership that sees raising concerns as positive and progressive? Our collective leadership in this area will be on show.

“There will be serious recommendations that will require attention.”

All in all, this is a big year ahead. We hope this masterclass series will support HR and workforce leaders to find their way through it confidently.