International Health Leadership Programme STRATEGIC HUMAN RESOURCE MANAGEMENT An NHS Study Andrew Foster Workforce Director 17 th March 2006

International Health Leadership Programme HUGE AND DIVERSE WORKFORCE 1.3 million NHS staff and 600 employers Over 600 jobs and grades 17 Trades Unions and Professional Bodies Pay bill £33bn takes 59% of spending Minimum salary £11,494; maximum £165,263 Around 120,000 undergraduate trainees Training budget NHS £4.5bn 79% of non-medical staff female 34% of doctors (but 60% of trainees) are female 13% black and ethnic minorities (population 9%)

International Health Leadership Programme NHS SPENDING YearSpend % %real terms£bn increase increase 97/ / / / / / / / / / /

International Health Leadership Programme NEED FOR A CLEAR SENSE OF DIRECTION

International Health Leadership Programme THE NHS PLAN

International Health Leadership Programme MORE STAFF WORKING DIFFERENTLY TWO OBJECTIVES

International Health Leadership Programme MODEL EMPLOYER MODEL CAREER IMPROVING MORALE PEOPLE MANAGEMENT The three star Trust Improving Working Lives and beyond The Skills Escalator 4 Modernisations: Workforce Planning Pay Regulation Education & Training Psychological Contract Staff and employers Staff and Government Staff and patients HRM Development Building Skills, Capacity, Quality, ‘Attitude’ THE FOUR PILLARS

International Health Leadership Programme IT MAY SEEM OBVIOUS…

International Health Leadership Programme THE MODEL EMPLOYER The moral argument People management aids recruitment and retention People management aids High Performance Common sense but also around 30 major studies worldwide in last 12 years Ulrich, Pfeffer and Huselid – improving shareholder value with ‘bundles’ of good practice Magnet Hospitals in US and Aston University Studies UK –Recruitment and retention –Organisational outcomes –Clinical outcomes

International Health Leadership Programme THE SKILLS ESCALATOR Pay SpineLearningLevel Career Stage RegulationRegulation Cadet Pre-employment Work Orientation Unemployed/ Excluded Skilled Assistant Support Higher NVQs and Higher Assistant Workers Occupational Standards Starter Induction, NVQs Occupational Standards Expert Qualified Higher disease/patient Registered Professional modules Practitioner Staff Disease/patient modules Degrees Diplomas Consultant/GP Self Directing Higher Degrees Senior Manager Principals Workload and Roles Careers

Pay Band AN ESTIMATE OF THE CURRENT WORKFORCE Consultants & Snr. Managers

International Health Leadership Programme THE LOCAL HR AGENDA More staff –Rapid workforce expansion Working differently –Skills Escalator Strategy –£3 billion investment in new pay systems –Agenda for Change an enormous OD programme –European Working Time Directive 2004 and 2009 And keeping the knitting going There are worse jobs…

International Health Leadership Programme SO FOND OF TARGETS

International Health Leadership Programme

PROGRESS CHECK… 194,000 more staff in last three years Doubling in applicants and 60+% more trainees Explosion in new roles –Delegated tasks e.g. prescribing –Extended roles e.g. nurse endoscopist –Completely new roles e.g. emergency care practitioner Positive staff survey results Lower vacancy and sickness absence rates Over 95% of staff on new pay systems But workforce is just an enabler…

International Health Leadership Programme IMPROVED RESULTS 98% of casualty patients being seen and treated within 4 hours Inpatient waiting times down from 24 to 6 months Waiting times for heart bypass operations down to 3 months from 2 years Deaths from breast cancer falling faster than anywhere in the world Declining mortality rates from cancer, heart disease and suicide

International Health Leadership Programme CHANGING CONTEXT From benevolent producerism to top-down control to self-improving systems System reform: patient choice, tariff + competition Financial pressures and funding slowdown from 2008 Workforce must respond to new policies –Patient-led NHS –Health protection and prevention –Shift from secondary to primary care –Integration with local government and social care –Electronic patient record

International Health Leadership Programme THE TEAM HAS A NEW OWNER

International Health Leadership Programme HALF-TIME TEAM TALK Build on the successes of last 5 years –Better recruitment, retention and return –Model Employer, Skills Escalator and new roles –Reduced vacancies and sickness absence –A more confident HR function (EUWTD and Agenda for Change) Respond to the financial environment –Integration of activity, finance and workforce planning –Shift from ‘More Staff’ to ‘Working Differently’ –Do the things that we know will work Deal with culture and behaviour

International Health Leadership Programme CULTURE AND VALUES Challenge of personalised care, choice, competition, a ‘subsidised’ private sector, patients as ‘customers’ Could the biggest obstacle be NHS staff? If so what does HR do about it? Need to both adjust and go with the grain –Staff have strong values about patients –Pre-registration and undergraduate training –Recruitment, selection and induction –Post-registration and other training –Knowledge and Skills Frameworks

International Health Leadership Programme HR HAS THE TOOLS

International Health Leadership Programme HIGH IMPACT INTERVENTIONS Retention – turnover costs 100+% in lost efficiency Shared services – can make 20-40% savings E-recruitment – Ashford St Peters saved 60% Temporary Labour – East Kent saved £3.5m Sickness absence – costs the average Trust £5.4m Job design – Addenbrookes halved radiotherapy wait Appraisal – associated with lower patient mortality Staff involvement; good people management; directed training investment and strong OD – predictors of high performance

International Health Leadership Programme

CONCLUSION From “last chance saloon” to a “New NHS” HR aligned and realigned to overall policy HR must help shape the patient-led NHS HR must add value to the NHS World class NHS needs world class HR One of the world’s biggest employers – want to be one of the world’s best employers First half tough; second half will be tougher

International Health Leadership Programme HR STRATEGY - TIME TO GET JOINED UP AGAIN

International Health Leadership Programme THANK YOU

International Health Leadership Programme SOME QUESTIONS HR – separate function or core managerial skill? Health staff – cost or asset? Raising morale – sentimentality or good business sense? Is there a causal link between staff satisfaction and patient satisfaction? If so, which way does it work? What do managers want from HR?