The Ward Round: Don't wait for the Treasury to get started

“The common culture and values of the NHS must be applied at all levels of the organisation, but of particular importance is the example set by leaders…”

This is not an extract from the interim People Plan. Instead, it is a quote from Sir Robert Francis in his report of the Mid Staffordshire Foundation Trust inquiry.

Shifting away from a “rotten” culture and fostering strong leadership was front and centre of the People Plan. But in the six years following the recommendations of Sir Robert’s report, why is culture still not being prioritised by the NHS?

The message that comes through from Baroness Harding’s interview with HSJ was clear – don’t wait for the Treasury to make positive change to benefit your workforce. Prioritise culture and people management, as, for far too long, it has been overlooked in favour of finance and operations. You could say it was a call to arms for NHS leaders.

“Is it any wonder that is what boards choose to focus on,” one HSJ reader commented. They have a good point. If NHS England and NHS Improvement want the health service to prioritise culture, the arm’s-length bodies must support leaders and give them the space to do this.

It’s no revelation the final plan and the level of investment for vital education and training relies on the spending review. This is crucial for recruitment and retention. But, since the plan was published, chief secretary to the Treasury Liz Truss said a full spending review is unlikely to take place this year, which makes it even more important for trusts to take matters into their own hands.

Work already being rolled out in Milton Keynes University Hospital FT is an example of what trusts can do without waiting for direction from the centre. Its chief executive Joe Harrison launched a three-year programme of work, ranging from free tea and coffee provided to staff, better rest rooms, negotiations for deals with local businesses and free car-parking for staff. The argument here was clear: the needs of the workforce have changed, and the NHS needs to keep up.

“We’ve been at risk of neglecting [culture] because we need to focus on money and numbers,” NHS Providers chief executive Chris Hopson said. “This strategy says, [money and numbers] are important, but they are not sufficient by themselves.”

However, Nuffield Trust chief executive Nigel Edwards argued good culture “won’t make much headway” when staff are seeing unsafe shortages every day.

“Many key measures simply won’t happen unless they are backed up by funding in the upcoming spending review,” Mr Edwards said.

Baroness Harding acknowledged herself progress alone on the measures set out in the interim plan won’t close the workforce gap, but as contended by Mr Hopson, this has the potential to kick off the detailed work on workforce the NHS has needed to do for some time.

The finer points

Some specific points in the People Plan raised questions about the future direction of NHS workforce training.

As mentioned in the long-term plan, the interim People Plan again set out that the NHS needs more doctors who can provide generalist care and announced a new internal medicine training model for doctors entering specialty training. It said also that medical schools should support and prioritise generalist careers.

HSJ has heard from doctors there is a disagreement that training for a generalist role should take less time and also that generalism and specialism should co-exist in the same doctors, rather than solely in a new cohort of generalist doctors.

Along with the drive towards generalism, plans to give prescribing rights to physician’s associates within 24 months of their regulation and pledges to expand the nursing associate pilot programme seemed to jar with another point in the plan. It said the workforce must be upskilled to keep up with scientific advancements and ensure the NHS has the right specialist workforce. So why spend money investing in generalists when the future calls for the opposite?

The plan also said there must be an increase in AHP applications to study in the shortage professions of therapeutic radiography, podiatry, orthoptics and prosthetics/orthotics. The latter have, however, just been removed from the Migration Advisory Committee’s shortage occupation list as it said there is limited evidence of shortages. 

The pensions catch

“Is this just for doctors?” A fair question posed following HSJ’s story earlier this week, which announced the government’s intention to consult on a 50:50 option for senior clinicians, in a bid to curtail huge tax bills and stop doctors from leaving the NHS.

“Presenting it as a senior doctor’s issue is not helpful,” Managers in Partnership chief executive Jon Restell said. “The issue of pensions flexibility is an issue for everybody in the scheme – issue for people who might not have very much take-home pay.”

The Department of Health and Social Care has since confirmed to HSJ the proposal is for the flexibility to be available not only to doctors – consultants and GPs – but also dentists, nurses and clinical scientists who deliver frontline care and can demonstrate a reasonable expectation of incurring a pension tax charge.

It is, however, unclear whether senior managers will also be able to use the 50:50 option as, according to the government, there is less clear evidence pensions tax is causing retention issues.

Mr Restell also raised the issue of the timescale, regardless of who will benefit from the proposed 50:50 option. “The need for pace is real,” he said. “The fact the government made an announcement without detail, they know it’s a problem but haven’t put resources into it.”

At time of writing, the consultation is yet to be launched. With senior clinicians unwilling to take on additional work, time is of the essence.

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