Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce.
“The workforce is the golden thread that runs through the health service,” the now former health minister Edward Argar told the Royal College of Anaesthetists President’s dinner on Tuesday night, while still in post.
In a slightly farcical turn of events Mr Argar apologised for arriving late and probably leaving early, but hopefully “not from this job” (oh well).
But alongside the jokes, he also made some sensible points about the growth of demand and the need to not only recruit more staff to deal with this, but also retain experienced professionals already in the NHS.
He referred to Framework 15, describing it as “setting in the narrative” and promised a more detailed strategy to follow, which would take a closer at the numbers, “looking at the specialisms too”.
But it was quite strange to hear about this work, commissioned by former health and social care secretary Sajid Javid when its progress will surely be in flux – even more so now it’s very likely a new health and social care team will be in place.
HSJ understands Framework 15 was close to being published, with final tweaks being made following late feedback from Mr Javid, who wanted more around productivity and workforce reform, contrary to the brief which he had originally set.
Meanwhile, as my colleague Dave West has noted, the new health secretary Steve Barclay is a “known hawk” when it comes to health spending. Will this make an already precarious situation worse when it comes to whether the long-anticipated workforce strategy will get the financial backing it needs? The potential benefits a new detailed workforce strategy could deliver have already long been hampered by a lack of funding commitment from the Treasury.
And clinical and workforce leaders argue staffing shortages and the serious impact they have on patient safety have been overlooked for far too long. Jo Mountfield, vice president for workforce at the Royal College of Obstetricians and Gynaecologists, said none of their members tell her their departments are fully staffed.
“When they try and raise [safety] issues they are told there is no more money,” Dr Mountfield said. Fulfilling the recommendations of the Ockenden review and improving care for mothers and babies depends on maternity departments being safely staffed, and this requires investment.
Mr Barclay gave NHS staff the now obligatory praise for the “compassion” and “dedication” they have shown throughout the pandemic. But, of course, warm words are nowhere near enough.
Reforming the people directorate
According to right wing political blog Guido Fawkes this week, Sajid Javid has decided to “scrap” the chief people officer role in his “war against waste” in the NHS. As discussed in detail in the most recent HSJ Health Check podcast, this is far off the mark, and a good example of spin over substance as ministers try to play the culture wars and present themselves as ‘anti-woke’.
Instead, Navina Evans, current chief executive of Health Education England, will become the chief workforce, training and education officer, with Em Wilkinson-Brice reporting to her as national director of people.
Dr Evans, with support from Ms Wilkinson-Brice, will continue with the work of the CPO, but with the internal HR and OD functions transferred to the chief delivery officer directorate.
Her appointment as the chief workforce officer has been warmly welcomed, but there have been a few grumbles around chartered HR professionals being continually overlooked for the top HR job in the NHS. But with some of the changes outlined above regarding the transfer of the internal HR function, and training and education brought into the remit, Dr Evans’ appointment makes sense.
In the podcast, we argued this was the most difficult job in the NHS. Not only does Dr Evans need to work as an astute political operator, pulling all the levers possible to lobby for more investment in the workforce and training from a reluctant HMT, but she must also oversee the very significant merger of the NHS England and Health Education England people functions.
In addition to this Dr Evans will also face the huge task of repairing the People Directorate, which was revealed by the most recent internal Staff Survey to be the unhappiest department within NHSE, scoring bottom in 7 out of 9 key measures.
There has been much speculation about what happened within the people directorate to make it so unhappy – undoubtedly complicated and nuanced. One HSJ reader has suggested that if it were a provider trust, the directorate would be in special measures and serious questions would be asked of the leadership.
HSJ understands Dr Evans is already working across HEE and NHE, with a strong focus on improving culture. But starting a job with a huge merger to navigate, and potential redundancies, will not be easy and is made even more complicated by the internal problems that have been allowed to fester. All eyes will be on this year’s staff survey.