STRATEGIC HUMAN
RESOURCE MANAGEMENT
An NHS Study
Andrew Foster
Workforce Director
17th 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 1997 - 2008
Year
terms
Spend
£bn
%
increase
97/98
34.7
5.1
1.9
98/99
99/00
00/01
01/02
02/03
03/04
04/05
05/06
06/07
36.6
40.2
44.2
49.4
55.8
61.3
67.4
74.4
81.8
5.6
8.9
9.8
11.9
8.8
10.0
10.0
10.3
10.0
2.8
6.4
7.4
9.3
6.1
7.5
7.5
7.6
7.3
07/08
90.2
10.2
7.5
International Health Leadership
Programme
%real
increase
NEED FOR
A CLEAR
SENSE OF
DIRECTION
International Health Leadership
Programme
THE NHS PLAN 2000-2010
International Health Leadership
Programme
TWO OBJECTIVES
MORE
STAFF
WORKING
DIFFERENTLY
International Health Leadership
Programme
THE FOUR PILLARS
MODEL
EMPLOYER
MODEL
CAREER
IMPROVING
MORALE
The three star
Trust
The Skills
Escalator
Psychological
Contract
4 Modernisations:
Staff and employers
• Workforce Planning
• Pay
• Regulation
• Education & Training
Staff and Government
Improving
Working Lives
and beyond
Staff and patients
International Health Leadership
Programme
PEOPLE
MANAGEMENT
HRM
Development
Building
Skills,
Capacity,
Quality,
‘Attitude’
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
Level
Career
Stage
Consultant/GP
Senior Manager
Self Directing
Principals
Higher Degrees
Expert
Registered
Practitioner
Qualified
Professional
Staff
Higher disease/patient
modules
Disease/patient modules
Degrees
Diplomas
Skilled Assistant
Assistant
Starter
Support
Workers
Higher NVQs and Higher
Occupational Standards
Induction, NVQs
Occupational Standards
Cadet
Unemployed/
Excluded
Pre-employment
Work Orientation
Pay Spine
Learning
International Health Leadership
Programme
R
e
g
u
l
a
t
i
o
n
Workload and Roles
Careers
THE SKILLS ESCALATOR
AN ESTIMATE OF THE CURRENT WORKFORCE
Consultants & Snr. Managers
9
8
Pay Band
7
6
5
4
3
2
1
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
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
International Health Leadership
Programme
International Health Leadership
Programme
International Health Leadership
Programme
International Health Leadership
Programme
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?
International Health Leadership
Programme