Public Servant Lifestyle

A new report argues that the logical conclusion of the Government’s health reform agenda is a significantly smaller and higher quality NHS workforce.

In Staffing and human resources in the NHS – facing up to the reform agenda, Nick Bosanquet, Professor of Health Policy at Imperial College London, says that reforms such as foundation hospitals, payment by results and patient choice will mean greater emphasis on productivity and flexible working.

He claims that the result will be the end of national pay bargaining, a reduction in the NHS workforce of at least 10% and greater investment in staff of all levels.

The report, published by the independent think tank Reform, claims that experienced high quality staff contribute far more to patient care than a larger number of inexperienced staff. Despite this, says the report, manpower policy since the turn of the decade has focused on quantity rather than quality. Total NHS workforce has risen from 1 million in 1999 to over 1.3 million now and is on course to reach 1.6 million by 2010.

"The costs of this expansion are one of the key reasons why the service is being driven into deficit", says Reform. "It is unclear how a service in financial distress will provide places for the extra students currently in medical school. Despite extra spending, key areas such as radiography and midwifery are understaffed and NHS staff morale is poor compared to other public sector organisations.

Welcome Reform

"The solutions to the problems of costs, shortages and low quality lie in the Government’s highly welcome reform agenda. A service with greater financial awareness and discipline will control its level of manpower. Pay levels will be increasingly determined by the competitive performance of individual hospitals and other providers. Stronger commissioning by Primary Care Trusts will reward higher quality staff and team working."

The report’s key points are:

The effects of centralised manpower planning have been negative. Human resources have been planned around individual types of staff, in particular consultants, rather than teams. There has been a total lack of focus on cost and economics, coupled with an emphasis on quantity rather than quality;

The combination of a doubling in the number of medical trainees, a low level of retirements and a very tight financial environment means that there is likely to be severe medical unemployment in coming years. There are far more young doctors graduating than the number of funded posts likely to be available;

There are serious staff shortages in some key areas, for example maternity and radiotherapy;

The NHS has much higher rates of sickness absence and lower morale than many smaller independent organisations;

Elements of the Government’s current policies will drive a new approach to human resources, which will itself support NHS reform;

Foundation Trusts, a greater variety of providers and practice based commissioning of new services will drive the system towards much more local and flexible systems of staff roles and pay structures. National agreements will play a declining role, based on defining minimum levels of pay;

Payment by results will mean that pay levels will be related to the competitive performance of the local healthcare enterprise;

Commissioning which sets quality standards will drive forward innovations in quality of care and will reward higher productivity;

Foundation Trusts can lead in developing new staff roles as care boundaries change. Independent treatment centres will also show what can be done through team–working to raise productivity and to provide patients with a one stop shop experience;

The transition to a new approach will certainly be difficult. It is likely that productivity gains will mean that staff numbers are reduced by at least 10% across all staff. This is not a central target but the possible reduction that providers could achieve;

In the longer term, staff will have gains from more choice, higher morale and greater job satisfaction from working in smaller, more independent organisations. Reform can produce gains for patients but it can also produce gains in control, rewards and job satisfaction for many staff as well;

"This is the first of a series of reports from Reform on the opportunities presented by
the reform programme in the NHS," says Reform. "We would hope that they will counteract some of
the overwhelming gloom and negativity of current comment.

Staffing

"For staffing reform could mean a system with flexible, local, initiative and scope for team building which will create much greater job satisfaction and professional pride. Reform can help to
ensure that we make full use of the great commitment and ability of so many staff in the NHS, replacing the frustrations caused by the failed system of centralized manpower planning.

Nick Bosanquet said: “Central manpower planning has delivered a huge increase in NHS staff but not the flexibility, quality and team-working needed to staff a modern system. The right change in strategy will be achieved by the Government’s highly welcome reform programme. The result will be a smaller NHS workforce with higher professionalism, morale and job satisfaction.”

Andrew Haldenby, the Director of Reform, said: “A bigger NHS workforce is one of the major reasons for the service’s financial difficulties. A smaller number of more effective staff will help the service return to financial reality as well as improving care for patients.”

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