As NHS Chief Executives and leadership teams up and down the country pore over their National Staff Survey results – not available to the public for 2 months until 7th March for some reason – here’s what NOT to do...
• Review and further enforce the Trust’s sickness absence policy and management of absence
• Re-double unsuccessful efforts to recruit staff to fill growing vacancy lists and reduce agency costs
• Dictate CBU compliance with staffing protocols and agency cap spending limits
• Spend time and effort trying to identify the hot spots and conduct a root cause analysis on the workforce issues and challenges
• Conduct an executive-led review of all recruitment and retention blockages and obstacles.
This is the time of year, on top of all the other mounting pressures on Chief Executives and their executive teams, that senior leaders tend to huddle round the Board table and ponder ‘how to fix another set of disappointing staff survey results’. And every year, the response is just as predictable and depressing.
So here are some blunt truths for those courageous and independent-minded CEOs who are fed-up with pulling the same HR levers every year, and end up getting the same results every year - just more of the same.
The workforce challenges facing Trusts can’t and won’t be solved by HR
Staff turnover numbers of between 7% - 17%, vacancy rates of between 4% - 10%, staff sickness and absenteeism levels of 4% - 7%, aren’t caused by any individual and collective failure to implement existing operational policies and procedures. They are the result of years in which healthcare professionals have been ignored and side-lined by the national system, and where morale and motivation has plummeted to an all-time low as staff are pressured to keep on delivering more and more, with less and less.
The 2015-2016 Agency spend of around £3,600,000,000 reflected a market that is broken, with NHS staff voting with their feet to leave the service in pursuit of less pressured work for greater reward. That huge Agency spend from last year will in all likelihood be exceeded this year, despite the caps imposed by national bodies which was meant to encourage local leaders to be more circumspect in turning to Agencies when facing staff shortfalls. The only problem with this clear intent, is that when faced with a choice of accepting unsafe staffing levels and risking patient harm or else breaching spending limits to ‘keep the lights on’, the pool of CEOs/FDs/HRDs willing and able to do the former over the latter is precisely nil.
So if Agency spend in April for 2016-2017 doesn’t exceed last year’s number, it will be a surprise. My guess is that the system will have spent upwards of £4,000,000,000 on short term staffing fixes for long-term staffing problems. In other words, they will be paying ex-NHS employees and their new agency employers multiple times what they need to be paid to keep them in the Service in the first place - and paying it every year. Until when? Forever? Until things change? Until the money runs out? No, no, and no.
So, what to do?
Evidence from more than 180,000 NHS staff (ref Listening into Action (LiA) Pulse Check) makes it really clear what needs fixing, and none of it is being addressed in anything approaching a systematic and systemic way (isn’t that what the system is for?):
• Less than 25% of staff feel that day-to-day frustrations that get in their way are easily identified and resolved. So, three-quarters of staff working in the NHS can’t do their day jobs as well as they would like to due to bureaucracy, inefficiencies and ineffective working practices that hold them back
• Less than 50% of staff feel valued for the work they do, and most staff feel that up to 70% of their energy is dissipated and lost, wrestling with the way things are today in their workplace
• Less than 30% of staff believe that communication between senior management and staff is effective – there are hordes of people employed by the NHS to make this work, but it’s not hitting the mark for the very staff who need to be engaged and communicated well to/with
• More than 3 in 4 staff say that organisational systems and processes do NOT support them to do their job.
This is why we are where we are. And the solution to this reality is simple.
First, focus on retention, not recruitment
There aren’t enough staff to fill the gaps in the current workforce, and all Trusts are chasing the same diminishing pool of available talent. The somewhat unsavoury effort by Trusts to purloin staff from other healthcare systems across the globe or entice staff from one Trust to come and work in another isn’t the long-term answer to anything. If a fraction of the effort that went into recruitment drives and events went into engaging, empowering and valuing those who work miracles in the service day-in day-out, the hemorrhaging of staff would slow down, and eventually stop. People would want to stay. Agency staff would in all likelihood return to the fold as local conditions improved and they heard from ex-colleagues that healthcare professionals were back in charge of patient care priorities once more.
Second, stop asking and start fixing
NHS staff are sick and tired of being surveyed, reviewed, assessed, root-caused, investigated and audited. They’ve told anybody and everybody willing to listen what the issues are. They know what needs done but aren’t allowed to do it. Every year, staff dutifully complete the National Staff Survey and, every year, they see no change whatsoever. If day-to-day challenges and frustrations stop them doing their day job, why aren’t the existing management teams working with them to fix the problems? That’s what they are paid for after all. When staff start to see things they have complained about for years being addressed, they will respond. When they can get on and change it themselves, all the better. You don’t have to scratch too far below the surface of a long-suffering NHS employee to discover an enormous capacity to forgive and forget the travails of the system. They just want to get on and do a great job.
Third, build your bank
The huge costs associated with Agency spend makes any investment to incentivise existing staff to fill gaps themselves look like chicken-feed. Many would appreciate extra pay for an extra shift. How can it be cost-effective to spend an extortionate £2,600 on Agency staff for EVERY NHS employee in 2015-2016 (with even more spent in the current year), rather than pay a fraction of that to existing NHS staff – to improve continuity of care, make sure patients are safe, and boost staff morale and motivation by continuing to work as a team? How does this make any sense?
Fourth, stop doing what you’ve always done and try something different
February and March will be resplendent with local initiatives across the NHS to refresh local values and behaviours, to re-launch the latest people strategy or OD plan, to re-structure and re-organise the management and leadership of the organisation, or to replace the existing transformation programme and re-focus on the delivery of impossible costs savings, improvements and efficiencies. You can almost hear the collective groan from medics, nurses and health professionals up and down the land, and the resonant pleas of "Please, No!" Note that many of the list of most likely interventions are pre-fixed by ‘re-‘, which in itself tells a story.
If it was working you wouldn’t need to ‘re-anything’, because it would be working! So don’t rehash what’s failed for decades now. But, do remember, if you let your frontline stars get on with what they are best placed to do – design, develop and deliver fantastic healthcare to patients – and support them in doing it, everything else will look after itself.
Co-founder of Optimise Limited and co-architect of the Listening into Action (LiA) approach