NHS Case Study

NHS Case Study – People
Management
The NHS’ reliance on using temporary agency work is putting the organisation at threat of
widespread morale deflation and risk to patient care, according to recent reports. Staff shortages are
a common in the NHS due to short-term illness and maternity leave, but also inefficiencies taking
place at the recruitment stage. Added to this are underlying factors such as poor pay, increasing
workloads, inflated targets and an already intense environment, all leading to more and more cases
of stress and burnout amongst clinical staff. The increased use of agency staff has been shown to
reduce the moral of permanent staff due to discrepancies between wages and responsibilities, with
permanent staff often expected to undertake roles that agency staff are unwilling to do, despite
receiving a lower wage.
However, despite these areas for concern, more people are training to join the NHS every year than
are leaving it. This could see the NHS being able to reduce its dependence on agency and locum staff
and thus improve the standard and quality of patient care, whilst reducing some of its staffing costs.
The NHS will need more registered nurses in 2020 than today, as will the social care system. HEE
forecasts growth of at least 6,000 extra nurses but this could be considerably higher if the NHS
successfully focuses on:
 Education and training.

 Retention.
 Return to practice.
 New fast track ‘Nurse First’ programme.
 Support new Advanced Clinical Practice (ACP) nurse roles.
 Use e-rostering and effective job planning
In terms of the medical workforce, while we still have fewer practicing doctors than the European
average (as we also do for nurses), we have seen a 50% increase since 2002, and the number of
consultants and GPs available to work in the NHS by 2020 is forecast to rise further. Ideas to resolve
this include:
 Undergraduate medical school places will grow by 25%

 Expand GPs numbers. HEE will train over 15,000 GPs between 2015 and 2020,
 Tackle pressures on doctors in training.
Action will be taken by the NHS to address specific staff shortages which fall into 3 broad categories:
Leadership, Training and Development, and Talent.
Leadership:
There has been talk around the need for a more engaging style of leadership within our healthcare
system. The latest King's Fund report makes a compelling argument for a shift from traditional
'heroic' leadership towards a more collaborative approach. This is supported by the national
leadership bodies who will take action to implement the next steps of the ‘Developing People,
Improving Care’ framework for improving leadership and improvement capabilities across the health
and care system, with a particular focus on systems working, building improvement skills for staff at
all levels, and compassionate inclusive leadership. The framework set out a number of immediate
actions in 2017/18, including making available support for systems leadership development to each
STP footprint, developing the role of local leadership academies, launching a system-wide
programme to address discrimination against staff with protected characteristics, supporting
organisations to improve talent management, and establishing a national support function for senior
leaders. We are also developing specific improvement capability programmes for boards and
executive teams and for primary care practitioners, and CQC and NHS Improvement are jointly
creating a single ‘Well-Led’ Framework.
It is important that trusts to build strong leadership and the capability to continuously improve their
services so they are sustainable for the future. The aim is to improve the working environment for
NHS leaders and revitalise the systems of talent management and leadership development. This is
being facilitated through the Faculty of Improvement initiative, which includes the input of
internationally recognised clinicians, to guide in the creation of improved movement across the NHS.
With the Care Quality Commission, trusts were consulted on a new well-led framework through
which to assess a trust’s leadership, management and governance. With The King’s Fund there is
now the offer to the NHS of an evidence based culture and leadership programme with practical
support and resources, developed and tested with help from three pilot trusts.
Training and Development:
There has been a call for the development and implementation of a wide ranging series of measures
to improve the training, values and education of all NHS staff over the next five years and beyond.
The measures have been published in the government’s mandate to Health Education England, a
new arms-length body set up to give NHS training and education unprecedented focus and
importance. It will be backed by £5 billion and will be accountable to ministers for delivering key
operational and strategic goals.
With 12 other national health and care organisations, the NHS has so far published a framework for
Developing people, with a focus on improving care by equipping and encouraging staff to deliver
continuous improvement in local health and care systems and gain pride in and joy from their work.
The Sir Peter Carr Award is also available, offering £30,000 for a clinician and manager partnership to
invest in their professional development to help achieve a shared improvement objective. An
Improvement Hub is also available for sharing of experiences, as this has been something staff have
advocated for. It is important to share experiences, so the hub has been developed to be used
collaboratively, where ideas can be explored with colleagues, improvement stories can be shared,
and resource availability can be highlighted.
Talent:
The NHS is committed to discovering and developing talent from ‘Ward to Board’ and understands
that it is an essential element in its strategic goal, and aids in the future success, increased morale
and commitment of its staff across the board.
In order realise this aim, as well as to be sustainable for the future the NHS needs to ensure that
there are staff aspiring to develop at all levels who are not only technically skilled and competent,
but are truly aligned to and leading services based on the NHS’s values and behaviours framework.
This will allow the NHS to be ‘spoilt for choice’ from an internal pool of talent when vacancies arise.
Leading Sustainability and Transformation Plans (STPs) and Accountable Care Systems (ACSs) will
work with their staff and trade unions on ways of encouraging flexible working and ‘de-risking’
service change from the point of view of individual staff. This could take the form of an NHS staff
‘passport’ to enable, for example, nurses to work in both primary care and in hospital, helping
support team-based working. Since only 52% of staff are currently satisfied with the current
opportunities for flexible working, it might also mean discussing with staff side representatives and
unions new options to encourage individuals who are currently choosing agency or locum work back
in to substantive NHS employment. The practicability of term time contracts, seasonal hours, and
annualised hours contracting will also be tested.
The NHS has a very challenging time ahead. Their refreshed workforce planning will confirm cost
estimates and resource requirements. HEE will publish its annual Workforce Plan in April in
partnership with the NHS. Local Workforce Action Boards will support their STPs in revising, updating
and delivering these workforce plans.
Adapted from:
NHS: Next Steps on the NHS – 5 year forward: https://www.england.nhs.uk/wp-

content/uploads/2017/03/NEXT-STEPS-ON-THE-NHS-FIVE-YEAR-FORWARD-VIEW.pdf
NHS Improvement - 2016/17 highlights:

https://improvement.nhs.uk/documents/1458/1273_NHS_Improvement_201617_Ann_Report_FINA
L_press.pdf

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NHS Case Study – People

 Education and training.

 Undergraduate medical school places will grow by 25%

Training and Development:

NHS: Next Steps on the NHS – 5 year forward: https://www.england.nhs.uk/wp-

NHS Improvement - 2016/17 highlights:

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