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Our last roll of the dice?

Dean Royles, director of human resources and organisational development at Leeds Teaching Hospitals NHS Trust, and the former CEO at NHS Employers, explains why workforce planning is not the main problem with the quality and design of NHS services.

This could be our last shot, the Five Year Forward View (now 3½ year) and the symbolic end of a decade that will spawn conferences and papers about the world in 2020. We are also halfway through an election cycle and the opportunity to reinvigorate policy development after the Brexit/Bremain Referendum will be unstoppable. For those interested in politics and the NHS, it will be, as the saying goes, “interesting times”.  

Workforce planning is not the problem 

This period will also provide the opportunity to kill off the shibboleth that the main problem with the quality and design of NHS services is a lack of workforce planning. It’s not. Let me add emphasis, it is most definitely not! I know, given recruitment problems, safety concerns, national targets being missed, and troubling times with employee relations that recruitment and workforce planning are the first to get the blame. That analysis is entirely understandable, but wrong. This could be our last shot. 

If we believe that we have a workforce planning problem, we will try and fix a workforce planning problem. Indeed, we have tried to fix it by recruiting overseas, agency spend, retraining staff, changing skill mix, etc. These solutions will be hard-fought, time consuming, expensive and very necessary to help fix the problem. But it won’t solve the underlying problem. 

Inability to deliver change at pace and with purpose 

The real problem is our inability to transact significant change in the way we deliver services at pace and with purpose and with the ability to take people with us: both our staff and our citizens. And by our inability, I don’t just mean managers, but politicians, government, regulators and system-wide institutions. I know it is complex, but this could be our last shot to get it right. My anxiety is that unless we confront this truth, we will continue to develop the wrong solutions to fix the wrong problems. 

I, and I guess many others, have put our hope in long-term strategic documents, planning frameworks and indeed more recently financial crisis and austerity in the hope that necessity would be the mother of invention. 

In 2008, on the back of the failures in the banking system, the private sector sneezed and the public sector got a cold – long-term funding restraint. It wasn’t the public sector that led to problems but over-lending to people that couldn’t afford it, subprime mortgages and perverse incentives to sell products that weren’t needed. The banks were bailed out and the public sector and the taxpayer met the bill. All the pundits, economists and commentators concluded that this change in funding would involve significant change in the way we delivered NHS services. And the NHS system on the back of that received wisdom (and reductions in turnover of staff at the time) reduced education commissions on the ‘certainty’ that services would be delivered very differently.  

It turns out we just ended up trying to do the same with less, some efficiencies, of course, but principally the same services delivered in the same way, running to stand still and often falling backwards. That approach has echoed through the years. A new strategy or our central plan heralding big changes followed by a conservative resistance to change and a lack of political will to follow through. 

The FYFV, 2020 and recent new investment: our last shot to get it right.  Do we plan our workforce around the ambitions of sustainability and transformation plans (STPs) and vanguards, or do we plan on the basis of what history has already told us? Take your pick.  This could be our last shot.

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