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With the government implementing a two year pay-freeze to support its “austerity programme” and planning changes to public sector pensions, concerns arise that health-care organisations might be effected by widespread industrial action for the first time since the 1980s.

Unions reluctantly accepted the necessity of the two year pay freeze though are now campaigning for a significant increase for staff when that deal expires in April 2013. Unions are strongly resisting other changes to employment terms, especially the reduction n the value of pensions.

NHS budgets are under more pressure than they have experienced for a decade and employers are contemplating ways to change the Agenda for Change pay systems which were established nationally in 2004.

By the end of 2010, the organisation NHS Employers had proposed a national enabling framework for local pay negotiations which would have allowed local agreement for freezing pay increments in return for a commitment on preventing compulsory redundancies. At that time, with strong indications from the unions that they would reject local pay negotiations, the initiative seemed to stall.

NHS Employers Chief Executive Dean Royles said recently “It is essential that local employers have meaningful discussions with local trade unions and staff about the workforce implications of the financial challenges for their organisations.”

Through 2011, planning conversations have continued on the management side and NHS Employers has recently reflected employers concerns, suggesting current national pay structures place unsustainable pressures on the NHS pay bill and proposing greater flexibility and local pay deals as potential solutions. Foundation Trusts, with their freedom to negotiate local employment terms with their staff, may follow Southend University Hospitals NHS Trust in starting to change the way pay works. The Nursing Times recently highlighted a number of cases where organisations were describing these tentative steps towards devolution -

• Mid Cheshire Hospitals has been quoted as  “working alongside other providers at a regional level to consider options to negotiate alternative terms and conditions” on areas including incremental progression and sick pay,
• University Hospital of South Manchester is said to be considering “proposals for changes to terms and conditions outside of the national framework”,
• Central Manchester University Hospitals’ attempt to withhold pay increments from employees with poor attendance is being challenged by unions,
• Birmingham and Solihull Mental Health was completing an options appraisal “regarding a move away from Agenda for Change” by 2014,
• Royal Surrey County Hospital polled staff to see if they would accept changes to employment terms in exchange for fewer job losses.

Employers understand the NHS employment market is a complex one and history has taught them that competitive behaviour between neighbouring Trusts has been damaging in the past. At present it seems NHS bodies will share thoughts, ideas and opportunities for change, seeking to move “in concert” on a menu of options and proposals to be discussed with local staff.

An even more dynamic strategy seems to be emerging with Calderstones Partnership NHS Foundation Trust working to set up a spin-out social enterprise subsidiary which will employ staff on non-NHS terms and conditions. With new services being established through this vehicle, services might be run at lower cost, though transferring existing services will pose more challenges with both TUPE and equal pay requirements to be met.

So what change could and should be made in NHS organisation’s pay strategy?

Read the rest of this entry →

Had some really interesting discussions with senior HR practitioners this week – all touching on the shape, design and delivery of corporate services in the NHS.  Talking about the challenges facing NHS corporate functions, in particular we talked about HR Services and how senior teams should be considering areas for review and redesign using stronger evidence of efficiency and effectiveness.

We agreed NHS organisations needed help to understand their contribution, effectiveness, costs and efficiency. With better information available about those services, CEO’s could talk to their Directors about areas and ways to find better, more effective and affordable solutions to universal and ongoing organisational challenges.

Attractor has been working with an NHS client to support its work deploying  Supervisor Self-Service – part of the Electronic Staff Record (ESR), the national HR and Payroll solution used by almost all NHS organisations in England and Wales.

Following effective change management and process review action, the Trust has now completed the pilot phase, proving business processes work and assessing the extent to which new working practices are both fit for purpose and beneficial.

At the end of the pilot phase, managers using the system have reported real benefits for them in terms of time saving, more effective working practices, access to vital staffing information and greater empowerment with the ability to act quickly on timely information.

Subject to Project Board sign-off, Self-Service will be made available to managers across the organisation in a accelerated launch phase, alongside which the functionality in Manager Self Service will be piloted.

Earlier this year (July 2011) NHS Shared Business Service (SBS), a joint venture between the Department of Health and Steria UK, announced its clients would get a share of a £1.2m ‘bonus’. SBS reports savings of 20-40% of operational costs for services it has taken over in back-office support in areas such as finance and accounting, payroll and family health services and says it has saved £50m already.

SBS continues to proactively grow it’s business by acquiring work from additional NHS Trusts with the aim of saving the NHS £250m by 2014. Attractor would highlight the point that evaluating the impact of shared services can be complex as the boundaries between client and provider can generate costs if they are not well designed managed effectively. It’s not clear from published material exactly what functions have transferred and where clients retain responsibilities and functions.

With the right service-design, an external supplier can certainly provide capacity some organisations would struggle to obtain and retain, delivering better outcomes and cost effectiveness than an in-house service. Like many outsourced transactional functions however, feedback Attractor has from SBS customers does vary, with some being very pleased with both financial results and operational delivery while others reporting less satisfaction with operational service delivery.

This market is not very mature and only time will tell the extent to which SBS and other shared service providers are successful in providing robust and cost effective transactional services across the NHS.

During conversations with Attractor’s associates and partner organisations, ideas are being explored about how to build and support effective interventions for NHS client organisations, helping them deliver on the huge service change pressures they are facing. Some are focussed on developing a positive culture and this is part of every successful organisation. In the NHS however, managing culture is especially challenging – there are so many people who “part-belong” or who only temporarily “belong” to each NHS organisation.

Even were it simple, balancing cultural conformity and innovation can be difficult in a time of substantial change. Get the culture wrong – expect people to live by a prescriptive set of values – and you can stifle change and adaptation when it’s most needed. Surely in an organisation that truly values diversity, it should be OK to hold and voice disagreements without fear of being singled out as “a trouble-maker”, or simply being “resistant to change”.

Attractor has been involved in many conversations recently about the challenge of engaging staff members in the NHS.  There is quite a consensus that effectively engaging the workforce can be a vital ingredient for delivering high quality care, positive health and broader business outcomes.

All that people need do then is engage! Obviously it’s not that simple however and many consider it requires a significant adjustment in the culture of NHS leadership and management.

• Withhold and Uphold – Secrecy and control are the preferred strategy – saying nothing until absolutely necessary. Ignore the rumours and abandon influence.
• Spray and Pray -  Management  shower employees with all kinds of information – simple but confusing
• Identify and Reply - Allow employees to identify concerns and respond to them. Stresses listening to people even when they don’t identify key issues.
• Tell and Sell – Communicate a set of messages that address core organisational issues, the decisions and direction of travel
• Underscore and Explore – Focus on several fundamental issues clearly linked to organisational success. Allowing employees  freedom to explore the implications of those ideas. Listen and respond.

On the  ”All About HR Forum” on LinkedIN, members were recently asked what one practical action would improve engagement and the consensus was “talking to people”. Having front-line teams routinely talk about performance and improvement in the workplace – encouraging managers to regularly meet with and talk to team members (individually and collectively) is important – but it probably isn’t enough! Engagement is a “two way deal” – it involves the exchange of commitments. Read the rest of this entry →

Photo : FotoRita, Flickr

Thanks to business links with Zenon Consulting and Skillstream - Attractor was invited to take part in a round table discussion about the challenges of managing the healthcare workforce. The event, hosted by Kings College, focused on the challenges of managing healthcare’s contingent workforce in a strategic manner.

Professor David Guest, reviewing recent European research on the deployment and use of contingent workers, highlighted a number of key areas for discussion by the small group of  healthcare management practitioners. Issues of cost, control and risk, work quality, patient safety and service were considered.

Research across Europe is showing the performance of temporary workers is, at least, as good as permanent workers while they are also reporting  higher levels of well-being than permanent workers.

This seems to contradict the suggestion that temporary work is typically of  low quality and involves exploitative working relationships. Instead, is seems, there are large numbers of workers for whom the job role or profession of choice, perhaps even the level of autonomy and flexibility offered by temporary work is more important than having a permanent contract.

Commenting on this point,  David Guest said -

“Temporary work is certainly less secure but this may not cause a problem unless a temporary worker faces the risk of becoming ‘unemployable’.”

In relation to temporary workers, healthcare management often express concern over the impact of temporary workers on the quality of patient care, linked to workers’ unfamiliarity with the environment and local service requirements, possible lack of experience or, more importantly “free-riding” – where workers are less inclined to take appropriate responsibility for care outcomes though a lack of commitment to the organisation.

While it is clear that support, induction and supervision are vital ingredients for protecting quality and safety, discussion participants considered most healthcare practitioners demonstrated significant professional commitment to patient care (contrasted with any healthcare organisation) to acceptably reduce the latter risk.

Given the extent to which UK employers talk about flexibility, it was interesting to learn the UK has a lower proportion of  the workforce in temporary contracts (around 6-8% or the workforce) than other European countries (typically over 10% with Spain as high as 30%) and about half these are in fixed-term contracts rather than “agency” work.

Healthcare has some large groups of staff working across the country who are typically not permanent employees of a particular healthcare provider – including junior doctors, the large in-house staff banks and medical consultants – each of which have special factors that have made them a permanent feature of the NHS.

So what are the key issues impacting on contingent workforce management in healthcare? Read the rest of this entry →

Photo : DeclanTM, Flickr

In 2010, Attractor identified some challenges for the future of the NHS Electronic Staff Record (ESR), in particular suggesting the changing strategic picture in the NHS would have a big impact on deployment and implementation of additional features. While the “new look” NHS seems very slow to materialise, a world of increasing decentralisation and delegated authority must call into question the suitability of a national IT solution.

In a sign that Attractor wasn’t alone in identifying this question, the Department of Health wrote to NHS organisations recently, stating a late 2010 review had supported the concept of retaining and expanding the ESR solution from 2014 onwards.

While this strategy will undoubtedly require an appropriate  competitive process at the end of the existing contract, but it seems clear those actively managing the system and the contractual relationship with McKesson consider ESR has a long-term future.

From January through to June 2011, most NHS users of the ESR system will have experienced a major overhaul in the way the system looks and feels as well as significant enhancements in the solution’s functionality and “reach”.

As well as introducing a whole new look for core application users – which has generally been received positively – there are important additional features being introduced for learning management and administration, solutions to many user-identified problems and a move to switch all NHS organisations over to use of smartcards for controlling access to staff records.

These features and the parallel development of the National Learning Management Solution (NLMS) demonstrate the clear view of some who retain the vision that a national IT solution can be an important strategic enabler for the NHS. Unfortunately for many NHS teams, these new challenges have had to be managed at a time when available resources from the Department of Health and locally have been under increasing pressure and some have found it very difficult to make progress with some of the expanded functionality.

Read the rest of this entry →

In the current climate, perhaps it is unsurprising NHS organisations are looking for clear financial justifications for making any investments in projects which will take some time to complete and deliver benefits. When resources are tight and a number of core corporate functions are being subject to scrutiny and pressure, people are not sure there is a financial justification for starting any new work.

Having had the Electronic Staff Record (ESR) in place since 2008 (at the latest), many NHS organisations have deployed self service tools in some shape though few appear to be making full use of all it’s key features.

Too many NHS Trusts have been “piloting” ESR Self Service for a long time, with only a small number of people across the organisation using some of the tools available. This pattern suggests NHS organisations have commenced deployment without a clear strategy or vision about how they want to change the way they work.

Like many large projects, it can be all too easy to fall into the trap of focusing on the technology rather than the desired business change.

Undoubtedly, self service tools face special barriers in a healthcare environment. Not everyone has routine access to a computer and the NHS workforce has been relatively late in adapting to new computing technologies generally. With effective planning however, these challenges can be appropriately addressed and overcome.

In part though, the lack of progress on ESR Self Service reflects an innately conservative approach of corporate teams to the introduction of new technology – possibly not an issue special to the NHS. To the extent that self service encourages devolution of control and decision-making away from corporate centres, it is quite natural for those teams to express concern about risks and potential loss of control.

The combination of hesitant corporate teams, competing priorities, financial pressures and institutional constraints has the potential to make many NHS organisations seem increasingly archaic to “modern” managers from forward-looking healthcare and private industry and a new generation of employees now joining clinical teams from universities – who are familiar with the features of modern self-service technologies including sites like Amazon, Lastminute.com, iTunes and Facebook.

Like many organisations then, the NHS has been relatively slow to implement self service tools in the workplace. It is all to common to hear the business benefits of ESR Self Service have yet to be fully understood or, more importantly, realised in practice. How can this be successfully approached? Read the rest of this entry →

Photo: Siddhu 2020, Flickr

The well-respected Flip Chart Fairy Tales website has recently covered some important themes relating to the challenge of improving efficiency and productivity in the public sector. Rick points out the differences between manufacturing and service sectors and the lessons of systems thinking. The track record of UK industry in productivity improvement has, indeed, been gradual rather than dramatic and public services have to move far faster.

It seems, though, examples of public sector inefficiency are not hard to identify. In September 2010, an anonymously penned article in the the Guardian echoed the feedback from public servants working across the UK, describing a number of examples of waste in public services -

• poor recruitment and appointment decisions,
• poor management handling of lazy and inept staff,
• poor specification, deployment and use of contractors,
• waste, bad design and poor delivery of major IT projects,
• poor economy in travel and expense practice.

While, perhaps, indicative of a culture that values neither productivity nor efficiency, addressing all these issues would be insufficient to tackle the level of savings envisaged by the Coalition Government’s austerity measures.

In other respects however, the observer focuses on a far more important issue -

“… teams tend to blindly follow out-of-date procedures while others create new measures and protocols for the sake of it – and no one stops to question the need for so many reinventions of the wheel. Much of my present role has come about because of the need to redo work that was never completed to a remotely adequate standard.

The same thing happens whenever “efficiency savings” are called for: another big review gets under way, the same problems are discussed, committees are created … and then everyone carries on as before. Instead of waiting like martyrs for the axe to fall, the civil service could act. It could forget about further costly top-down examinations of recurring problems and instead ask everyone to take it upon themselves to do something about wastage.”

While this diagnosis may seem over-simple, it reveals an important truth. It is often within the outdated and ineffective working practices – which have accumulated over many years – that most of the inefficiencies remain deeply locked. To make effective change here, far more radical solutions are required and, in some places, shared services are seen as the answer. However, this response to inefficiency can be worse than the original problem. Read the rest of this entry →