‘Providing efficiency and workforce –
the key challenge’
Dean Royles
Director, NHS Employers
17 March 2011
If HR developed film titles
• The Good, the Bad and the Surgically Challenged
• Four Civil Partnership Ceremonies and a Funeral
• The Monarch’s Presentation and Assessment and
Intervention by his Speech Language Therapist
• Where Eagles Fail to Undertake a Comprehensive
Risk Assessment
Changes to workforce development
• The Department of Health has proposed changing the way
the healthcare sector plans, commissions, trains and
develops its workforce, both medical and non-medical,
setting out significant changes to the way the system is
organised.
• This provides the opportunity to:
- Reshape and simplify the system so that it can respond
to the changes that are happening in the NHS.
- Develop a multi-disciplinary approach to workforce
planning with better links between those planning future
workforce requirements and those commissioning
education and training.
- Move to a demand led rather then supply led system
aligned to the needs and expectations of patients
Past ten years of significant changes in
the medical workforce
• The introduction of the 2003 consultants' contract
• The implementation of Modernising Medical
Careers (MMC)
• The development of training curricula with
progress to CCT and beyond based on agreed
specialty standards and competencies
• The developing role of the Specialty Doctor grade
• Implementation of the European Working Time
Directive
Huge efficiencies savings needed
across the entire health sector
• Efficiencies savings can be realised by
redesigning the structure and terms of specialty
and consultant contracts to better reflect
developing roles
• The £400 million clinical excellence award
scheme for doctors is out-dated, unfair and not
clearly linked to the needs of today’s health
service.
The future of the medical workforce
• Shifts in UK demographics are likely to have a significant impact on the type of
workforce we might need in the future.
• Some specialist services being delivered closer to home
• Local hospitals providing generalist care and more regional specialist centres.
• Expansion of generalist skills and at the same time the development of superspecialist teams.
• Career pathways will need to adapt to transformations in healthcare delivery
and demographic shifts in the medical workforce itself.
• With changing demographics, higher expectations and new demands on
health services, a more flexible approach to training and career development
is required.
• A modular approach to training?
• Core medical, mental health, research and surgical modules across a range
of settings, continued professional development in more specialist areas.
The future role of specialists (1)
• Role of non-consultant level medical staff is changing.
• Not all qualified doctors will want to take on the teaching and
managerial aspects involved in a consultant position, just as
consultant and GP principal opportunities may not be
available for all qualified doctors in the UK.
• Temple suggested different levels within the consultant
workforce may be beneficial, and with newly appointed
consultants requiring mentoring especially where they feel
they lack experience or expertise.
• A more flexible career ladder would provide opportunities for
doctors to practice effectively within clear limits of
competence
The future role of specialists (2)
• More innovative teaching within curricula will also be needed to
ensure that doctors are able to develop the level of competence
and capability required to work independently within a shorter
timescale.
• Employers want to enable specialty doctors and their trust
equivalents to gain recognition for the knowledge, skills and
experience they acquire throughout their careers.
• A multi-disciplinary approach to workforce planning is needed
with better links between those planning future workforce
requirements and those commissioning education and training.
• The NHS should move to a demand led rather then supply led
system aligned to the needs and expectations of patients.
Psychological contract?
Summary
• The provision of good quality care is not only about treating
high volumes of patients in a timely manner. It is about
delivering patient safety and a good patient experience.
• More of a balance is needed between training to achieve
competencies and developing capable doctors, who can adapt
to situations, react quickly and safely and instill confidence in
the patients under their care.
• Patients are less concerned with doctors’ job titles and more
concerned with having experienced, up-to-date and qualified
people to meet their healthcare needs promptly and effectively.
• Still a big quality and productivity challenge.
The QIPP Challenge
income
£
expenditure
projected real income based on CSR
projected expenditure based on current trends
productivity
QIPP Gap =
£20 bn
cash
1997
2011
2015
A productive workforce and the social
political and economical environment
• Efficiency savings of £15 - £20bn required in the
NHS
• A significant programme of structural reform,
including a 45 per cent reduction in management
costs
• An ageing demographic and rising expectation
among the general public as a result of
increasingly sophisticated methods of treatment.
Current context – Operating Framework
2011
This year’s NHS Operating Framework continues the Government’s
programme of change, addressing key workforce issues including:
• Staff engagement:The framework acknowledges the challenges that the
service is currently facing and the importance of ensuring that staff are
engaged (more later).
• Health and wellbeing: The framework reiterates an earlier commitment to
improving staff health and well-being and reducing sickness absence, as set
out in the Boorman review.
• Finances: The framework outlines proposals to provide staff with significantly
improved security of employment in return for foregoing pay increments for
two years
• Workforce planning, education and training: The framework promises to
put employers at the forefront of new arrangements for workforce planning,
education and training. The education and training consultation seeks to
ensure, workforce planning is driven by employers. Consultation now
launched.
Core metric framework
Legend
Workforce Costeffectiveness =
Cost-weighted
activity/
Workforce Costs
Inputs
Volume
Unit Costs
Nonworkforce
inputs (£)
Paybill per
FTE (£)
Paybill (£)
Paybill per FTE/
cost-weighted
labour input per
FTE
Cost-weighted
labour input,
excluding staff in
the community
Temporary
Staff
average
unit cost (£
per FTE)
Sickness absence
(%)
Contextual
metrics
Labour
Productivity
Staff satisfaction
(composite
indicator)
Turnover (%)
Outputs and
Quality
Value-weighted
activity.
In practice, this
would be qualityadjusted, costweighted activity
Cost-weighted
labour input
Temporary
staff volume
(FTE)
Temporary
staff costs (%
of workforce
costs)
Ideal benchmark
Skill mix
Staff
numbers
(FTE)
Workforce
costs (£)
Unit Costs
drivers
Central benchmark
Labour
Productivity =
Cost-weighted
activity/Cost
weighted
labour input
Note that community
based activity data are
not readily available,
therefore labour inputs
are adjusted to account
for the lack of
community in the
outputs
Cost-weighted
activity (£)
Total measure of
activity, including
activity in the
community setting
Composite
indicator of
three
dimensions
of quality clinical
effectivene
ss, safety
and patient
experience
Hospital
acquired
infection rates
Waiting times
Patient
satisfaction
Regional QIPP dashboard
Detailed page: Sickness absence
Staff engagement context
Background:
• The Francis Report and the NHS Staff Survey
Context:
• Using survey scores as an indicator of local performance
• Developing a score that covers multiple behavioural factors
• The Staff engagement score
The Evidence:
• Comparing the staff engagement score with other
performance data in the NHS
• What can it mean?
Developing a score that covers multiple
behaviour factors
The evidence tells us that staff with high levels of
engagement display a number of positive behavioural
traits:
• increased commitment,
• a belief in their organisation,
• a desire to work to make things better,
• suggesting improvements,
• working well in a team,
• helping colleagues,
• a likelihood to ‘go the extra mile’
Engagement & health and wellbeing
General Health (Lower scores better)
Survey data shows that overall engagement is linked to better general
health & well-being, lower presenteeism and less work-related stress.
General Health by Engagement
This link is reflected
in each of the 3
areas that make up
overall engagement
3.9
3.7
3.5
3.3
Low
3.1
Medium
2.9
High
2.7
2.5
Overall
Intrinsic
Involvement
engagement
Advocacy
Engagement & the Annual Health
Check results
Overall staff engagement significantly relates to Annual Health Check data. The
higher the engagement score, the higher the Annual Health Check score
AHC Results by Engagement
1 = Weak, 2 = Fair, 3 = Good, 4 =
Excellent
4
This is especially
seen in the ‘Quality of
Services’ element.
3
Quality of services
2
Use of resources
1
Low
Medium
Engagement
High
Staff engagement and patient
satisfaction
Overall staff engagement significantly relates to Patient Satisfaction scores.
Patient Satisfaction by Engagement
81
80
79
78
77
76
75
74
Low
Medium
High
Importantly the chart
shows this is a
relationship where it
is moving to high
levels of engagement
that makes the
biggest difference
Staff engagement and rates of
absenteeism
Overall staff engagement significantly relates to rates of Absenteeism.
Absenteeism by Engagement
Importantly the chart
shows this is a
relationship where it is
moving to high levels
of engagement that
makes the biggest
difference.
4.7%
4.6%
4.5%
4.4%
4.3%
4.2%
4.1%
4.0%
3.9%
3.8%
3.7%
Low
Medium
High
The NHS Constitution
The NHS belongs to the people.
It is there to improve our health and wellbeing, supporting us to keep mentally and
physically well, to get better when we are ill
and, when we cannot fully recover, to stay as
well as we can to the end of our lives. It
works at the limits of science – bringing the
highest levels of human knowledge and skill
to save lives and improve health. It touches
our lives at times of basic human need, when
care and compassion are what matter most.
The NHS Constitution – values
• Respect and dignity
• Commitment to quality of care
• Compassion
• Improving lives
• Working together for patients
• Everyone counts
The NHS Constitution – staff pledges
• To provide all staff with clear roles and
responsibilities and rewarding jobs for teams
and individuals
• To provide all staff with personal development
and access to appropriate training
• To provide support and opportunities for staff
to maintain their health, well-being and safety
• To engage staff in decisions that affect them
• Meaning, belonging, hope, growth
Thank you