Developing the NHS Long-term Plan – the need for more active involvement of staff.

Every member of NHS staff I have ever talked to has had some clear ideas about how to improve both the work that they do and the organisation for which they work. Sometimes these are very simple, and you are left wondering why they just don’t happen. Others need some complex changes in the way in which their organisation is run. Yet others still need system changes to involve a wide range of organisations.

‘Yet others’ just can’t be done. (Sorry, but there just aren’t 10000 GPs this year).

Most of these changes are empirical and involve removing barriers that get in the way of work. (In a couple of weeks’ time I’lll return to an example of a nurse-owned initiative for their own wards called “Time to Care”. This gained some traction 15 years ago but like so many other good things in the NHS it has been forgotten – but it was full of possibilities that extended nurses’ time to care, and we need to remember how we did it).

It’s true that most groups of staff feel that with more of them the NHS would work much better. But it’s also true that most groups of staff have clear experienced-based ideas about how, if they could only work a bit differently, they would be able to improve both their care and their productivity.

And whilst many of these are not issues of grand strategy those of my friends who are senior managers in hospitals all tell me that “If we maximised the utility of nurse rostering, we would improve care considerably”. Most big improvements do actually comprise lots of significant little ones.

Whilst it is vital to involve staff in situ – since it is here that they have a direct impact on how to build better health and health care, nearly every NHS staff member is part of some other form of organisation besides the one that employs them.

The NHS is probably the most unionised organisation in the UK. Unions bring similar and different staff together. They have important ideas and opinions about their work that go beyond individual employers. They operate on national, regional and local levels and if, in 10 years’ time, the NHS is to thrive we need to ensure their voices are heard at all three in the development of the plan.

Not only is the NHS one of the most unionised organisations but it also has a higher proportion of staff organised into specific skill and knowledge groups. The plan will develop arguments for change. Some of that change will lead to disagreement with some staff groups. That fact alone argues for (and not against) the early involvement of those staff groups in the plan’s development.

For the NHS to move forward and thrive we are going to have to acknowledge and learn from the flourishment of ideas that arise from those disagreements about the way forward.

There are two things to change here. First the hundreds of small changes that each staff group feel could improve their work. And second, whilst many of these changes would not figure in the overall plan, what should is the importance of having mechanisms and strategies in every NHS organisation to make listening to staff an everyday event.

Staff involvement in the development of the NHS should leave us with more than just ideas for change that can be used in developing a much better plan. The planning process should leave as many NHS organisations as possible, with a legacy set of mechanisms that makes listening to staff routine.

We know from surveys that there is a significant difference between how staff feel about their different employers and whether they feel part of the whole decision-making process.

We also know that staff retention rates vary dramatically between different trusts (and that low retention rates costs a great deal both in terms of both finance and care).

So it follows that, perhaps one of the best outcomes of developing the NHS plan with staff would be not just their input, but legacy mechanisms by which staff can provide it in a much easier way it in future.

Of course, not all staff will agree about what they want the 10-year NHS plan to achieve, let alone how to achieve it. Nor, even more so, will all members of the public or all patients agree. Some will be disappointed that their views and hopes aren’t included in the final plan. And this disappointment will lead to some disagreeing with the way the plan was developed – and its outcomes.

There are those that would argue that the offer of participation in the development of a plan is therefore a cruel proposition. Since we know that some people – staff and public – will be disappointed, some would say it’s wrong to put them through the effort of involvement if all they get is the experience of disenchantment.

But this is an argument against the whole democratic process. It is expecting people to behave like young children. The deliberative processes outlined in my previous post – like the idea of juries – expect people to be able to sort through conflicting arguments and come to an opinion. Within a citizen’s jury there will be conflicting opinions. (Trial juries disagree).

We should anticipate that there will be disagreements between different staff groups. And yes a few, whose ideas did not get into the final plan. will say that was a complete waste of their time.

But most will recognise that if the NHS is to thrive it will need to involve many more people – staff and public – not just in the overall nature of the plan, but in the active creation of health, and in much more involvement in the planning and delivery of health care.

2 Replies to “Developing the NHS Long-term Plan – the need for more active involvement of staff.”

  1. Some NHS organisations have been effective at engaging staff in service improvement ideas in recent years but in others (poor) culture can get in the way. NHS IMPACT is a new national initiative to promote this, and should be welcomed.

    1. I agree enthusiastically about NHS IMPACT. As CEO of the modernisation agency in the noughties David Fillingham had a very big personal impact on helping a large number of trusts reduce long waits. His work as chair of NHS IMPACT will once more be very important.

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