The Lord Carter Review and the need for a national people strategy

Under the Lord Carter review, the NHS has been tasked with ending variations in quality of care and finances, in attempt to claw back billions in savings. The question remains of what this means for the entire NHS – an organisation that is already under significant pressure, and also for the individuals that make up the workforce and the management teams responsible for its implementation.

SJ Leatherdale & Sarah Lovell, Partners at Odgers Interim discuss the impact of recent developments and absence of a national people strategy during this time of turbulent transformational change.

Purse strings

The findings of Carter, whilst independent, have been collaborative across the 32 Trusts engaged in the report. Revealing that most trusts need help if the £5bn of efficiency is to be accomplished, Carter is focused on eliminating variations in running costs, sickness absence, infection rates and prices paid for supplies and services. In principle, this is low hanging fruit which will enable savings to be made quickly, but the reality is potentially a different story all together.

The pressure from Carter is compounded by confirmation that there will be no additional funding or growth for the NHS in the coming years. Other issues that are symptomatic of the NHS reducing its overall pay bill are also making the headlines, most notably strike action following the imposition of the Junior Doctor contract. With the growing expectation to work more for less pay, the question remains as to which section of the NHS’ workforce could face scrutiny under Carter next.

The staff bill represents 70% of the NHS’ budget, which goes to show how much the people need to be at the forefront of developments. Speaking broadly, many within the public sector choose the path due to fulfil a values based and moral calling, but will this calling be enough for those facing these pressures in 2016 and beyond?

The need for a national people strategy

Putting a spotlight on senior roles within Trusts across the country, we’ve seen Chief Executives vacating positions at pace in recent months, and this is having detrimental effects on the workforce. Increasingly viewed as a highly challenging task with little support and high pressure, leadership positions are becoming undesirable and no longer something to aspire to. Ultimately, when working closely with the NHS and looking who its future leaders will be, it is becoming increasingly difficult, because those with the right level of experience who in years gone by would have done all they could to move up the ladder, are being dissuaded. 

There’s no doubt there are exceptions to the unusually high turnover of staff, but the trend is undeniable, and stems from the lack of a national people strategy coupled with imminent pension reform. The NHS’ workforce at all levels is no longer nurtured with training and development opportunities as it once was. It needs to harness and galvanise talent at management level to identify who the senior managers of the future will be; where this was once the role of the CEO.

Developing a national people strategy would enable the NHS to identify where there are gaps in the system and nurture talent to grow into them. Additionally, analysis needs to be focused on why halting what could easily develop into the NHS becoming an unattractive place to work it may be around culture, values or pay, but this needs to be explored. This may help prevent the need to look abroad for talent which is unfortunately becoming more common.

Driving change

The work of the NHS is globally renowned and continues to be of high quality, despite the challenges facing it. Yet the lack of a national people strategy is affecting staff at every level and the Lord Carter review is already increasing the collective downward pressure on senior leaders, who have played, and will continue to play an integral role in helping the health service respond to the austerity agenda, plug specific skills gaps and drive system wide, as well as local health economy transformation.

With this backdrop, it seems that their skills are needed more than ever to help implement major restructuring and allow permanent management teams to keep their focus on the day-to-day operations, quality and above all, safe staffing.  Increasingly Directors of Nursing and other leaders in clinical governance are sought after to ensure that there are no shortfalls in the quality of and provision of care.

HR support is in demand to assess what Carter means for the workforce, and to help everyone adapt and cope with any periods of unsettlement. They are also being called upon to help plug skills gaps that can emerge from the organisational changes, and managers that have worked outside the NHS and the public sector are increasingly sought after.  

Effective HR is essential to make Carter work and drive the cost savings it is supposed to, as well as to decipher how we can retain really experienced people. Cultural transformation on this scale can sometimes be met with resistance. These are just a few examples of many specialist temporary roles that legislative change is creating in the NHS, while the importance of robust finance managers and directors should also not be underestimated in the current climate.

For the NHS to continue to deliver a world class health service, those working on Carter need to avoid taking a transactional approach to its implementation, instead putting people at the forefront of ongoing development and ultimately, improvements.