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‘It’s the workforce, stupid’, as Bill Clinton might have said, if in some parallel universe he’d found himself at the helm of the NHS. With almost third of GPs say that they are thinking about quitting the profession within the next five years (in the UK); a rising leaving rate among qualified nurses and midwives in England; and disaffection rife among junior doctors, he’d be right to make it a priority.

On the face of it, there are very few grounds for optimism. Growing work related pressure and stress, which led to over a third of staff feeling unwell in 2015 in the English NHS, together with more staff deciding that they want a life outside the NHS, poses obvious challenges to the quality and continuity of care available to patients.

What’s more, it creates a huge financial head-ache for providers, as a higher proportion of their pay bill is taken up by agency staff wages, which are usually higher than those of equivalent permanent staff: Between 2013/14 and 2014/15 spending on agency staff increased by over a quarter, from £2.7bn to £3.4bn. It all contributes to the ‘perfect storm’ of rising demand and cost pressures, described in our new research report, which is threatening to overwhelm the health service.

Given these challenges, and the crucial but often neglected fact that staff costs account for three-fifths of total NHS providers' expenditure, you would have thought that workforce would have been high up the list of national policy priorities. And yet, as our new report on workforce, Fit for Purpose, shows, there is a conspicuous lack of clarity or coherence at national level in relation to workforce policy. Considering that forty national bodies have some kind of policy role when it comes to workforce planning, education, training and regulation this is hardly surprising. On the flip side, frontline NHS providers – the bodies which actually employ most of the workforce – have hardly any discretion to develop policies in line with local needs. These problems, and our response to them, are set out in Richard Taunt’s blog in this newsletter.

When you consider the very clear link between the presence of an engaged, motivated workforce and a whole host of positive patient and performance outcomes, the case for concerted action at every level of the system is overwhelming. Our Power of people film, Bottoms Up, shows how people working in Southern Eastern Health and Social Care Trust (SEHSCT) in Northern Ireland were encouraged to improve care, as part of a wider programme to create a culture where all health and social care professionals felt supported to play a part in transforming patient care.

Our Shared Purpose programme also shows what’s possible to achieve when all parts of the NHS workforce work together. Shared Purpose was based on the premise that improvement is everyone’s business, and that people working in corporate support functions such as IT, HR and estates have an important role to play alongside clinicians. We funded nine projects which aimed to align corporate and clinical services around common quality goals.

A case study on one of them, UCLH’s Liberating Sisters to Lead project, is included in this newsletter. It is a project that highlights the challenges of embedding new ways of working in a large, multi-site, organisation, where there are few opportunities for corporate staff to build any kind of relationship with frontline staff. And yet if you want, to ensure that basic processes such as your induction arrangements for new starters are as seamless as possible, so that people can get paid on time, have access to IT services and the right uniform and so on, these relationships are crucial, the project found.

The level of time, planning and engagement required was considerable but it resulted in improved processes allowing people to make better use of their time, and of course removed some of the stress associated with starting a new job. A key lesson from this project therefore, and from others such as the MyDay project in Birmingham and the Value Based Interviewing project in Oxford, is that you can’t cut corners when it comes to planning and building the will for change.

At the start of the programme, some of the teams, used to normal frenetic pace of working within the NHS, questioned whether they needed a nine month set up and planning phase. Surely, they would be able to get something off the ground more quickly, they reasoned. But very soon they realised the value of biding their time and avoiding a rush towards implementation. A sense of shared purpose just can’t be built within a few months.

These examples show you what can be achieved by valuing the people at the heart of our NHS. And as Richard Taunt says in his latest blog the system needs to be thinking beyond financial incentives and penalties and better understand the culture, values and positive intrinsic motivations that guide NHS people every day.

Bryan Jones is an Improvement Fellow at the Health Foundation.

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