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Monday 17 June 2024

Managers need a government that supports their drive and ambition for the NHS

By Rhys McKenzie & Jon Restell

ELECTION 2024: As polling day nears, Jon Restell and Rhys McKenzie set out MiP’s agenda for the next government: supporting the workforce, stabilising the health and care system, boosting productivity and giving managers freedom to do their jobs.

Cartoon – NHS staff questioning a politician as a patient looks on

Heading into this election campaign, public satisfaction with the NHS was lowest it’s ever been. With seemingly insurmountable waiting lists and chronic staffing shortages, it’s harder than ever for the public to access timely care. Health and care staff work tirelessly for patients, but they’re burnt out and need better support from the next government.

As the union for health and care managers, MiP know that our members are ready to do what it takes to get healthcare services delivering again. All they need is a government that matches their drive and ambition.

MiP has identified four priority areas the next government must address to get the best out of its managers:

  • Workforce
  • Stability
  • Productivity
  • Autonomy

Action on each of these will help to get the NHS back to where it should be: delivering high quality timely care to everyone who needs it.

Workforce, workforce, workforce

You can have all the policies you like, but they mean nothing without the staff to implement them. The NHS has been carrying over 100,000 vacancies in England for several years, while social care, with 150,000, has even more. Dealing with these chronic shortages may be the most important way to get services back on their feet.

The NHS Long Term Workforce Plan, published last year, was a step in the right direction, but its sole focus on increasing clinical numbers still leaves substantial gaps in the workforce. Its ambitious modelling relies heavily on a rapid expansion of university spaces and training placements, and on the assumption that those newly trained staff will stay in the NHS for a career. The lack of an equivalent plan for social care is another glaring hole that needs addressing.

Over a decade of declining public sector pay has left NHS workers worse off now than in 2010. With both the Conservatives and Labour admitting that investment will be limited, improving pay will be a challenge. A good start would be moving on from the tired pay review body process. Its recommendations have never been significantly different from what the government says it’s willing to pay and the protracted nature of the process means staff do not see the award in pay packets until months after it was due. Although the government portrays it as an independent advisory body, the review body plays a far more political role, giving ministers an expedient excuse when defending what is ultimately their own decisions on pay. It’s also time to refresh Agenda for Change so that it meets the ambitions of the Workforce Plan.

Pay is just one part of the puzzle. Staff turnover remains higher now than before the pandemic and the NHS is not retaining enough staff to stabilise the workforce. Culture, flexibility and career progression all play a role here. The next government must work with employers and unions to find ways to keep staff motivated, supported and ambitious in their careers.

Most of us also recognise the truth in the saying “people leave managers, not jobs”. Skilled managers have a hugely positive impact in the workplace, but they need the right tools, expectations and culture to succeed. Investing in management, through training and proper resources, and by creating ‘do-able’ jobs, helps managers drive standards across their organisation, benefiting workplace culture and improving colleagues' morale, productivity and retention.

End the flux in NHS structures

After numerous costly, often wasteful, reorganisations and mergers in the past 12 years, now is the time for stability.

It becomes impossible to plan for the long term when you don’t know the headcount of your organisation, its purpose or whether you will have a job in it or not. Organisational change creates an environment of uncertainty, fear and, more often than not, chaos. It is hugely demoralising to staff and often ‘brutal’, as one NHS executive described it to us. Structure is not set in stone, but form must follow function — allowing structures to evolve and adapt without tearing everything down and starting from scratch every few years.

Further organisational change will be disruptive and counterproductive. The next government must avoid major structural reform and allow staff to get on bringing down the backlog, improving access and getting health and care services back on their feet.

The productivity trap and how to avoid it

Productivity has come up fast on the rails in the race for attention from politicians and NHS leaders. It will be a priority whatever government we get. NHS England’s board recently considered a report suggesting a 10% gap in productivity has opened up since 2019.

Measuring productivity in healthcare is difficult and controversial, because the quality of care aspect of ‘output’ doesn’t get a full look in. Analysing causes and planning responses is also hugely complex. MiP wants a genuine discussion between the service and its trade unions about how to improve productivity.

In our view, previous attempts to improve productivity via pay restraint and headcount reductions have led to the industrial strife we see now. We need better, more sustainable solutions. MiP’s case (and that of several think tanks) is that you cannot cut your way to efficiency. Investing in management, estates and IT is critical for short, medium and long-term productivity gains.

The experience of our members is that fewer managers are being asked to do the same or more. NHS England itself says we have seen a big loss of skills and experience in the operational tier of management since the pandemic.

This approach will never improve efficiency. Further downsizing an already slim administrative and managerial workforce hinders productivity rather than improves it. Research last year found that these gaps in management and administrative staff simply lead to clinical staff spending less time with patients and more time with paperwork. An efficient healthcare system needs to consider the quantity and quality of its managers. In MiP’s view, this is the key to unlocking NHS productivity.

Give managers more autonomy

Members tell us about how it becomes impossible to plan for the long term as you lurch form one crisis to the next, with quick-fix political interventions coming too late to make a meaningful difference. Short term funding pots, last minute directives and ministers’ shifting priorities all hinder strategic and long term planning, creating a chaotic environment where staff are under relentless pressure but have little say about how to turn the tide.

This leaves staff working to political cycles and, in many cases, political priorities, limiting managers’ ability to plan for the long term. When staff feel like they are being made scapegoats for problems in the health service often driven by politicians themselves, the impact on morale is huge.

No one knows their local health systems better than the managers working in them. Managers should be given national direction on a few well-chosen targets and then trusted to make the long-term, strategic decisions they know will benefit local populations. By equipping managers properly and giving them enough autonomy, the next government can enable them to move away from the short-termism that has failed to deliver service improvement.

Healthcare managers want the same things as the public — waiting lists to come down, better access to services and care to be delivered safely. They are experts in finding solutions and delivering change, making them ideal partners for a government looking to reform services, improve workplace culture and raise standards of care.

Whoever forms the next government needs to tap into the unique skillset and expertise of health and care managers, and work with them rather than against them. Doing this will benefit them as much as it will patients and staff.

  • Jon Restell is MiP chief executive and Rhys McKenzie is MiP’s communications officer.

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