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Thursday 14 February 2019

Our response to the Long Term Plan

By Jon Restell

The good intentions in the Long Term Plan will come to nothing if the government doesn't give the NHS workforce the attention it needs.

Jon Restellsmall

The themes raised by members from across the UK at our summit in November have found an echo in the Long Term Plan (LTP) for the NHS in England. This is unsurprising – and reassuring! – as our members should be at the heart of system planning. Documents such as the LTP do a necessary job by pulling together policy threads and seeking to accelerate positive trends. As such, members will welcome much of it.

It’s also possible to welcome the new money for the NHS – and congratulate Stevens and Hunt for getting it – while pointing out that it isn’t enough and keeping one eye open for the inevitable political massaging of the figures. In common with many others, our greatest concern is the ongoing political cold shoulder given to social care, followed by the failure to properly resource public health.

In our response to the LTP, MiP will focus on the three overlapping areas where we can have the most influence: organisational change, leadership and workforce.

Principles for change

The LTP signals more big organisational change for England as we move towards Integrated Care Systems in every area, with the associated streamlining of commissioning, ‘reductions in duplication’ in system management and regulation, and a Groundhog Day assault on back office ‘waste’. MiP will aim to ensure that organisational change is based on some key principles: that form should follow function, staff should be engaged as soon as there is a twinkle in a leader’s eye, and the valuable skills and experience of managers should be stewarded, not squandered through redundancies.

The LTP also raises the possibility of legislative change to support the new arrangements. Many members will see the sense of this – although it’s hard to see much political opportunity in our Brexit-obsessed parliament – but they will be cautious, knowing what a mess politicians can make of NHS legislation. MiP will work closely with our allies in parliament if legal change does get off the ground.

Contact with reality

Leadership and accountability gets a reasonably good airing in the LTP, not least with the expansion of the management training scheme. The “new compact” for the “most senior leaders” is very welcome and crystallises recent helpful interventions by Dido Harding, chair of NHS Improvement, and health secretary Matt Hancock. Talk of “time and space” and “air cover” is all fine and dandy, but what will happen on contact with reality? We still have strong reservations about the accountability framework for board directors, including the Fit and Proper Person Regulations – and, frankly, for all the welcome words, the revolving door in troubled trusts just seems to turn faster.

MiP is ready to put our shoulder to the wheel with government and system bodies if we can find genuine common ground on creating a compact where people can have stretching, accountable jobs that are also ‘do-able’.

A big hole

The NHS workforce is the big hole in the LTP, and one which we hope the Workforce Implementation Plan and the spending review will fill later this year. The government’s new-found commitment to workforce strategy, and the emergence of new national and regional structures to help providers deliver it, is obviously welcome. But training and recruitment will both need major investment if the LTP’s goals are to be delivered. There are also some big workplace culture issues that need addressing: wellbeing and employment flexibility, bullying, and diversity and equality. MiP will continue to lead national work on tackling bullying, and will play an even more active role in improving the experience of BME, women, LGBT and disabled staff – which is to say most of the NHS workforce!

Finally, we will repetitively bang the drum for the non-clinical workforce, as more and more research piles up to show the importance of managers in improving clinical outcomes and efficiency. And this year we will continue to partner with UNISON on our campaign for greater support for line managers.

Our national officers will obviously concentrate on supporting individual members through this latest round of structural upheaval. But through the strength and expertise of our members, and our influence within the staff side, MiP is also there to support you and your organisation in managing change for the good of all staff and services.

Jon Restell is chief executive of Managers in Partnership

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