‘Following his well-received speech to the HPMA national conference, Dean Royles, President of the HPMA, blogs on the challenges and opportunities ahead, including the importance of Partnership working with trade unions and facing our biggest OD challenge.’

Whether you think you or whether you think you can’t, you’re probably right.

Let me take a guess on how you are feeling… I’m guessing there is a mixture of things on your mind.  You will be feeling tired and exhausted even, it’s been a long two and half years since the start of the pandemic, and you have got going and steeled yourself for that one last push..and then the next one.. and then..the next…You should also be feeling proud of the work you have done over the last few years, it has been an extraordinary once-in-a-generation test of character, and you have indeed risen to the challenge and shown your spirit and your dedication.  You may also be feeling anxious or worried about the months ahead and, in particular, what winter may bring.  But you should also be feeling confident in your ability and the skills that you have acquired and honed in the crucible of a pandemic.

Reflection is important.  Do take time over the next few weeks to network with colleagues and share your coronavirus stories, not through a sense of boasting but in mutual recognition and appreciation of just what you and your colleagues have achieved.  This talking through will be therapeutic and may even be cathartic, but it will be good for the soul as the nights start to draw in.  And I know your achievements aren’t purely personal; you have only achieved them through collaboration with colleagues, staff, and trade unions.  This really is teamwork.

I generally avoid politics in blogs, but sometimes it is important to make a public point on seminal political moments.  Earlier this month, it was confirmed that our new Prime Minister would be Liz Truss, and during her campaign, she has laid out her priorities, aims and objectives.  And I genuinely wish her well in the post; our country is hugely dependent on government as we approach this winter period.  Among her priorities was a commitment to review trade union power and workers’ rights.  The scenario that has been painted is that because of increased industrial action in the rail industry and other parts of the public sector and some pending industrial action, we potentially face a winter of discontent.  Not a winter of discontent brought about by cost-of-living rise and increasing energy costs but seemingly brought about through the actions of irresponsible trade unions.

 

Now, I understand the need for a political narrative and rhetoric, similes, and metaphors to engage the public.  But, this is not like the late 1970s and the original industrial action winter of discontent.  The office of national statistics confirms that in 1979 the UK lost almost 30 million working days due to industrial action.  In 2018 that figure was 270 thousand.  In the 1970s, strikes could be called by a simple show of hands in a meeting room – so-called wild cat strikes initiated by union barons; since then, we know that has changed to a postal ballot and, more recently, with a requirement to demonstrate a turnout of at least 50% of those eligible to vote and a majority voting in favour.  The thresholds are higher in important public services.  The area of the management of industrial action has been heavily legislated since the 1970s, making it in practice harder to call strikes and other forms of industrial action but… and this is important but, it is also harder for governments and employers to delegitimise the action when those democratic ballot thresholds are achieved.  Now, you may ask why a simple HR guy is making a point to people about trade union rights.  Well, it is because I believe in partnership working with trade unions, not just in the good times but in the hard times too, in fact, more importantly, and intentionally in the hard times.  And, we know we face tough times ahead.  In my view, further interference and antagonising trade unions in this area risks breaking the important social and psychological contract that exists between employer and employee.  There is a fine balance of reciprocal rights and obligations in public sector workplaces that; we should be extremely careful of distorting that balance.  I am pretty confident that almost everyone reading this blog knows that we have benefited in the last decade or so from partnership working with our NHS trade unions.  They have primarily worked hand in glove with us as we have navigated our way through covid.  It may not be popular with some, but whilst I will always emphasise the importance of patient safety during any dispute and the need for negotiations to avoid strike action, I, for one, will also stand with trade unions to argue the case for an effective floor of employee rights.  We must preserve and respect the mature working relationships we have with trade unions if we are to plot and chart our way safely through the difficult times ahead this year.

We know this dispute is about a national pay award rather than disagreements with local employers.  It would be fantastic in negotiations to avoid the need for industrial action.  Resolving the cost-of-living crisis isn’t only morally important; we know that if we have staff struggling to heat and eat, this will impact NHS and care services, too, and I know so many of you are being creative to support staff locally.

In addition to a new Prime Minister and we have also had an announcement of a new Secretary of State for Health and Social care.  I have written to Therese Coffey – you can view the open letter by clicking here.  In writing the letter, I’m not trying to make a political point about the NHS.  But I am trying in a mature and constructive way to use the privilege of my position as President of the HPMA to try to speak some truth to power.  I am not one of those that think all ministers are driven by personal ambition. I’ve been around a while and worked with ministers from several political parties, and, in my experience, the policies they choose to pursue are routed in what they personally and politically believe will work rather than through a personal, ambitious selfishness that they are often accused of.

I have urged the new Secretary of State not to make the mistake of others by undervaluing and failing to appreciate those that work in support of frontline care; administrative staff, managers and those working in central functions such as IT, HR and finance staff.  It is easy to demonise these staff for populist headlines, yet they too are part of the team that has delivered so fantastically over the last few years and are just as much an essential part of recovery of the sector.  Valuing and appreciating them will help in delivering the improvements in health and care that we all want to see.

I do wish the new secretary of state well.  It is a tough job, one of the most important in government, and our workforce and citizens depend on them getting it right.

Winter is coming, and I know it will be challenging, and I know our HR teams will rise to that challenge, but as we look ahead, I think we face one of our most significant cultural challenges and opportunities.  It is an OD task the size of no other, and I believe we have only just begun to scrape the sides of the task.  The task is about collaboration.  Real, meaningful collaboration that will benefit patients.  The first NHS Trusts were incorporated just over 20 years ago.  Before that, we had a system of district health authorities overseeing services in a given geography.  And I know we have different models of delivery in Scotland, Northern Ireland and Wales, but I know many of the points I make now will resonate.  Trusts brought with them the need for competition; the idea was that money (funding) would follow the patient – as Trusts improved their services, more people would want to utilise this better service.  Whether you subscribe to that model of service improvement or not, the fact is that for over 20 years our models of management and leadership in the NHS have been predicated on that construct.  We have been trained as hunter-gatherers, not only competing for patients and for funding as services expand but also competing for staff.  When we are all fishing in a similar labour market pond, we know we can only get staff at the expense of our neighbours if we have a better working environment, culture or conditions.  For many, it’s the only model we know.  Now I’m sure most here will subscribe to collaborating across systems, but do we really live it?  Think how often we play our cards close to our chests when sharing incentives for bank work, mileage rates, health and well-being initiatives, or the delight we feel when more of the student outtake choose our organisation rather than a neighbours to work in.  We know there is something in our competitive psyche lurking just beneath the surface honed by years of being trained and regulated this way that wants our organisation, our service, and our department to do better than others.  By the way, I’m not here just pointing a finger; I’m guilty as charged!  I used to pour over staff survey results to see who I was better than!  And yet those are the behaviours we need to change, which we need to unlearn after more than 20 years of competing, and then learning new collaborative values and behaviour to create a new working paradigm.  It is a big ask, but this OD challenge is central to improving our local populations’ health.  An integrated care system will only work with an integrated workforce and integrated workforce planning.

One of the NHS’s key roles, particularly across systems, is to address health inequalities.  The NHS is also an important contributor to the social and economic well-being of the geographies we serve.  Most recruit a workforce locally, and the NHS and social care is also the largest employment sector in most areas.  Not just for health and care jobs.  The NHS is often the largest employer of IT staff, finance staff, HR staff and so on.  Getting collaboration and partnership working right in a local system puts people management and HR at the heart of achieving those ambitions.  Our workforce is our population, and our populations are often our workforce.  The health of all of them counts.