Annex A: Developing the report

Both the Interim NHS People Plan (June 2019) and We Are The NHS: People Plan for 2020/21 – action for us all (July 2020) committed to a review of NHS human resources (HR) and organisational development (OD). The programme to develop a future vision for HR and OD was commissioned by the NHS Chief People Officer in 2020, and the programme began in January 2021.

The programme had three aims:

• to produce a baseline of people services across the NHS and understand what the people profession needs to fully implement the People Plan and People Promise
• to determine a shared vision for the future
• to recommend how the vision can be realised by 2030

The work was developed in line with the following principles:

• engage the people profession, and the customers they serve, to co-design the vision and plan for realising it
• consider external perspectives, external benchmarks and wider contextual realities for the people profession
• explore the role of the people profession in improving health, and health care
• better understand and address challenges related to equality, diversity and inclusion for and within the people profession
• understand the development needs of the people profession required to meet health and care needs – both today and in the future
• collect and share examples of good practice from across the people profession

The senior responsible officer for the programme was Thomas Simons, Chief HR and OD Officer for NHS England and NHS Improvement, supported by a dedicated team in the People directorate.

The programme had input from a steering committee comprising the NHS Chief People Officer and members of her senior team, the Department of Health and Social Care (DHSC), Health Education England (HEE), NHSX, NHS Employers, the Healthcare People Management Association (HPMA) and the Chartered Institute of Personnel and Development (CIPD).

The programme was also actively supported by three advisory groups made up of chief executives, heads of profession and HR directors. The HR Directors Advisory Group members, which met every two weeks, was critical to ensuring that the programme connected with the service regularly (through regional networks) and provided advice from senior people professionals and led the working groups in developing recommendations.

The team worked with three external partners: Lancaster University Management School, CIPD and EY. They provided global experience, best practice, academic rigor and evidence, as well as thought leadership in human resources, organisational development, digital technologies and talent management. They were also supported by Clever Together – specialists in facilitating digital crowd conversations and co-creative processes – who brought the voices of stakeholders from across the NHS to the fore in two ‘Big Conversations’.

Methodology

The programme had two phases of work: the research phase and the development and testing phase (described below). At each stage, the work was co-created and tested with the people profession and key stakeholders.

Phase 1: Research

The research phase aimed to gain a qualitative and quantitative understanding of the key issues, challenges and ambitions of the people profession.

Extensive engagement was carried out with people professionals and their customers, along with organisations working with them across national, regional, system and local boundaries.

External partners, including CIPD, used several evidence-based diagnostic tools and surveys to build up a clear picture of the key issues. This was supported by desk-based research, using available data such as the NHS Model Health System, and working sessions.

A key element of this phase was the ‘Big Conversation’ – an online social media-style platform in which more than 3,500 individuals took part and were able to ‘like’ or comment on options. Representatives from every trust in the country chose to participate at this stage, resulting in more than 10,000 comments.

Phase 2: Development and testing

This phase of the programme concentrated on developing recommendations to realise the vision for 2030. This was done by working groups comprising senior leaders from the NHS England and NHS Improvement People directorate, chief people officers and subject experts, through weekly meetings.

The vision and recommendations were tested back with members of the people profession and their customers through a second programme of engagement events, including another ‘Big Conversation’. The project steering group, CEO group and HR Advisory Group also provided feedback, along with further scrutiny and challenge.

Annex B: Summary of research findings

An independent review of the people profession (see research undertaken for the purposes of this report [CIPD Impact Tool]) revealed that its capabilities are above average compared with other sectors, with strong functional maturity in individual provider functions. Meanwhile, in the research for this report (see outputs of the ‘Big Conversation’ and research undertaken for the purposes of this report), colleagues across the NHS said they strongly valued the contribution of the people profession.

This annex sets out the research findings that underpin the vision.

The research for this vision highlighted some areas of excellence in the NHS people profession:

• The first ever NHS People Plan provided clarity, focus and a common set of goals to align local strategies and national initiatives. This provided a more consistent focus on delivering what matters to our NHS people.
• The pandemic provided significant opportunity for the people profession to play a strong role and demonstrate added value, by responding to the needs of our NHS people.
• Respondents cited examples of strong collaboration and an excellent array of HR and OD networks and forums, such as regional networks and the Chief People Officer webinar, to share good practice.
• Respondents highlighted a strong and co-ordinated response to national initiatives, such as mental health support and access to employee health and wellbeing apps

How people services are currently delivered within the NHS

A detailed review of people services for this report (see research undertaken for the purposes of this report [CIPD Impact Tool]) found an above average capability of people functions. If work processes and practices were standardised and shared, we could build on these instances of high-quality and use our resources more effectively.

Most NHS organisations arrange and deliver their people services separately, with each employing its own people professionals and developing its own strategy, and the research identified significant variation in the way these are provided. Organisations employ many different work processes, using a wide array of software to deliver different functions. Some outsource parts of the service, while in primary care there is little access to these services at all. Most have a senior people professional within the executive team, or around the board table – but not all. Neither do all organisations make sure line managers take sufficient accountability for their people management responsibilities.

These differences mean that our NHS people have a range of experiences depending on which part of the health service they work in and the expectations and accountability of their leaders and line managers. It is not unusual for NHS organisations to compete for talent and resources.

Nevertheless, there is growing collaboration across organisational boundaries and some vertical and horizontal integration. So far, this has been locally led, with varying models across the country, but the development of integrated care systems will accelerate this collaboration across organisations and providers. The people profession will need to adapt and work differently to make sure people services are properly aligned across systems.

Where we are: evidence, by theme

The remainder of this annex summarises the evidence gathered for the purposes of this report to provide a snapshot of people services in early 2021. The findings are set out within each of the key themes shown in the box above.

Equality, diversity and inclusion (EDI)

• Strategic direction: While there are examples of good work data such as the Workforce Race Equality Standard (WRES), the Workforce Disability Equality Standard (WDES) and staff survey results show a lack of strategic impact (WRES and WDES data – supported by consecutive NHS staff survey results).
• Governance and quality standards: There is a lack of emphasis on EDI and other staff experience metrics in assessments of organisational performance by regulators such as the Care Quality Commission.
• Accountability: Ownership of the EDI agenda by boards, senior NHS leaders and people functions is inconsistent, perpetuating inequality at all levels.
• Experience: The EDI indicators within the National NHS Staff Survey show wide gaps between the worst- and best-performing trusts. Our NHS people, leaders, and everyone we work with need to do more to treat Black, Asian and minority ethnic (BAME), disabled and LGBTQ+ colleagues in an equitable manner (HPMA London Academy. Experience of HR and OD professionals from BAME communities in the NHS. 2020. [cited 2021 June 08]).
• Access to learning: There is limited training on offer to enable people professionals to become role models for EDI, to guide and support leaders. As the training that is available has not been evaluated, the impact has not been measured.
• Belonging: People professionals identified creating a sense of belonging and an inclusive environment as a key priority and felt there was significant work needed to achieve it.
• Networks: There are excellent staff and professional networks, using lived experience to inform action. These represent opportunities to build on good practice, encourage collaboration as well as learn and share from each other.
• Impact: Data (WRES, WDES and NHS Staff Survey results) and lived experience shows that the NHS and the people profession have much more to do to reduce bias and discrimination and improve experience in the workplace.

Cultural and strategic positioning

• Increased profile: The people profession has risen to the challenge of COVID-19, demonstrating the value it adds to the service and the importance of the people agenda.
• Strategic positioning: Not all people professionals have a seat at the executive or board table and the people profession is still sometimes seen as a cost centre rather than a strategic partner to drive transformation and change.
• Impact: Much resource at provider level is spent on transactional activities rather than activities that improve patient care and outcomes. There is a need to measure the people profession on its impact on culture and behaviour as well as on transactional effectiveness.
• Reporting requirements: The multiple reporting requirements at national and system level are not joined up and limited reporting capabilities. As a result, this is often a time-consuming manual process.
• Leaders and managers: Capabilities of leaders and managers are highly variable, impacting on the experience of staff.

Technology and data

• Data systems: Out-of-date systems make it difficult to gain a snapshot of core people data across the NHS, impeding cross-organisational working.
• Procurement: The lack of a consistent framework for procuring people systems has led to a situation where multiple systems are being deployed by providers, duplicating efforts to secure funding. This results in lost opportunities to share purchasing power and learning.
• Interoperability: Limited interoperability between systems makes it difficult to analyse people data to measure and improve performance and increases the amount of manual work involved in reporting on key metrics.
• Self-service: Frequent challenges with managing self-service and people analytics through core HR information systems create a poor user experience and prevent systems being used to their full potential.
• Digital capability: Levels of digital capability across the workforce result in missed opportunities to optimise the experience of the NHS (as an employer and provider of health services) and to improve our responsiveness and efficiency.
• Integration: Better integrated systems analytics would save time and money and further support the people profession to deliver better services to our customers.

Employee experience and wellbeing

• Prioritising wellbeing: The COVID-19 pandemic has brought the importance of employee experience and wellbeing into sharp focus and the NHS has been responding to this need.
• People initiatives: There are excellent examples of people initiatives in EDI and wellbeing. However, because these are delivered inconsistently and line management is variable, the lived employee experience varies greatly across the NHS.
• Surveys: The NHS Staff Survey provides an excellent opportunity to benchmark employee experience, but employers need access to real-time data so they can be more responsive to need.
• Value proposition and brand: The NHS employee value proposition should be strengthened. There is a strong NHS brand, but it is not always used to best effect, to attract new talent into the NHS.
• Employee offerings: Competition between trusts has led to a divergence in the use of rewards and benefits and much is dependent on local organisations’ reward strategy and available budgets.
• Partnership working: There is strong collaboration and working with trade unions. However, much time is spent reviewing, negotiating and updating policies.
• Just and restorative culture: Some trusts have reorientated their people policy and working practices towards a just and restorative culture, reducing systemic discrimination, but there is a need for all people functions to implement this approach.

Workforce planning

• Real-time data: The NHS needs a cross-organisational view of talent and a centralised capability database to enable people to move between organisations and systems. This will help the people profession plan and deploy the workforce, to meet patient needs.
• Systems-level planning: Incomplete data and a lack of interoperability – coupled with a lack of alignment between local, system and national workforce planning – make it difficult to plan services across different parts of the health and care infrastructure.
• Alignment: Nationally, there is a disconnect between long-term workforce supply predictions, education and commissioning and the workforce numbers needed to meet health and care demand.

Professional development

• Development: There is some excellent HR and OD development but no consistent approach. Delivery is often siloed and not offered universally. The profession does not have a clear view of the capabilities that must be developed to meet the future needs of the NHS.
• Standards: There is no consistent approach to applying a clear set of professional standards and competencies.
• Equity: There is an under-representation of people with protected characteristics in the people profession – especially in senior roles.
• Continuous learning: The people profession lacks the infrastructure required to build a culture of continuous learning across the NHS or for OD capability to systemically help form and develop high-performing teams.
• Investment: There is inconsistent commitment to the development of people professionals in different parts of the service. For example, some NHS organisations sponsor CIPD qualifications, while others do not.
• Professionalism: Connection to professional bodies and adoption of evidence and research from academia could be strengthened.
• The future generation: Currently, there is no coherent talent pipeline into, or within, the profession.

Structure and process

• Process and delivery: There is considerable variation in different organisations’ process and delivery, leading to duplicated efforts and an inconsistent user experience.
• People policies: Each organisation has multiple, complex people policies that are cumbersome and labour intensive to interpret, implement, administer and update. Work is duplicated among different local employers.
• Core processes: Core processes are too complex. Our NHS people and their line managers waste time doing simple things that could be simplified and automated – particularly as they move across and within systems.
• User experience: People services do not consistently canvass the views of their customers to continuously build and improve the service. There is no regular customer feedback mechanism to track progress.
• Initiatives and programmes: Colleagues across the NHS have developed multiple people-related initiatives and programmes – for example, in wellbeing, EDI and workforce planning.

Integrated care systems (ICS)

• ICS strategy: Integrated care systems are not yet statutory bodies, so in some areas the strategy for integrated, collaborative working is still in its infancy. The extensive benefits of system working for the people profession and the wider workforce are yet to be fully realised.
• System working: Often, competition between providers remains and there are missed opportunities to collaborate, leading to a lack of productivity.
• Silos: Primary and social care are often siloed within systems and excluded from key initiatives. Often, systems cannot access a view of the entire workforce. The provision of people services to primary and social care is variable and, in many cases, does not exist at all. This hampers work across the profession, including efforts to create workforce plans and talent pipelines.

Talent, leadership and line management

• Line managers: There is no universal expectation or standard for leaders and line managers at any level in the NHS. This means there is no agreed standard in the ability to create and sustain a compassionate and inclusive culture. Neither is there a mechanism for spotting or nurturing promising potential leaders.
• Capability: The NHS has invested in building strategic leadership capability, but the employee experience of leadership and line management depends on individual skills. Leaders who lack the skills to effectively manage the people issues for which they are responsible do not always get access to the development they need.
• Talent management framework: There is no agreed talent management framework used in the NHS and this makes it difficult to effectively mobilise talent within and across systems.
• Accountability: There are few consequences for line managers and leaders who do not fulfil their people responsibilities. This results in people professionals spending extended time focusing on tasks that affect the few, rather than those that affect the many.
• Team development: Although the evidence linking high-performing teams to patient safety is clear, there is no consistent approach in the NHS to developing teams and those who lead them. Some OD teams offer team development, but many do not. Where they do, the approach is seldom systematic.

Organisational development

• Understanding: There is a lack of shared understanding of what OD means, both within the profession and among stakeholders. ‘People development’ is often confused with ‘organisational development’. Both are important and necessary.
• Value and potential: Limited value is placed upon OD compared to other aspects of the people profession. However, the potential of OD is increasingly apparent as the focus shifts towards addressing our organisational cultures and integrating services across organisations.
• Capacity: Although many members of the people profession contribute to developing our organisations, national benchmark data shows that only 6.2% of our resources are dedicated to OD. Increased capacity is needed to meet current and future demand.
• A profession in itself: The skills required to be an effective OD practitioner often mean that these staff have not come through the traditional HR route and are not fully integrated with the wider people profession. There is much to be gained from sharing and learning from each other.