Examination of Witnesses (Questions 40-59)
MR ANDREW
FOSTER, MS
DEBBIE MELLOR,
MR KEITH
DERBYSHIRE AND
DR JUDY
CURSON
11 MAY 2006
Q40 Jim Dowd: What about the disadvantages
of this reorganisation?
Dr Curson: Certainly in terms
of the SHA reorganisation, there is a concern that there are very
few workforce planning skills amongst SHAs and in the NHS generally
and that is one of the reasons National Workforce Projects have
actually set up the first training programme for workforce planners.
There is a very real concern that these skills might be lost as
people apply for jobs, even outside the NHS, while they are waiting
to see whether they do have a future in the new health authorities.
We are putting as much support in place as we can to ensure that
people are retained and once the new people are appointed we shall
be providing information packs for example and offers to help
and advise them on where they can get information and so on if
they are new to workforce planning. It is a concern, but one that
everyone is actively addressing.
Q41 Jim Dowd: Mr Foster, the Chairman
mentioned your interview with the British Journal of Healthcare
Management. In that you describe the closure of the Modernisation
Agency as a terrible mistake. I should say in passing that, as
the Director of Finance at Lewisham Hospital was poached specifically
to work for the Modernisation Agency, it was a particular blow
locally to learn that it was being closed. If it was such a mistake,
what are you doing to redress that and why was it closed?
Mr Foster: I should perhaps make
it clear that I was giving an interview in a personal capacity
and I have not actually seen this interview yet; I was not speaking
officially on behalf of the Department, as you will probably appreciate.
In my opinion, we set up the Modernisation Agency in order to
give us really cutting edge, world best practice in terms of service
and job design and it was beginning to do a fantastic job when
it fell victim to the financial pressures of other priorities
in the NHS. The work that was being done, indeed by some of the
people who are advising this Committee, to accelerate, define
and expand new roles, to develop a competence-based workforce,
has lost some of the impetus behind it as a result of the disappearance
of the Modernisation Agency. The new NHS Institute has taken over
some of the former roles of the Modernisation Agency, but it is
a smaller body, it does not have the same capacity to influence
job redesign at ground level, so we are going to have to devolve
the initiative to do that to NHS organisations themselves more.
I personally feel we would have been able to do it better, if
we still had the Modernisation Agency.
Q42 Jim Dowd: What about the impact
on programmes like the advanced practitioner programme?
Mr Foster: Exactly. The programmes
themselves remain, so out of the former work of the Modernisation
Agency much has been retained and devolved to organisations like
Skills for Health, the Sector Skills Council, to the NHS Employers
or to some individual strategic health authorities. However, it
has become rather more fragmented than it was and it will be more
difficult therefore to coordinate as an overall pattern and there
is less capacity behind it as well.
Q43 Jim Dowd: In conclusion, are
you saying that the benefits which it offered were clear but were
just too expensive?
Mr Foster: I am saying that the
decision which was taken to remove the Modernisation Agency came
just as the Modernisation Agency was really beginning to accelerate
and deliver benefits. If we had waited another six or 12 months,
we would never have removed the Modernisation Agency.
Q44 Dr Taylor: I am afraid I cannot
be terribly quick because I am just totally and utterly confused.
We already know there have been something like 30 reorganisations
of the NHS in the last 20 years. We are now getting organisation
after organisation with acronyms, all differing, which come for
a few months and disappear again; I am completely lost. We have
got the National Workforce Development Board, the Workforce Numbers
Advisory Board, the Modernisation Agency, NHS employers, none
of which still exists. Then we go over the sheet of our brief
and we have Workforce Development Confederation, we have them
being made co-terminous with strategic health authorities, then
them merging. How does anybody know what is happening and what
is going on? It strikes me as utterly ridiculous.
Mr Foster: May I separate those
out? One is about structures of the NHS overall, so the move from
PCGs to PCTs and then reducing the number of PCTs, the reduction
in the number of strategic health authorities, previously directorates
of health and social care, all of that is one set of things which
I am happy to talk about if you like. In terms of workforce planning,
the conclusion of your committee in 1999 was that we were not
sufficiently sophisticated and it is hugely complicated. You will
know as well as anybody how difficult it is to do medical workforce
planning. Take an example like cardio-thoracic surgery where during
the period of training of a cardio-thoracic surgeon the technology
has changed so dramatically that we do not need what we started
off the training with. So we need an ever more sophisticated set
of arrangements which does mean setting up specific bodies with
the right expertise. I apologise for the use of acronyms, it is
because they tend to have such long names to represent the combination
of expertise that they are representing, that we do reduce them
to these acronyms. For each of those bodies and for the evolution
of each of those bodies, there has been an extremely good reason,
as outlined by Dr Curson, about getting the system ever better
year on year, albeit that I fully accept that it will never be
perfect.
Q45 Dr Taylor: May I go back to the
combination of the workforce development confederations and strategic
health authorities? Is that not going to dilute the effectiveness
of planning? How are you going to make sure that planning at strategic
health authority level becomes really competent?
Mr Foster: Again, I have expressed
in that article that I regret the disappearance of the Modernisation
Agency and I also regretted the disappearance of the separate
workforce development confederations who were tasked very specifically
with being responsible for workforce planning and commissioning
of education and training. The reason for incorporating them into
strategic health authorities goes back to some of the issues we
were talking about earlier on, about better integration of workforce
planning with finance and activity planning and the view which
won the day, accepting that there are arguments on both sides,
was that it would be better to locate the workforce planning and
training commission functions absolutely inside the strategic
health authority, so that what was a separate workforce development
confederation now becomes an integral part of the strategic health
authority to improve the integration of planning. That is the
logic behind that.
Q46 Dr Taylor: Do you think with
the reduction of 28 to 10 that they will be able to cope?
Mr Foster: Dr Curson has already
outlined her concerns that there is a risk of loss of talent.
On the face of it, we shall have more numbers of people than we
need posts for, so there should be a surplus, but there is always
a danger in reorganisations that the best people go quickly and
therefore we may have some short-term problems. I am sure that
Judy and her team will be doing their best to compensate for any
short-term friction with a view to restoring a much stronger system
under the 10 new strategic health authorities.
Dr Curson: From our perspective
as the Workforce Review Team trying to work with the 28 health
authorities, what appeared to happen was that when the WDCs were
brought with the health authorities, and I can understand the
rationale about integrating workforce and financial and service
planning, although we regretted it at the time, when that happened
what appeared was that some health authorities retained a much
stronger workforce and workforce planning function than others.
Our hope is that with the 28 coming down to 10 they will all have
equally strong strategic workforce functions which have been set
down as one of the functions of the new health authorities.
Q47 Dr Taylor: And that is a hope?
Dr Curson: That is a hope.
Q48 Dr Taylor: Will it come true?
What can you do to make sure it does?
Mr Foster: We cannot say at this
stage because the detailed arrangements of the structures of the
new strategic health authorities are still being worked out. I
should very much hope that this Committee in its conclusions on
this process would have something to say on this, because you
were very influential last time.
Q49 Charlotte Atkins: Mr Foster,
you were speaking earlier about redundancies and you seemed to
be taking a somewhat blasé view about redundancies. I have
to say that sitting in North Staffordshire—and you mentioned
my local hospital—we take a less relaxed view about redundancies.
You particularly mentioned my local hospital and you spoke about
300 extra staff being recruited in the first quarter. Can you
elaborate a bit more about that?
Mr Foster: First of all, I was
by no means being blasé about redundancies. Everybody who
works in human resources and workforce would say that they are
the very last measure that any organisation should ever take and
we have been very clear on a series of other things that can and
should be done first before compulsory redundancies are even contemplated
and far from being blasé, I was simply pointing out the
contrast between the headline numbers that are being banded about
as job cuts, which are in fact reductions in numbers of posts
and not redundancies of individual people. So far from it.
Q50 Charlotte Atkins: So you would
expect in North Staffordshire we are still talking about over
500 redundancies?
Mr Foster: Yes. I also said that
there are two or three exceptions of which I am aware of organisations
where the level of cut is so great that there will be more significant
numbers and regretfully North Staffordshire is on of those two
or three organisations. But, the example that I gave, which really
follows the investigation that has been taking place into why
North Staffordshire found itself in this situation that it is,
did reveal that in the first quarter of last year there was this
increase in workforce numbers which simply demonstrated the lack
of integration in that instance between workforce planning and
financial planning.
Q51 Charlotte Atkins: What was the
justification for taking on these extra 300 staff?
Mr Foster: I do not know the answer
to that, because I have not asked that question. I would imagine
that it is because workforce planning is done in a separate place
from financial planning. The workforce planners say what work
they expect to have to do, they need more staff so they start
recruiting them without actually reconciling that to the budget
they have available.
Q52 Charlotte Atkins: So who is responsible
for linking up the issue of workforce planning with the financial
resources available?
Mr Foster: Following the last
sitting of the Committee on this subject, the publication A
Health Service of All the Talents made the point that there
is a level of responsibility at every stage in the system. There
is responsibility inside a provider organisation for integrating
its planning, there is a responsibility at the level of the strategic
health authority for challenging and ensuring that those figures
are collected and then there is a responsibility nationally for
us to aggregate the strategic health authority plans. I gave you
the example of last year when we aggregated the first of the strategic
health authority plans and it demonstrated a 6% increase in workforce
planning which we said did not make sense in the financial environment.
There is a challenge at the higher levels of the pyramidical structure,
but the fundamental responsibility for planning lies at local
level in each provider organisation.
Q53 Charlotte Atkins: What worries
me, and you have already spoken about the strategic health authorities
and how of course they are going to be reduced in number, while
even in the smaller scale, is when you have the Shropshire and
Staffordshire Strategic Health Authority with a vast hospital,
the University Hospital of North Staffordshire, in its patch,
which did not pick up on the fact that workforce was being recruited
not centrally by the University Hospital, but by each separate
department and there was no central control, which you indicated,
with that 300 extra staff just recruited with no reference to
the financial implications.
Mr Foster: Just as I have indicated
that under the new structure there are responsibilities at every
level of the NHS, when something goes badly wrong, as it has done
in North Staffordshire, there is a degree of responsibility at
every level.
Q54 Charlotte Atkins: So the responsibility
lies with the strategic health authority, it lies also with the
management of the particular hospital.
Mr Foster: Inevitably.
Q55 Charlotte Atkins: But the reality
is that the hospital management, in the case of the University
Hospital of North Staffordshire, go off and get plum jobs whereas
the staff, the very committed, dedicated staff of the hospital
end up with their P45s.
Mr Foster: Yes, and partly as
a result of that and other stories, the system has been strengthened
further this year. I do not know, Debbie, whether you want to
outline the information we are now proposing to collect from each
organisation?
Ms Mellor: We started last year.
There was a challenge process where we sat down with the SHAs
and we looked at their workforce and their finance plans and on
the back of that we decided we needed to collect a bit more data.
So we started collecting some workforce data around the numbers
of staff in post in various groups and across the total workforce
and the pay bill and the agency costs that were associated with
that. We are going to strengthen that system in the current financial
year by making sure that we have a joint collection process which
actually will bring together, within the financial information
management system, FIMS, which previously has collected financial
data only, a financial dataset alongside a workforce dataset,
so that we can actually track these linkages and analyse them.
Then we can feed that back and we can help both the strategic
health authorities, in terms of the information that is available
to them, and individual trusts by making sure that we have good
benchmark information which they can then use.
Q56 Charlotte Atkins: But if this
process started last year, why was it the case, just before Christmas
last year, well into the year, that it was still not clear in
the University Hospital of North Staffordshire what the deficit
was, what the financial situation was, just before in fact the
whole board of the hospital resigned?
Mr Foster: My understanding of
that, and this is somewhat second-hand, is that the challenge
process happened. The strategic health authority visited the trust
board and asked it to explain how it proposed to deal with the
financial situation that it faced, did not get a satisfactory
response and that is why the board resigned.
Q57 Charlotte Atkins: What worries
me is whether the strategic health authority only visits the hospital
once a year?
Mr Foster: That is really what
I was inviting Debbie to explain, how we are now going to be collecting
information on a monthly basis so that capacity to challenge is
served by an information dataset and you will have that information
much earlier.
Q58 Charlotte Atkins: Who will verify
those figures? That is the other issue. There were conflicting
figures washing around in North Staffordshire, none of which was
verified. Who is responsible for verifying this?
Ms Mellor: It will be the SHA
who will be responsible for verifying the figures which come up
from their patch.
Q59 Charlotte Atkins: The very organisation
that did not pick up on this problem last year.
Mr Foster: Or, alternatively,
the organisation which did pick up on the problem, but rather
later than we would have hoped.
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