Examination of Witnesses (Questions 900-911)
SIR JONATHAN
MICHAEL, MR
MIKE SOBANJA
AND MS
SUSAN HODGETTS
18 JANUARY 2007
Q900 Mr Amess: I was an MP when the
Griffiths report was first published, and I certainly do not think
that the Florence Nightingale issue has been addressed at all.
Our workforce planning inquiry is not exactly setting the world
on fire, and I do not think that the naff questions that I am
about to ask will add too much to it. Therefore, if only one of
you answers yes or no I shall be content. Is workforce planning
seen as a distinct and valuable career path for NHS managers—yes
or no?
Mr Sobanja: No.
Q901 Mr Amess: What kind of people
tend to go into workforce planning?
Sir Jonathan Michael: I do not
think we should criticise those of our colleagues who try to look
at the workforce needs of an organisation, but I go back to my
earlier comment to Charlotte Atkins: is one trying to manage this
across the whole NHS? My organisation is looking at its workforce
needs within the organisation, and that is a manageable thing
to do. To look at it across the whole of the NHS, particularly
if one is looking at clinical workforce where the training programmes
are prolonged, the sub-specialty outcomes of training may be very
complicated and multiple and the needs of patients change and
the science on which one bases that care change quite quickly,
it is a very difficult job. I argue that perhaps we should not
try to be so specific in terms of workforce planning across the
whole of the NHS. I think we are trying to be too specific, but
to criticise those who are trying their best would be unfortunate.
Q902 Mr Amess: As a supplementary,
Anne Rainsberry of NHS London told us at our session on 14 December
that she felt a lot of this work was being done by junior staff.
Do you agree with that and, if it is a problem, how can it be
addressed?
Sir Jonathan Michael: I am not
in a position to comment as to the staff doing the actual work.
Mr Sobanja: There are some very
senior people in workforce development confederations which have
moved into Strategic Health Authorities, so to suggest that this
work is being undertaken by junior staff is in my view wrong.
Whether or not it is joined-up work is something on which I would
focus attention. For instance, is it reconciled back to PCT development
plans, commissioning intentions and trust development plans and
their intentions? Is it reconciled back to affordability and likely
sources of supply? It seems to me that whether or not it is being
undertaken by junior or senior staff is the single failing of
workforce planning on which I would put my finger.
Mr Amess: Is there any significance in
the fact that my colleague Dr Taylor seems to have a bag underneath
his desk which sports the NHS Alliance logo, or is it just a coincidence?
Q903 Dr Naysmith: Perhaps I can rescue
the situation. There is an important point underlying the naff
questions that Mr Amess has just been asking. Perhaps I can turn
round these questions a bit and ask: is workforce planning possible?
Can we do it? I say that in the light of a BMA press release this
week from which one would think all hell was about to break loose.
Two years ago we did not have enough doctors; now we have too
many, and in two or three years' time we will not have enough.
If one reads that press release carefully it appears that the
whole of the National Health Service is about to collapse. Can
we plan for things like this or not? Is it possible?
Ms Hodgetts: I think workforce
planning is essential if one thinks of the kinds of budgets that
one is working with, particularly the MPET budget in terms of
the training of our clinicians, for example. I think that the
mismatch has happened due to the lack of communication between
national and local planners. We have people with a very high level
of skill in workforce planning, for example on our workforce review
team, and we also have people working locally in workforce planning
but who do not have those skills. The question is how we have
the conversation between the two and think about the way we are
revising and reviewing the way we work at the same time. It is
complex, but not to do it would probably be foolish.
Q904 Dr Naysmith: Are you saying that
it is not working terribly well?
Ms Hodgetts: It has not worked
terribly well. I hasten to say that I think we are improving as
we learn and reflect on what has gone wrong in the past and see
how we can make it better in the future.
Sir Jonathan Michael: I would
perhaps err on the side of doing less or doing something less
specific and keep it at a fairly strategic level for the country
as a whole and the NHS in the wider sense and allow individual
organisations to have more responsibility for their own workforce
planning. Clearly, there is no point in an organisation such as
mine planning that it will need a certain number of nurses if
nobody is training nurses in this country. There needs to be some
workforce planning, but to try to manage it to the specific level
that we have been is fraught with difficulty and almost guaranteed
not to succeed. You cannot ignore the relationship between workforce
planning and terms and conditions of employment. In the same way
that I believe workforce planning is fundamentally something that
organisations need to do, I would like to see a move away from
national unitary contract negotiations on terms and conditions
to something that is linked closer to the requirements of local
organisations.
Q905 Dr Stoate: The present situation
is pretty hopeless because, to pick up an earlier point, it is
totally piecemeal and is not joined up at all. That point has
just been reinforced by Sir Jonathan who says that he is perfectly
happy to do workforce planning in his own organisation, but that
is exactly the wrong way to go. First, the BMA says that there
are 10,000 too few GPs; now it says there are no jobs for GPs;
then it says there are not enough cardiac surgeons; now we have
cardiac surgeons with nothing to do and it is all dreadful. We
get into a ridiculous situation where we have literally boom and
bust in all sorts of professions at different times, but if we
allow each individual organisation to plan for itself no one will
take a strategic decision as to how many doctors, nurses or physiotherapists
to train. We are then told that 70% of physiotherapists coming
out of colleges this year cannot find jobs; five years ago you
could not get a physiotherapist for love nor money. We are dogged
by unjoined-up mechanisms. We have heard evidence that workforce
planning is very poorly integrated with financial and service
planning. Is it because financial and service planning managers
do not pay enough attention to workforce issues?
Mr Sobanja: I believe that the
system does not pay enough attention to integrating those things.
If you look at the performance management arrangements in the
health service, whether they are through Strategic Health Authorities
or elements undertaken by the Healthcare Commission, they do not
seek specifically to measure or manage that degree of integration.
I am nearer Ms Hodgetts' point than Sir Jonathan's. I think there
has to be a national system. It will always be an art rather than
a science. The particular problem in the health service is that
training lead times are sometimes extremely long, but that means
you have to look further out and have a vision of what the service
looks like. The failure to articulate what the service may look
like in five to 10 years' time makes workforce planning extremely
difficult. Currently, the vision is that there will be a 5% transfer
from the acute sector into primary care. Will that be undertaken
by general practitioners or pharmacists, nurses, physiotherapists
or whatever else? People will say that it will be a mix of that.
Unless you have a service planning view of what the service looks
like—one of the key roles of a PCT locally is to articulate
that view—you will not get anywhere in terms of meaningful
workforce planning.
Q906 Dr Stoate: That is exactly my
point. I recently wrote a pamphlet for the Fabian Society arguing
that 10% ought to be transferred from secondary into primary care,
but somebody needs to have that strategic vision; otherwise, we
are all chasing our tails. Nobody knows how many practice nurses
or what other skills in the field of healthcare assistants we
need in 10 years' time. It seems to me that nobody is making those
big decisions and we just lurch from year to year with boom and
bust of every description.
Sir Jonathan Michael: You could
argue that the reason we lurch backwards and forwards is that
to try to do centralised workforce planning is impossible. Therefore,
one needs to take account effectively of market forces in terms
of employment. If people wish to go into the legal profession
there is not a structured workforce planning arrangement which
says that there should be a certain number of litigation experts
in this particular sub-discipline. If people want to become lawyers
they will make a judgment about where they see career opportunities
matching their interests. I think that we need to move more in
that direction. It does not, however, mean that you do not have
a national overview about the likely number of doctors, nurses
and other clinical professionals who are required.
Q907 Dr Stoate: But that will not
do. If, for example, in five years' time one suddenly decides
that one needs 10 more pharmacists in one's hospital and there
are not any because nobody has bothered to train any pharmacists
five years ago what will you do?
Sir Jonathan Michael: As with
any other grown-up organisation we will recruit them from elsewhere.
Q908 Dr Stoate: From where will you
recruit them—other countries?
Sir Jonathan Michael: If need
be. We do not have the focus of a parochial organisation. We recruit
from overseas as well as from this country. Other people recruit
those we train to work overseas.
Q909 Dr Stoate: Let us save money
and close all the pharmacy schools and recruit all our pharmacists
from Europe. We have to have some idea of how many pharmacists
to train in the next 10 years.
Sir Jonathan Michael: That is
the sort of strategic workforce planning that I think is sensible.
I agree with that.
Dr Stoate: My view is that we do not
have a medium to long-term view of how many pharmacists we will
need in five, 10, 15 or 20 years, which is the problem.
Q910 Jim Dowd: Have we not allowed
the royal colleges to make the whole clinical business, if you
like, far too specialised and their role as gatekeepers is limiting
scope? You mentioned the parallel with lawyers. You train lawyers
and they then decide what they want to specialise in at a basic
level, but the royal colleges, and the BMA for that matter, have
traditionally resisted all that; they jealously guard their role
as the gatekeepers and definers of what is a qualified clinician.
Sir Jonathan Michael: They are
responsible for defining the competencies required for the training
within disciplines, but the wider question is: do we need to have
the sub-disciplines? The reality is that clinical practice is
changing and the answer is that you no longer have a generic surgeon
who will open your head, belly and chest. You would prefer to
have a sub-specialist who is trained to do the specifics. That
is one of the complexities.
Q911 Mr Amess: I was in recruitment
for many years. We have seen a ridiculous rebranding of the job
title "personnel officer" or "personnel manager"
to "human resources director", as if it means anything
different. In general, what do you think of the quality of these
personnel officers, managers, human resources directors, whatever
you want to call them? Are they making a real contribution to
workforce planning, or are they just interested in the conditions
of the workers?
Mr Sobanja: My background is such
that when I entered the service there was no such thing as "personnel",
never mind HR management. My first substantive post in the health
service was as a personnel manager before it turned into HR. I
have some interest in this area. It seems to me that the job of
the HR director should be about assessing the best way in which
the workforce can contribute to the service development aims of
the organisation. Do they do that uniformly? No. Do they work
at a strategic level? I do not believe so. That does not mean
to say there are not some very highly skilled and efficient HR
persons out there. Are they allowed to contribute to workforce
planning sufficiently? No.
Ms Hodgetts: I believe that over
the past few years anybody involved in HR has had a very difficult
job, bearing in mind consultant contracts, Agenda for Change and
the European Working Time Directive. All those things have merged
together and caused a tremendous amount of skilled work to implement
all those changes. There must be a degree of skill to be able
to deal with all those particular changes. My experience in dealing
with HR managers is that they tend to be more operational than
strategic, to reinforce Mr Sobanja's point. At the same time,
there are some stunning directors of HR who perhaps have been
brought in from the private sector but are still contributing
a great deal to the development of organisations.
Dr Naysmith: We will draw this session
to a close. We have gone down some interesting byways this morning
and have received a lot of valuable information from you. Thank
you very much for your contribution.
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