Without People You're Nothing

With workforce costs in many public sector organisations accounting for 70%, or more of total expenditure there will be an increased focus on savings coming from staff costs.  However, the solution of running more efficient services is not necessarily to cut swathes of jobs.  Indeed a key finding from the Francis review of care at Mid Staffordshire NHS Trust was that there was insufficient focus on care while cuts were being made. 

A narrow focus on reducing headcount risks increasing total costs through costly redundancy, an over reliance on expensive temporary staff and a negative impact on the remaining staff.  Often turnover and sickness rates of those people remaining increases over time.  In addition, key skills, leadership and experience can be lost which impacts on the quality of services. 
You only have to look at the tragic stories which came out of Mid Staffordshire and Maidstone & Kent previously to see what can happen when organisations lose their focus.  A doctor who worked at Mid Staffordshire Trust is quoted in the Francis report:
“The nurses were so under-resourced they were working extra hours, they were desperately moving from place to place to try to give adequate care to patients.  If you are in that environment for long enough … you either become immune to the sound of pain or you walk away. You cannot feel people’s pain, you cannot continue to want to do the best you possibly can when the systems says no to you, you can’t do the best you can.”

What is needed to deliver the Government’s vision of “more for less” is an effective approach to workforce planning across public sector organisations that provide services.  This will increasingly mean public, private and third sector organisations working together as non-public sector organisations increasingly provide more services. 

At all levels in the public sector there needs to be a recognition of the requirements for both tactical (short term) and strategic (longer term) workforce planning.  Both are essential, with the NHS demonstrating it carries out tactical workforce planning on a daily basis, with varying degrees of success.  However, there is lack of effective strategic workforce planning in many organisations.  This is due in part to the lack of capacity in strategic workforce planning, but also there is a need for workforce planners to reflect on the inability of their functions to deliver strategic workforce planning in a sustainable way. 
Tactical workforce planning tends to focus on the immediate task of filling “work slots” and often looks at performance management metrics with a view to resolving the immediate problem, such as sickness absence.  Whereas strategic workforce planning will focus on how the service is designed, what activity levels are required (including whether the work is actually required) and then designing the optimum way for the workforce to deliver the service.  This approach needs to reflect the needs of the people receiving the service, it is essential to understand the complex needs of people and how this impacts on the level (acuity in healthcare) of care that is required.  

I strongly believe that strategic workforce planning is a “must do” for public sector provider organisations – as essential to effective service planning as business and financial planning.  However, workforce planners must prove their value to senior managers, or risk being the first “out of the door” at a time of massive pressure to reduce costs and especially management costs. 
A crucial factor in workforce planning is having a detailed understanding of the implications of changes in the needs of the population and not just the main headlines.  By understanding the population, a picture of the service needs can be identified and by engaging different organisations creative solutions which are cheaper and better can be designed and implemented.  In the future all adult services will need to be able to respond to the needs of older people and not just specialist older people’s services. 
In a previous role I facilitated a multi-agency workshop which identified that police constables were frequently called out to respond to calls from vulnerable elderly people who were living alone and in fear of break-ins and vandalism.  The team devised a service where, following comprehensive training, health and social care staff could take on some of these services as part of their regular contact with this client group.  It was felt that they were better placed than the police to respond to non-urgent cases as they had detailed knowledge of their clients’ domestic and social circumstances.  

Effective workforce planning builds elements into the design of the roles and tasks that will ensure safety and quality services are delivered, so for ward staff time is included for hand hygiene, for health visitors time for safeguarding is included in the core role.  This approach allows strategic workforce planning to match demands for services and the activity levels to the workforce in terms of skills as well as headcount.  
Organisations need to develop their business planning processes to ensure that realistic workforce plans are fully integrated.  These realistic workforce plans need to include clear actions which identify the person responsible and with timescales which reflect the time to train people.  
Strategic workforce planning is more than modelling numbers.  Effective workforce planners need to have a wide range of skills, but critically planners need to move out of the back office and engage front line staff directly.  Therefore key skills will include: strong facilitation skills, being creative in thinking of solutions and being strong enough to challenge the status quo.  There is a need to understand Human Resource processes; the theories of change and employee engagement; and be able to demonstrate commercial acumen.  

The challenge of delivering “more with less” is not going to disappear from the public sector for the foreseeable future.  Therefore strategic workforce planning is needed now, but as a process it needs to demonstrate its value and crucially a return on investment for individual organisations and especially the local population. 

As a service industry health and social care organisation need strategic workforce planning to help deliver the future services through their staff.  de Melo (2011) summed it up nicely when he said of his service industry “the key differentiating element in banking is people, products are imitated, technology can be bought but people make the difference.”  Joe Strummer may have been talking about the public sector when he said “without people you’re nothing.”

Posted by Wyn Jones on July 22nd 2013

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