{"id":44817,"date":"2019-06-13T12:02:57","date_gmt":"2019-06-13T11:02:57","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=44817"},"modified":"2019-06-13T12:06:38","modified_gmt":"2019-06-13T11:06:38","slug":"will-warburton-away-from-blame-can-a-new-people-plan-for-the-nhs-help-shift-culture","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/06\/13\/will-warburton-away-from-blame-can-a-new-people-plan-for-the-nhs-help-shift-culture\/","title":{"rendered":"Will Warburton: Away from blame\u2014can a new people plan for the NHS help shift culture?"},"content":{"rendered":"<p><span style=\"font-weight: 400\">What is the single biggest problem facing the NHS? According to Dido Harding, Chair of NHS Improvement, it\u2019s that &#8220;we don\u2019t have enough people wanting to work in it.&#8221; The NHS has a shortage of more than 100,000 staff in hospitals, mental health and community providers, including 41,000 nurse vacancies. Without recruiting at least 5,000 nurses from abroad each year, these shortages are likely to increase further. Adult social care faces similar pressures.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Challenges include recruitment and training of new staff, and retention, development and morale of current staff.<\/span><span style=\"font-weight: 400\"> Recent reports cite further problems with a bullying culture<\/span><span style=\"font-weight: 400\">, and insufficient diversity in leadership, with the percentage of non-executives from a black and ethnic minority background nearly halving in the last decade.<\/span><span style=\"font-weight: 400\"> Little wonder that workforce has taken its place alongside finance and performance as a major policy priority for the NHS. <\/span><\/p>\n<p><span style=\"font-weight: 400\">The new &#8220;<a href=\"https:\/\/improvement.nhs.uk\/resources\/interim-nhs-people-plan\/\">Interim NHS People Plan<\/a>&#8221; sets out ambitious goals in response. The report remains &#8220;interim,&#8221; in part because key decisions that affect delivery of the plan are yet to be taken, and lie outside direct NHS control. These include critical issues such as pension reform, investment in training and development, and financial support for student nurses, many of which depend on the Government\u2019s Comprehensive Spending Review, the date for which is unknown, and subject to current political uncertainty. Restrictive migration policies act as a further barrier.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Critics have pointed out that certain areas of the plan lack specificity as a result.<\/span><span style=\"font-weight: 400\"> But within these constraints, the plan identifies actions that are more within the NHS\u2019s gift, for example on increasing the number of nursing placements, making the NHS a better place to work, and improving leadership. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Given the growing evidence for the interrelationships between culture and quality of care, this emphasis on &#8220;improving the leadership culture&#8221; of the NHS is particularly welcome.<\/span><span style=\"font-weight: 400\"> The desired end state is a leadership culture that is more diverse, compassionate and inclusive, where leaders enquire deeply into the realities facing staff, then listen intently to answers, and support action accordingly.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The plan is optimistic on the possibility of swift change, asserting that culture change even in challenged organisations can be &#8220;rapid&#8221; with &#8220;the right leadership.&#8221; But in this understandable desire for pace, there are elephant traps, particularly when leaders are operating with one hand tied behind their backs within the policy constraints outlined above.<\/span><\/p>\n<p><span style=\"font-weight: 400\">One is that in suggesting culture change is always possible quickly, the plan risks adding to the problem it seeks to solve\u2014of creating a national-level expectation that the complex and demanding work of organisational change should be swiftly deliverable in all cases, regardless of local starting points. In the gap between these expectations and the reality of the challenge facing some local leaders, it is easy to see how pressure can build, relationships fray, and stress and anxiety become distributed through the system, from regulators, via managerial and clinical leadership lines to frontline staff. <\/span><\/p>\n<p><span style=\"font-weight: 400\">The second trap is in locating culture change as mainly within the gift of the leadership of organisations. Leaders certainly set tone and have a critical role, though it can be falsely comforting to place responsibility for culture with them: pinpointing boards as primarily responsible may psychologically release others from their role in solving the problem. Culture will be shaped by many hands, including through individual clinicians, managers and regulators, and as such change will require participation on a much wider scale than from those in the boardroom alone. This is especially true in an age of &#8220;new power,&#8221; where experiences and opinions surface from multiple sources, then form and spread rapidly via peers on social media, rather than through official channels.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The third trap is that patterns of behaviour between national bodies and the local NHS have become entrenched. It will take time and visible examples for staff to believe that the NHS is a &#8220;psychologically safe&#8221; employer, where workers can speak up without fear of recrimination, and where organisations can have genuine dialogue and give constructive feedback to regulators. The scale of this shift can\u2019t be overestimated: evidence from evaluation of national programmes demonstrates that after decades of &#8220;targets and terror,&#8221; managers and frontline staff instinctively interpret national initiatives, however well-intentioned, as being designed to find fault and assign blame.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The Interim NHS People Plan makes a good start by signalling the right intent on culture change: a new group of national leaders will have to demonstrate clearly, visibly and repeatedly their commitment to these new ways of working to make it a reality.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><em><span style=\"font-weight: 400\"><strong><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/01\/Will_Warburton.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-43871\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/01\/Will_Warburton.jpg\" alt=\"\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/01\/Will_Warburton.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2019\/01\/Will_Warburton-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><\/a><\/strong><\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Will Warburton<\/strong>, Director of Improvement, The Health Foundation.<\/span><\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: None declared.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>What is the single biggest problem facing the NHS? According to Dido Harding, Chair of NHS Improvement, it\u2019s that &#8220;we don\u2019t have enough people wanting to work in it.&#8221; The [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/06\/13\/will-warburton-away-from-blame-can-a-new-people-plan-for-the-nhs-help-shift-culture\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38759,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-44817","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Will Warburton: Away from blame\u2014can a new people plan for the NHS help shift culture? - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/06\/13\/will-warburton-away-from-blame-can-a-new-people-plan-for-the-nhs-help-shift-culture\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Will Warburton: Away from blame\u2014can a new people plan for the NHS help shift culture? - The BMJ\" \/>\n<meta property=\"og:description\" content=\"What is the single biggest problem facing the NHS? 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