How do you even begin to solve the HR problems of the NHS? Not only isit the UK's largest employer, it is arguably the only one wherenon-employees worry about the perceived lack of people and money as muchas the 1.3 million staff who actually work there. Get it wrong, and youdo not just disengage your own workforce; everyone else knows about ittoo.
Clare Chapman, director general of workforce, former HR director at theUK's second-largest employer (Tesco), ponders the question. It isexactly one year ago this month since she swapped shopping trolleys fortrolley beds to take charge of the highest-profile HR job in thecountry. Her appointment followed a dreadful six months for the service- revelations that it was 512 million in debt, ex-healthsecretary Patricia Hewitt being booed off stage at the Royal College ofNursing's (RCN) annual conference, and job cuts exaggerated by thepress. Six thousand losses ballooned to 8,000, and then to 13,000. By 5January 2007, the day Chapman moved into her Whitehall office, The Timestrumped them all, saying 37,000 jobs needed to be axed to keep withinthe NHS salary bill budget. RCN general secretary Beverley Malone,meanwhile, was calling for "a recovery strategy not redundancy notices;nurses being valued as assets not overheads".
"The only place you can start is by looking at what you've got," Chapmananswers matter-of-factly, expertly meeting a big question with a simpleanswer. "I spent my first three months touring hospitals simply tounderstand the system. What I quickly found was that, unlike Tesco,where performance is measured quarterly and occasionally every threeyears, reforming the NHS would be a 10-year project.
"My job boils down to one simple thing," she continues, "working outwhat improves the lives of patients and employees, then seeing to whatextent the NHS is designed to do this."
Chapman's clarity of thought is disarming at first but makes perfectsense in the broader picture of the changing NHS. Next Stage - Our NHS,Our Future, the interim report by Lord Denham, was published in Octoberand sets a template for the next decade. At the heart of it is improvingpatient quality of service. "I've joined at a time where my backgroundin recruiting to capacity for service is entirely useful for the NHS,"she says. "Improving patients' lives is often what employees want tomake their jobs better, so service provision should solve bothproblems."
This is Chapman's first interview since taking up the role - "there wasno point before I had anything to talk about," she quips. She reports toDavid Nicholson, NHS chief executive, who sits on the health secretary'sdepartmental board. The result of her silence, however, has been to fuelmore job cut rumours, mostly due to over-recruitment in the first place.The NHS target for hospital doctors was 74,590 by 2007, but, as early as2004, there were already 78,000, which rose to 82,000 just one yearlater. And if there's one thing Chapman learned from Tesco, it is hownot to employ more staff than is needed.
"I can look you straight in the eye, and say that the years of simplyhiring more doctors and nurses has now ended," she says resolutely. "Ido believe we have the capacity in the system to provide a first-classNHS service. We've got to move away from the overall growth story. Todaythe story should be about improving service."
But hang on. Can she really improve service with the same or fewerstaff? This is something politicians have consistently failed toreassure voters about. Can Chapman do any better? "The media hasn'ttaken the trouble to ask me this direct," she says. "It's fair to saythat when the first NHS reforms were announced three years ago, we spentmore time talking about the levers of these reforms than we did aboutthe care of patients. But I'm not facing the uphill struggle the mediamight suggest I am. In the past year just 2,300 forced redundancies weremade, and 82% were non-clinical. If I am to be responsive, these sortsof cuts have to happen. When you go through any period of change, youmust learn new things, and this is what I'm having to learn now."
She describes change as the "increasingly pluralistic way healthservices are being deployed - where care can sometimes be delivered byhospitals, at other times by the social care system and others" - all ofwhich, she says requires "better managers, those who understand how tolead staff across a more complex system." A leadership development planhas already been introduced to spot "good people earlier" but, asservice becomes the benchmark, Chapman says her priority has been toinvolve staff more in designing their own working practices. "It's avery simple story to tell to staff. It's a lot easier giving staff apicture of where we have come from, where we are at now, and where weare going At the same time, doctors and nurses were saying: 'involve usearly in the design of services because that way, they'll be designedproperly, and that way, we feel more equipped and engaged to do our jobsbetter.'"
Chapman has already launched a pilot project in the South West, calledThe Staff Conversation, which formalises these feelings, and is usingfeedback from frontline medical staff to take to the HealthcareCommission with a view to using it to overhaul staff satisfactionsurveys. "We know nurses are more optimistic about their role than theyhave ever been (satisfaction is up from 64% in 1996 to 79% in 2005),"she says, "but what I want to know is: are we making their livesbetter?"
Her mission, she admits, is under the almost constant threat ofderailment as MRSA, hospital closures and a whole host of other storieshit the headlines: "I do get pulled into these, but my focus is clear.There is what I call my elective work - stuff I want to do, likeengagement - and what I call my emergency work - pensions, frontlinepay, training. The latter are all important, but only as a means to anend. If you're not careful, they can take up an awful lot of time andI'm seeking to ensure that the emergency does not predominate."
Under tight new recruitment rules, Chapman says managers have beeninstructed to "seek vacancy freezes, and redeploy existing staffwherever they can". She believes that with a culture of "managers notbeing told how to manage" she is already seeing dividends, mainly infalling vacancy rates. But one criticism Primary Care Trust (PCT) bosseshave had to face is financial mismanagement, not least when it seems toundermine one area Chapman wants to improve - training.
Training is not something that seems to be consistent. "We've got theUK's largest talent pool, and as the patient experience comes to mattermore I'm making sure we put leadership training on the curriculum forall clinical staff," says Chapman. This may be the HR aim, but a stringof budget-balancing health authorities, notably Hampshire and the Isleof Wight, have been caught 'raiding' training budgets to juggle theiroverall financial books (it took 20 million). Could a group-wideedict from Chapman simply prevent this expedient behaviour?
"I wouldn't want to," she says resolutely. "You can't give managersauthority to make their own decisions, and then take it away from them."It seems a curious reply. What does she really mean? "Where hospitalshave taken action there has been a need to balance books. Hospitals thatreally know what impact training has on service will not cut theirbudgets. This was something I learned at Tesco, and the benefit oftraining was something I became very articulate at defending. That willcontinue to be the case here."
Unsurprisingly, instant results are not something Chapman can claim forher first 12 months. "What I can say is that the past 10 years ofcapacity building - the NHS has grown by 280,000 in the past decade -has provided the groundwork to enable me and my team to embark upon thenext era of the health service to use this built-up capacity to enablestaff to provide more value." In fact, on more than one occasion Chapmanrefers to being there at the "perfect time". It is easy to see why. Thebroader NHS transformation plan is already there, and she sees herselfas the person to see it through. "The NHS has been well versed in termsof the supply of talent - the numbers of doctors qualifying each year -but has not always known what the demand for these doctors is. Now, PCTshave to define their own strategies and visions, so they are having totalk this language."
Predictably enough, there will be no quick fixes. "Emergency-type workwill yield improvements within one year," she says. "Elective work ispractically a 10-year project, although in three years I think you'llstart to see some differences." That is a big promise, but Chapmancertainly gives the impression she will still be there, making sure thework she is starting comes to fruition. Last month the DH produced itsoperational framework document, which, says Chapman, puts staffsatisfaction as one of three national parameters.
And Chapman has by no means finished her staff tour. Rather thanmunching mince pies on Christmas Eve and Boxing Day she was visitingmore hospitals, seeing for herself the sort of tragedies that seem evenworse when they happen over Christmas. "I'm doing a job I really want todo," she says. "Seeing staff help people makes doing a tough job so muchmore worthwhile. We have many people that want to make the NHS better.It's almost a privilege to enable this to happen."
CV
2007: Appointed director general of workforce, NHS
2004: Joined the Qualifications and Curriculum Authority
2003: Became a non-executive director of First Choice Holidays
1999: Appointed group personnel director of Tesco
PREVIOUSLY: VP of HR for Pepsi Cola International's central Europe
0perations; and dean of Quaker University, Quaker Oats Incorporated,
where she established the company's worldwide learning institute
