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People management in the NHS

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Whenever cases have come to light of the failure in protection of vulnerable people - such as Victoria Climbie and, more recently, Baby P - I’ve always hoped that the resulting enquiries would uncover the inevitable true root cause: poor standards of people management.

Now the Stafford Hospital enquiry has done just that. The chairman stated: "As a result of poor leadership and staffing policies, a completely inadequate standard of nursing was offered on some wards in Stafford".

In the late 1990s, I was seconded to a large district hospital to carry out a root and branch audit into their people management practices. This involved interviewing staff from all disciplines and levels to find out how practice stacked up against a model framework for 'HRM Efficiency and Effectiveness in the NHS' that was being piloted at that time. It was an exceedingly good model, the bones of which I still use for HR audits today.

The outgoing CEO was widely known to detest appraisals so although the hospital had an appraisal process, it was entirely voluntary whether managers implemented it. Therefore, unsurprisingly, most didn't. I interviewed many consultants, registrars and senior nurses who said they would not have any truck with structured performance management processes since they were far too busy dealing with matters of life and death.

Also, unsurprisingly, the departments where the managers were most vehemently set against performance review processes were the ones where performance against specified standards and key indicators were extremely low and where the HR team spent an inordinate amount of their time processing poisonous grievances and counter-grievances.

There were a couple of departments where influential members of the senior staff bought into the whole idea of performance management and talked very positively about how they would not only always find time to do their appraisals, but would also follow them up throughout the year in regular structured one-to-one meetings with their people.

I asked how they managed to find the time and they said they made this a priority because it paid dividends in terms of staff focus, capability and motivation. The two departments that could find time away from the bloody battlefield of life and death had by far the highest rate of achievement against their performance indicators. And you probably guessed the punch-line: I'm talking about A&E and Intensive Care.

I left the hospital with two pages of specific improvement recommendations which I was told would be put to the board. Whether they were ever adopted or implemented I don't know.

What I can say with 100% confidence is if that if recommendations of the same kind had been rigorously and consistently implemented at any hospital, including Stafford and Queen's, we would not be seeing the gross failings that only ever come to light in the wake of a series of personal tragedies. And just to reiterate, my recommendations were based on a model of excellence available within the NHS 15 years ago.

I'm sure Dean Royles will rise to the challenge of leading a wholesale OD approach to transforming standards of leadership in the health service. But I firmly believe that until reporting by all bodies against human resources key performance indicators is made mandatory, with funding and commissioning sanctions for those that fall below a satisfactory level, we will continue with our own life and death battle to get senior people in organisations to take people management seriously.

Helen Giles (pictured) is HR director at homeless charity, Broadway