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Royles: Common sense is not always right

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Everyone thinks they can solve people problems at the NHS, but what may appear to be common sense does not always yield the best results. NHS Employers boss Dean Royles explains how being a HR director can sometimes feel like being the England football manager.

It’s been said that the job of HR directors is akin to being the manager of the England football team. Really, it has been said! Not because HR directors are spending their time deciding on who will be the first eleven for the World Cup in Brazil, but because we have the same managerial problems as Roy Hodgson in that everyone – everyone – thinks they can do the job better. People stuff is just common sense, right? Wrong.

The last week has seen a couple more reports on the NHS. Well, dozens actually, but I just want to concentrate on two with a direct impact on HR.

The first was a report from the Royal College of Nursing about reductions in senior nursing posts. In effect the report said that, although there had been an increase in nursing numbers, there had been a reduction in senior nurses (those earning around £50k plus). “Reckless management”, the RCN said.

The second report was from the Health and Social Care Information Centre, with its census of the NHS. Numbers of staff are generally up, yet many commentators said numbers were important, but so was a need for a nationally set ratio of nurses to patients. Interestingly, as an aside, the census also showed that for the first time the NHS has more female GPs than male.

Both those conclusions fit into the common sense category. Fewer senior nurses is a bad thing and a national ratio of nurse to patients is a good thing. Right? But you can see where I’m going? The second (more nurses) is quite easy to achieve at the expense of, first, fewer expensive nurses.

Most people are familiar with hospital wards and we know from Care Quality Commission surveys that the overwhelming majority receive good care.

So take two wards.

One has invested in additional housekeepers and admin support to allow nurses more direct patient contact time, the ward has great relationships with the speech therapists, dieticians, physiotherapist and occupational therapists who regularly attend hand over discussions between shifts. Good feedback from patients, good outcomes, good staff engagement scores.

The other ward hasn’t made the same sort of connection but has slightly more nursing staff. Which would you prefer?

Work has changed, we work in more multi-disciplinary teams. We rely on experience from a variety of specialist professionals. This means patients spend less time in hospital (average 12 days in 1980 – 4.5 days now). This means the skill mix has to change, we have to adopt new practices, we need to let local teams use tools to work out what is best for their patients in a given day – not just match some nationally-set figure that will end innovation.

For the avoidance of doubt, I know specialist nurses make a fantastic contribution and I know there is a link between staffing levels and safe care. But the ‘common sense’ answer is not always the right one.

Dean Royles is the chief executive of NHS Employers and a HR magazine blogger