For many years, NHS managers and corporate staff have been characterised in the press as pointless “pen-pushers” or “faceless bureaucrats” – to the point where it has become conventional wisdom that tackling waste must require another round of back-office cuts.
Few would disagree that the design and delivery of our health services should be led by the needs of people who use them, or that frontline staff should be empowered to deliver effective care. But something that gets said far too rarely is that this can be enhanced by harnessing the skill and commitment of corporate staff in multi-professional teams.
I speak as someone who has worked as an operational healthcare manager, and at times I was infuriated by the sector’s hierarchical structures. But I was invigorated when I had the opportunity to work in partnership with clinical leaders and the people who use our services.
At the Health Foundation we recognise that corporate and support staff – such as HR, estates and IT – can be key to boosting quality and efficiency, yet they are an often overlooked resource. So a few years ago we started a programme called Shared Purpose to help clinical and corporate teams work together to improve care. We believed that creating a platform for collaboration between these groups would improve their impact and their ability to sustain improvements over the long term.
One of the projects we supported was a team at Northumbria healthcare NHS foundation trust, which was seeking to transform care for older people. Dignity in practice was ambitious and wide reaching; it aimed to understand and address the barriers to dignified care, including a range of initiatives to ensure the workforce, environment and clinical care were fit for purpose. This was achieved by aligning the work of the trust’s HR and patient-experience staff with that of the clinical staff.
The team created eight elder-friendly wards, with nutrition assistants to promote more choice, extra snacks and sociable eating. Age UK representatives were invited to observe teams and give feedback to help improve services. Information resources and a telephone helpline were also introduced.
The staff induction programme was changed to provide an upfront message on dignity and the “Northumbria way”. Peer support and resilience training were provided to ward managers and a new framework for recruitment based on values was introduced. More than 500 managers have now been trained in values-based recruitment, and more than 2,000 members of staff selected in this way.
The trust has introduced a live reporting system to track the patient experience of dignity and respect, and regularly publishes the ratings of senior medical staff. And national survey results show the percentage of staff members who believe that high quality care is the number one priority has risen from 63% in 2011 to 86% in 2015.
Last week, Northumbria was named the best trust in the country for patient experience. In its recent report, the Care Quality Commission (CQC) rated the trust as outstanding, only the fourth trust to be given this rating. Compassionate care was one of four factors behind the rating, with the CQC citing the Shared Purpose programme as a contributing factor.
This project – and others from the Shared Purpose programme (pdf) – show just what can be achieved when corporate and clinical teams work collaboratively. It was driven by a strong team, inspirational leaders and senior executives who understood the impact this work could have on the wider organisational culture.
As a result, the team has created the conditions in the trust to allow staff members to personalise the care they provide, to celebrate successes and to support the intrinsic values and motivations of healthcare professionals – whether from a clinical or non-clinical background.
Successes such as these should be held up as examples for others to learn from and to counter lazy narratives about back-office waste.
And at a time when there is a renewed push to reduce management and administration costs in the NHS – with the recent Carter Review proposing a 7% spending cap – they should serve as a warning that cutting corporate functions in a crude or arbitrary way could hinder our ability to reform and improve services in the future.
Libby Keck is a programme manager at the Health Foundation
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