NHS 2010-2015: From Good to Great and The Operating Framework 2010/11

Plans have been published outlining the future of the NHS in the short to medium term. Jodie Sinclair explains more about these key issues.

NHS 2010-2015: From Good to Great

On 10 December 2009 Secretary of State Andy Burnham introduced a five-year plan to reshape the NHS during the current tough financial environment: ‘NHS 2010-2015 from good to great’ (the”Report”).  The report sets out the practical measures on how the Department of Health (“DoH”) hopes to reshape the NHS in order to ensure delivery of high quality care against the backdrop of a challenging financial economy.   As with local government, the NHS is also being forced to re-evaluate and reconfigure so as to be able to deliver exemplary services whilst also achieving the efficiencies required.  This service transformation and innovation has forced the DoH to consider new organisational structures and new ways of working, as is being seen across the entire public sector.

Chapters three and four of the Report specifically focus on what the various measures will mean for NHS staff and how they will be supported through the process over the next 5 years. Staff are expected to embrace these new changes and it has been made clear that efficiencies can only be achieved if they are prepared to be flexible and co-operative with the various proposals.  The DoH is, however, eager to stress that they wish to see staff proactively involved, ensuring that their input is considered at all stages of the process.

Andy Burnham has made his commitment to NHS staff clear:

"The improvements in the last decade have been made by NHS staff. It is vital to protect frontline staff in order to deliver services to patients. The challenge to the NHS, and to NHS leaders and staff around the country, is to reshape services further and faster than ever before. We are proud of the achievements of NHS staff and we will do everything we can to support them through the next period of change."

'NHS Operating Framework for 2010/11

The report's medium-term vision is specifically supported by the 'NHS Operating Framework for 2010/11' , published on 16 December 2009, which specifically sets out how the NHS will achieve this vision through their priorities for the upcoming year.  As one commentator has put it, the Framework seeks to 'put more flesh on the bones of this vision' .

The Operating Framework does not contain anything which commentators considered unexpected; it does in fact keep in place the same five national priorities, as seen previously in the last two Operating Frameworks. 

Despite this, the NHS Confederation chief executive Steve Barnett has stressed that it:
“provides a further reminder of the scale of the efficiency savings the NHS needs to make if it is to survive the biggest financial challenge it has faced in a generation."

In summary the measures specifically related to HR and workforce issues, as raised in these two publications, are:

'NHS 2010-2015: FROM GOOD TO GREAT'
Chapter 3: 'The Deal for NHS Staff'.

This chapter specifically sets out the Department’s reforms and what they will mean for NHS staff:

Embedding and extending the concept of social partnership

• The aim is to 'embed and extend the concept of social partnership' and the Department reiterated their earlier announcement that they will invest £500,000 to support partnership working throughout the NHS this year and next.

Change led locally and supported nationally

• The Department will share knowledge and work with other organisations, such as NHS Institute for Innovation and Improvement, NICE and Social Care Institute for Excellence
• The Department will back major programmes of work to commissioners and providers.  The programmes are to be locally led but nationally supported to ensure spread of innovation.
• NHS Institute for Innovation and Improvement will align entire work programme to support NHS organisations.
• DoH will work with National Leadership Council to set standards, underpin and champion the talent and leadership programme.  In particular they will focus on 5 priority areas:
• • Clinical Leadership
  • Top Leaders;
  • Board Development
  • Emerging Leadership; and
  • Inclusion
• NHS Constitution: 4 pledges made to staff which represents NHS commitment to go above and beyond normal legal responsibilities of employers. This highlights how the Constitution sets out vision of strong partnership with staff to provide high quality healthy workplace.
• The Government has accepted the 20 recommendations in Dr Boorman's independent review of health and well-being of NHS workforce (carried out Nov 2008). They are looking to the NHS to implement them in 2010/2011.  It is estimated that if all are realised it could save direct staffing costs of £555million annually.

A responsible approach to pay and security of employment

• The DoH wants to ensure that future pay awards strike the right balance between rewarding staff for increased quality and productivity and the need to maintain security of employment by retraining and redeploying staff to meet additional demand. Immediately applied sustained pay restraint will be required to do this.
• Warning that review of the final year of the three year pay deal is unfavourable and the recommendation for staff not covered by a multi-year deal is for restraint.  Recommendation that consultants and very senior mangers receive no pay increase 2010/11 and that any increase in NHS income for GP practices should be restricted to cover projected increases in practice expenses. Further, practices should be expected to make at least 1% cash-releasing efficiency savings
• Pros and Cons of employment guarantee being considered; where frontline staff are offered an employment guarantee locally or regionally in return for flexibility, mobility and sustained pay restraint.  This in turn should make transfer of employees easier between different employers within local health communities.
• The Department will be examining the case for asking the Pay Review Body to consider more demanding efficiency requirements from GP practices.
• The Department has also asked NHS Employers and trade unions to explore the scope for linking future pay awards to improvements in quality and productivity

Securing the NHS Pension Scheme

• Considering how potential barriers, such as pensions, might be lessened so as to make it more attractive/possible for third sector and private businesses to provide services for NHS.  At present it is difficult for them to compete with NHS provisions.

Improved support for retraining and redeployment where services change

• The Department recognises that the redesign of services around patients will have important implications for staff.  Therefore they have assured staff that they will engage them in decisions that affect them (e.g. design of services) and support them to adapt their current skills and experience where necessary.
• To do the above, the Department will require SHAs, PCTs and employers to review training plans and align them to support 'delivery of local clinical visions and new ways of working'.
• The Department will also insist on commissioners and providers working together to maximise security of employment.  They have asked that the NHS Staff Council consider protecting continuity of service for staff transferred from NHS who later choose to return.

Implementing Staff Passport

• Staff Passports have been produced which build on the pledges made to staff in the Constitution  and sets out the common standards that staff transferring between NHS funded services can expect.  The passports will therefore ensure that the staff working for non-NHS organisations on NHS-funded services will enjoy terms and conditions that overall are no less favourable than those of staff transferred from NHS.

Chapter 4: 'How the system will support NHS Staff and organisations to deliver'.

• This chapter has a section entitled 'Helping staff through change' which sets out that the Department is aiming to 'empower and enable NHS staff to lead change and service transformation', recognising that staff will be asked to go through an 'unprecedented amount of change' in order to create the 'people-centred, preventative and productive NHS' of the future that is being envisaged by the Department.
• It makes reference to a new ‘NHS first’ approach (to be further explained in Procurement Guidance due this month); where there is an underperformer and the NHS is an incumbent provider, the NHS will be given the first opportunity to improve the service to the level of the best.
• Frontline clinicians are to be given autonomy and responsibility for their own service through front-line management, i.e., they will be in charge of their own budgets and thus will have the financial freedom to improve their services further.

The remainder of the chapter looks more specifically at Commissioners (what is expected from them; goals to be attained; incentives etc and also intention for the NHS to work more closely with local partners), integrating services and support for high-performing organisations, streamlining the reconfiguration process and the drive for innovation.  Further it sets out the goal for management costs in PCTs and SHAs to be reduced by 30% in the next 4 years. 

'NHS OPERATING FRAMEWORK FOR 2010/11',

Unsurprisingly a considerable amount of what is set out in the framework was pre-empted by 'NHS 2010-2015: From Good to Great' and the staff focused measures do not escape this repetition, with much of what is set out in the initial publication appearing again in the Framework.

One area where the Framework does however provide further detail is in regards to 'Education, training and professional regulation'; highlighting the positive response received towards the apprenticeship initiative and setting out five measures which SHAs, PCTs and employers must focus on to promote a 'responsible approach to education and training'.  These are to: 

• review their training plans and align them to support the delivery of local clinical visions and new ways of working;
• review and where possible reduce the number of postgraduate medical specialty training posts, consistent with long-term requirements;
• review and where possible reduce the number of pre-registration commissions for nursing, allied health professionals and healthcare scientists, consistent with long-term requirements;
• ensure sufficient investment to support the redeployment of staff into new ways of working, especially those moving to new roles and settings; and
• implement Education Commissioning for Quality and the review of the Multi-professional Education and Training (MPET) review to give education commissioners the metrics and financial levers to incentivise and reward high quality education.

The Framework also explains how the introduction of medical revalidation in 2011 will ensure doctors are up to date throughout their career thereby ensuring that quality of care and patient safety is kept high and how the introduction of an equivalent tariff for education will incentivise and reward quality in this area.

In practice

What is evident from these documents is the high level of ambition on the part of the DoH to make significant changes to the way that the NHS is organised and the direction in which care is to be taken.  It is therefore demanding big changes from the PCTs, SHAs and NHS Employers in the way that they operate and manage their provision of services, with future care being provided in different ways and different settings.  In turn the expectation upon current NHS staff is extremely high; a pledge for greater partnership and collaboration comes hand in hand with a demand for greater flexibility and a strong dedication to achieving the required efficiencies.

1. [BMJ 2009;339:b5573 ("NHS operating framework for 2010-11 places emphasis on quality", Jacqui Wise)]

 A copy of the full constitution