This year promises to be a time of huge change for the NHS as the Agenda for
Change programme beds in. Government plans to give top-performing trusts more
control over budgets and management by awarding Foundation Trust status also
mean significant new people management challenges for healthcare HR
professionals. NHS HR director Andrew Foster explains why he is optimistic the
changes will be beneficial
Q. How will the Agenda for Change programme boost retention and
A. It will do so in a number of ways. First of all, and quite simply,
it puts more money into pay, and there is a well-understood economic model; the
more money you put into pay, the more attractive jobs are. So that in itself it
has an impact on recruitment and retention.
Also, what we are trying to achieve with Agenda for Change is much better
career opportunities for staff. There is no longer the expectation that you get
a job in the NHS and that’s it, that is your job. What we are trying to
underpin with the agenda is this ‘skills escalator’ concept. The idea that
whatever job you do, we will support you through learning, to acquire the
knowledge and skills necessary to take you to the next job.
The idea is to encourage people to take on more responsibility and pay them
extra for it. Although part of the logic is that contented staff are better
motivated and more productive, it also uses the skills in the health service
far more effectively.
Q. Is there a danger that Foundation Hospital status could create a
two-tier health service, at least in the short term?
A. The Foundation Hospital approach is a process intended to raise
everybody’s standards. I think there is some fear that, in the early days,
there are going to be 20 or 30 foundation hospitals and the rest will be the
NHS. If this was the case, then by definition, you would have had two different
types of NHS.
But really, what the secretary of state has made clear is that there are a
few people who are ready to go into this status quickly, and we want to
encourage others to raise their game in all the areas necessary so they too can
become foundation trusts. Eventually, foundation trusts will be the model.
Q. Is there not a danger that trusts without foundation status will find
it harder to recruit?
A. There is a risk of that, and we will be operating a series of
systems to try and minimise the effect of that. I think it is inescapable that
if hospital A is super-duper and hospital B is said to be struggling a bit,
then if you are a nurse looking for a job you will be more attracted to
hospital A. We can manage that to some extent by requiring local employers to
co-operate with each other. We would make sure you wouldn’t have prices going
up against each other.
Q. When you spoke at the Association of Healthcare Human Resource Management
conference in October, you mentioned plans to create an HR development centre.
How much progress has been made on this, and what will it deliver for the NHS?
A. We have appointed Dean Royals, who is ex-deputy-chief executive of
an NHS trust, as head of our capacity unit.
The capacity unit’s job is to increase the numbers, the quality and the
capability of people who work in HR management in the NHS. This, by extension,
will raise the quality of people management and general management in the NHS.
[Royals] is setting up that unit with a budget that will grow over the next
three years. And this will be partly to commission extra training and partly to
identify gaps in the system at the moment. It is really to introduce a much
more systematic approach so we can develop the appropriate types of training
for people when they are recruited, and then as junior managers, senior
managers, and all the way through.
Q. You also highlighted the possibility of introducing an NHS-wide
balanced scorecard to be piloted this year. When is this likely to go live?
A. Last year, we produced a strategy for the workforce in the health
service. It has two primary objectives. One, to get more staff into the NHS,
because we are trying to recruit at the rate of about an extra 50,000 people a
year. And second, it is about working differently. That means reorganising
services and jobs around patient needs.
We have four strategic pillars to do this. One is by making the NHS a model
employer; the second is by offering a model career; the third is by improving
morale, and the fourth is raising capacity, and that is really the strategy.
We want to launch the scorecard at our major HR conference in June and test
it during next year (2003 to 2004), so it will be non-obligatory, but something
we will trial because clearly there are some fairly subjective judgements
Then in the next financial year, this will become the system that measures
the contribution of HR. It will be an element of the overall performance review
– the star rating.
Q. At what stage of development is the NHS University? And what impact do
you hope it will have on workforce training and development?
A. It is due to start properly in November this year. The NHS University
launched its consultation plan last autumn.
I think the initial vision is a body that can extend learning to areas that
are arid at the moment. For example, we spend a huge amount on medical
education, and less on porters and cleaners. In supporting the concept of a
‘skills escalator’, we need to be encouraging the porters and cleaners to
become healthcare assistants, and the healthcare assistants to become
In due course, I think the university aspires to be an umbrella for learning
in the whole NHS. It won’t be a bricks and mortar university, but will look at
other ways of learning – using workplace learning, learning at home,
e-learning, and formal training.
Q. How is the NHS implementing flexible working?
A. I think the NHS is the best large employer in the country for
We introduced a strategy called improving working lives three years ago
which is now biting in every corner of the NHS. Virtually all staff should have
the opportunity to help control their working hours. Surveys show that at least
80 per cent of staff are given the opportunity to work flexibly.
Andrew Foster’s CV
– 2001 – HR director, NHS
– 2001 – Chairman, Wrightington, Wigan and Leigh NHS Trust
– 2001 – Member of the North West Region Modernisation Board
– 1999 – Human Resources policy director, NHS Confederation
– 1996 – Chairman, NHS Confederation HR Committee
– 1996 – Chairman, Wigan and Leigh Health Services NHS Trust
– 1992 – Chairman, West Lancashire NHS Trust