Facing NHS problems head-on

Andrew Foster, HR director at the NHS, talks to Mike Berry about managing vast numbers in the world’s third largest workforce

The numbers that Andrew Foster, NHS HR director, deals with are truly astonishing.

The National Health Service employs 1.3m people – the third largest workforce in the world after the Chinese Red Army and the Indian Railway. Employee numbers are increasing by 60,000 year-on-year and there is an annual training budget of around £4bn at his disposal.

Unsurprisingly, Foster cites managing those numbers as one of his main challenges.

“The whole of the NHS is expanding rapidly to improve quality, and our existing workforce is an ageing one. So we need many more staff.”

Integral to that, the NHS is also one of the foremost international recruiters in the world. Foster acknowledges that foreign workers are the lifeblood of the health service.

“We look abroad in an organised way,” he said. “We have an ethical international recruitment policy, so we will only recruit from countries where there is a government-to-government agreement,” he said.

Other challenges for the coming year include implementing pay reforms under the Agenda for Change scheme – which took four years to negotiate with the unions – as well as new contracts for consultants and self-employed GPs.

The NHS is currently undergoing a huge cultural shift. It is developing a more customer-friendly approach where patients are central. The Government wants NHS staff to treat patients as consumers of services, something that Foster strongly agrees with.

“The new NHS Improvement Plan talks about creating this concept of a personalised service. This is an area where we can definitely learn from the private sector,” Foster said.

“Customer care is one area where business is extremely good. It has also been very successful at implementing major IT projects and measuring performance.”

Foster believes that to raise quality, the NHS must create a culture of continuous improvement that can be delivered through frontline staff.

“We have got to get used to change. Drugs are improving, we’re learning about better treatments, and we can improve working practices,” he said.

“Improvement is not the same as uncertainty and in terms of employment, if people are prepared to take on new skills, then they should enjoy very high levels of job security.”

Foster is also critical of how the media often portrays the UK’s health service.

“It irritates staff every bit as much as it irritates me. I suppose bad news sells newspapers. I admit things do go wrong in a service where we see roughly a million patients every 36 hours, but I think it’s quite offensive when these [negative] incidents are portrayed as being typical,” he said.

Despite this, he says morale at the coalface is good. The 2003 NHS staff survey reveals that three-quarters of staff are ‘generally satisfied’ with their jobs. Foster described that as “a very powerful return”.

The service’s record on training has also improved, with nine out of 10 staff receiving some form of training and development during the past year.

Foster’s ultimate goal is to see NHS Trusts and Primary Care Trusts appearing in The Sunday Times list of 100 best companies to work for.

He is also keen on promoting HR excellence, and anyone who witnessed his now infamous entrance on a Kawasaki motorbike at the ‘HR in the NHS’ conference earlier this year will understand that it is all part of raising the profile of the HR function.

“I think we should aspire to be world-class. Some of the initiatives we have on flexible working and childcare support are already there,” he said. “We have a lot of good employment practices in place, but there’s further to go.”

Foster’s CV

2001 Director of HR, NHS

1999 Policy director (HR), NHS Confederation

1996 Chairman, Wigan & Leigh NHS Trust

1992 Chairman, West Lancashire NHS Trust

1991 Non-executive director, Wrightington Hospital NHS Trust

1981 Director, Worldcrest

Working Time Directive will challenge NHS

Since 1 August 2004, the Working Time Directive applies to doctors in training. It introduces a maximum 58-hour working week (falling to 48 hours in 2009), as well as new minimum rest requirements.

Foster said the directive was “a huge issue”, which meant the NHS had to drastically change the way it staffs hospitals at night.

“It’s a very challenging programme, moving to shift-based working rather than on-call working,” he said. “We are narrowing down the number of hospitals struggling to achieve compliance.”

Foster admitted there was a ‘rump’ of difficult areas where he was concentrating his efforts and that some trusts would have to move to “plan b or plan c”. The latest polls suggest that around 16 per cent of trusts are failing to comply and are finding it difficult because it involves a major shift in how doctors’ work is organised.

“One of the possibilities is individuals opting out of the directive, which would permit them, in some circumstances, to continue with the older patterns of working,” Foster said.

Hospital trusts that breach the directive face the prospect of fines up to £5,000 from the Health and Safety Executive.

The British Medical Association has also warned that it is ready to support overworked junior doctors who decide to take legal action.

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