NHS Employers chief: “Workforce supply is the biggest single concern”

With the NHS constantly in the headlines as we approach an election, new NHS Employers chief executive Danny Mortimer has had a busy few months in the hot seat, as Virginia Matthews discovers.

While the distinctly Machiavellian portrayal of HR departments in BBC shows such as Casualty or Holby City are not particularly to his taste, as the son of a midwife and the husband of a nurse, Danny Mortimer does admit a sneaking penchant for Call the Midwife.

After 25 years in the health service, the NHS “runs through me like a stick of rock”, says the 43-year-old Brummie. His previous role was executive director of workforce strategy at Nottingham University Hospitals NHS Trust, where he oversaw a budget of £850 million and employed around 13,500 staff.

As an A-level student, he worked as a porter in his local hospital and, far from putting him off a career in the health service, he became an NHS graduate trainee after completing a degree in politics.

Despite his honours specialism, Mortimer is widely acknowledged as playing a straight bat, rather than indulging in political intrigue.

Although he does accept that in the run-up to the general election, health has inevitably become a political football.

“I can’t take a party political stance, nor can I comment on whether Ed Miliband talked of ‘weaponising’ the NHS, or if I believe David Cameron is intent on monetising it.”

“But I understand that the NHS is part of the soul of the nation and whoever wins the next election will have a major role to play in safeguarding the health service for the future and building consensus around how we can cope with demographic and lifestyle change.”

A&E in crisis

Although he breathes a heartfelt sigh of relief that Unison’s planned strike over pay was called off, diplomatically paying tribute to both employers and trade unions for working together, it is the crisis in A&E where alarm bells ring the loudest.

“Emergency services are no doubt the biggest single pressure point in health right now, but I should stress that this pressure has been building up for some considerable time,” he said.

“While we are painfully aware that we have failed in recent months to meet our target of seeing 95% of people within four hours, employers are determined to invest further in beds and staff in order to regain lost ground.”

More broadly, he says, the service needs to understand why people go to A&E in preference to using the non-urgent telephone service NHS 111, local pharmacies or GP surgeries, and must examine ways of coordinating the work of different providers.

He winces audibly at recent headlines such as “A&E meltdown forces thousands of operations to be cancelled” and says they “aren’t necessarily helpful”, yet he is at pains to stress that passivity is not the issue: “Anyone who is being given the impression that we are somehow sitting back and doing nothing about these missed targets and lack of beds needs to know that NHS staff are passionate about caring properly for patients and doing so in an appropriate setting.

“Our people get very distressed at seeing members of the public waiting around for treatment, and while I fully understand the nation’s concern, I want to stress that the most recent figures for A&E performance are showing signs of improvement.”

Skills shortages

Mortimer, a chartered fellow of the CIPD, sees all manner of workforce issues – ranging from musculoskeletal problems to mental health issues – as his biggest challenge.

“Workforce supply is unarguably the biggest single concern for employers in the NHS, particularly the shortage of nurses, but to a lesser extent, the gap in terms of doctor numbers too.”

While employers look to their own staff to work extra hours where they can, he believes the continued use of costly agency staff is inevitable. Again, this provides good headline fodder, with a report by the Royal College of Nursing suggesting that the NHS will spend more than £1 billion on agency nurses this year.

“Many employers attempt to keep agency costs to a minimum via procurement and booking practices, but across the piece, what none of them will ever do is dispense with agencies entirely. In my view, that can never happen.”

The NHS has been vocal about its commitment to recruiting for values, but how does this sit with the use of agency staff who may only be in trusts for temporary periods? Mortimer stresses that agency staff are invariably ex-NHS and are, in any event, required to meet rigorous professional standards of their own.

While he notes that the findings of the original Francis Inquiry into failings in care at the Mid-Staffordshire NHS Foundation Trust – published in February 2013 – appeared to mark a sea-change in attitudes among health professionals, he stresses that many of the recommendations around culture, safety and leadership were already being implemented in Nottingham and elsewhere.

Pride in the profession

Mortimer says he fully backed the move six years ago to make nursing a graduate-only profession and he rejects the view that there may be an inbuilt tension between studying to be a nurse and showing compassion.

“As my mother will tell you, the graduate entry route was hard fought and long overdue. It’s restored a good deal of pride in the profession and I cannot accept that by being graduates, nurses are somehow less likely to be caring towards their patients,” he says.

Although Mortimer says he sleeps worse as he gets older, this is not surprising given the sheer scale of the NHS machine – 1.4 million staff and a £115 billion-plus budget this year – together with the continuing need for reform. Although the changes in demographics is a bigger concern:

“We face the enormous challenge of having an increasingly frail older population and we need to find new ways of deploying our budget to cope,” he says.

While smoking and obesity add to hospital trust burdens, he believes that there is a large degree of consensus as to how lifestyle impacts on healthcare. Rather less attention, he argues, is focused on social care or on potential integration of the two.

He believes there needs to be “more exploration of how the existing and future NHS workforce can be trained to work differently; in people’s homes for example”, but notes that this will require more focus on workforce supply and support, robust pay deals and contracts that are more fit for purpose.

Part of the team

“Leaving aside how we’re portrayed in TV drama, though, I would say that HR’s standing in the NHS is very good nowadays and as a profession, we’re seen as an integral part of the team,” he says.

Although pressure on the health service will continue, he adds that “the relationship between NHS organisations and their workforces can keep improving and honesty and teamwork will be key in achieving that”.

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If there is one single change he would like to make right now, it would be to see an acknowledgement among employers that frontline staff are “the real experts in patient care”.

He says: “People join the NHS because they want to make a difference and whether it’s a simple thing like altering work rotas or using our expensive equipment more efficiently, I’d like to see us support our staff far more and harness their talents to lead the process of change.”