Anyone seen HR?


February 11th, 2015

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“The NHS treats people so badly, goes as far as abusing people. You get wonderful nurses, who get used and abused so they leave because they feel they haven’t been able to give the care they wanted. I know people who’ve left because they can’t provide the care that even gives patients dignity.”

That’s not a quote from ‘Freedom to speak up’, the Francis report on NHS whistleblowing published today.

It’s from my own conversations with NHS employees about change; about how employees are treated if they question management initiatives.

On Radio 4’s ‘Today’ programme this morning, Chris Hobson, Chief Executive of NHS Providers defended the thousands of appropriately handled errors, near misses or incidents in the NHS every day. That’s good to know but misses the point. Francis rightly spotlights the most clinically critical concerns, but there are wider issues here. In my own conversations with NHS staff, what I heard was the same treatment of staff who raise any question and challenge about changes. Here’s an example. An ill-conceived, well intended but failed rota change that resulted in nursing staff leaving, resulted in a huge agency bill, and the manager behind the change calling the nursing staff ‘dogmatic’ and “not putting the needs of the ‘business’ first.” In my book, it’s got to be pretty hard core ‘dogmatism’ that makes quitting your job the best option. So what’s going on and where was HR?

Regarding another change, I asked one person what the change instigators could have done differently. The answer? “Talk to us; ask us”. She added, “People would be very suspicious though. They pretend to consult us, and, to be fair, have listened a bit, but usually if anyone questions anything, the message back is …..we’ve done the thinking. Your role is to implement the change, not to question or challenge.”

What I consistently encountered was highly experienced medical staff applying clinical judgment and compassion for their patients, questioning the requirement to implement practices primarily aimed at cost saving but to patients’ detriment.

But let’s pause. Francis stresses that “we need to get away from a culture of blame”. He adds that “Managers are so pressured in the work they do, that they react in ways they wouldn’t do normally”. In the less measured words of one of my interviewees “These managers have forgotten what it’s like to be on the coal face. They are under so much bureaucratic pressure from the DoH (Department of Health) and they have so much stress, numbers, stats, costs (to manage).”

So, there are no heroes here and no villains. NHS managers are simply doing what makes most sense to them, in the face of targets, constrained budgets and staffing. But Roffey Park’s Management Agenda 2015, found that ‘targets’ and ‘doing what your manager wants’ the most common source of pressure to behave unethically.

So while there may be no heroes and no villains, there are certainly victims and there are cowards.

Think of the elderly patient in the community whose visit by the nurse is so brief it can’t begin to adequately address their medical needs. They’re a victim. But so is the community nurse whose workload is so unbearable, whose schedule so tight it’s unachievable, whose sense of guilt at providing inadequate care is so crushing, whose constant stress and poor mental health so intolerable, that they quit the NHS. They too are a victim. And that’s a real person I’m talking about, by the way.

I said there are also ‘cowards’. Harsh? Maybe. But if courage is the opposite of cowardice, now’s the time for courage, if it’s not too late, from HR.

For the people I talked to, it seems HR has checked out. It’s checked out on the well-being of employees; that space in the NHS is now occupied by ‘Staff Side’. It’s checked out on shaping organisational effectiveness through people – that space in the NHS is now occupied by OD. But in case NHS HR people are feeling got at, you’re not alone. What HR have become in the NHS is common to other organisations we work with, and not just in the public sector.

Francis sets out 20 principles to start turning this round. The overarching Principle is that “every organisation needs to foster a culture of safety and learning in which all staff feel safe to raise a concern.” Principle 3 proposes a culture free from “bullying and other repressive behaviours”; Principle 4 a culture of “visible leadership – that welcomes and encourages the raising of concerns by staff. Principle 5 – A culture of valuing staff.

Wouldn’t it be great if there was a management discipline that understood all this stuff, how to create that kind of culture, develop that kind of leadership. Anyone seen HR?

In the words of another of my interviewees, “if you don’t look after your staff you won’t get the best out of them. If you give a little, they’ll give twice as much back because they’re grateful to you for listening”.

Francis said in today’s report “A listening system is a safer system”’. I’m hopeful that the listening will now begin. But my fear is that, in being seen simply as management’s implementer of transactions, HR has sacrificed its right to challenge where the listening isn’t happening.

HR too are frazzled. But as a profession, not just in the NHS, we’ve made a choice about where we stand, and what our role is. And now there’s another choice to be made. Remain irrelevant or start to challenge. But be clear, after today, if HR doesn’t, others will.