Clare Chapman plenary

Director General of Workforce for the Department of Health, Clare Chapman.

Thank you Ed.

It's great to be here at my first national workforce conference particularly at this vital time in the life of the NHS.

Over coming months and years, there is a real opportunity for us as the leaders of workforce to be key players as healthcare and the legacy of 1948 is refreshed.

This will require a lot from us all, but even so I have real confidence that we will succeed.

This comes from having confronted the facts and from finding the lessons of those experienced people around the service.

I've now been in this new role long enough that I am ready to share with you what I have found.

Also to discuss with you all the implications for our way forward.

Over the next 20 minutes I will do 3 things:

* Remind us where we are taking the health service.

* Share with you what I see is important.

* Summarise the challenges and priorities for next year

for us both individually and in partnership.

I am then looking forward to a lively question and answer discussion

I find this summary really helpful - David Nicholson, Chief Executive's Annual Report.

It reminds us where we've been.

1. Started with the NHS Plan & focused on building greater capacity

* Thousands more doctors, nurses, therapists, scientists & other staff

* New pay deals.

This is an extraordinary achievement with over 200,000 new people brought into the service and the most ambitious pay reform agenda in the country.

In retrospect, you've told me that it may have been put in so quickly that not all of the benefits were realised but that does not take away in any way form the size and scale of what you were able to do.

There is no doubt that you created room for reform to take place to deliver a more responsive system

2. Restructuring of the service to create commissioning organisations and autonomous providers, supported by payment by results and made dynamic by patient choice.

Progress clear but despite the achievements - a lot left to do, with the morale issues that Steve referred to be addressed.

3. This is going to require us to be able to combine the extra capacity and reforms in order that we can transform the experience of patients

* An NHS that is devolved, responsive, convenient and safe.

People from outside ask me if we have the will to do this.

I do see us as being ready - as having the appetite to move. The Ara Darzi next stage review is just one of the visible signs.

Apart from anything else we have no choice except to change.

New drugs, breakthroughs in technology & patient expectations will continue to push for more.

This next stage will be as big - perhaps bigger than last 2 and we have a vital role.

What will this new phase feel like? - I'm exaggerating to make a point.

More looking out to the patients, staff and public for authority: less looking up for central targets

* More leadership based on involvement, dialogue & debate vs targets and coercion

* More national consistency by focusing on shared purpose and values rather than on tightly managed project planning

* More conversations with public, patients and staff. These will increasingly be evidence based and adult: not just a list of wants but co-education on choices and linked to action.

There is a role for both approaches laid out on this chart - but as we know they have different uses.

List of behaviours on left can help with disciplined daily execution with known problems and solutions.

The bigger issues of the day - eg tackling obesity, health inequalities and more personalised healthcare will require us to enlist and mobilise rather than marshal and measure.

As ever this will demand a lot from us as systems leaders.

Coming from a very customer focussed organisation my experience is that it took years to achieve.

It requires disciplined thought and action but also leaders who can be courageous and who have the self confidence not to be selfish.

This lack of selfishness matters a lot since those with big egos tend to go round making themselves look big by making others look small.

This erodes rather than builds confidence to act: particularly at the frontline with staff and it can leave patients feeling like services are not joined up.

In enterprises that are really customer focused you often find this lack of selfishness and a real focus on improving the lives of others.

But more on this later.

Now going to take each of the 4 behaviours mentioned on the previous chart and illustrate what I think the next phase of the journey will look like.

This is a very important step - you can't be responsive if you don't know what matters.

My observation is that the NHS has invested a lot of effort in researching what's important.

The challenge now is not to create a lot of new stuff but to give ourselves the headroom to use it and make it simple to action.

Let me share with you what we've learnt.

As you can imagine, there is lots of rich data around what matters to patients.

Over the summer this was pulled together and refined.

Patients also asked us to put the findings into everyday language.

This has been done and points to the fact that overall, there are four main things that really matter to patients.

* Get the basics right

* Fit in with my life

* Treat me as a person

* Work with me as a partner

This is now being refined so we can understand what it looks like for different types of patients.

This is easy to say but difficult to do and I genuninely hope that this difficulty will be reflected in the comprehensive spending review announcement this afternoon.

As many of you are aware, we've also done extensive research on What Matters To Staff.

We too started with what already existed.

And we asked partner organisations to inform both the desktop research and the scope of the new research.

That was followed by research across the country and an exercise to correlate the findings with the results of the Healthcare Commission.

The results won't be a big surprise because hopefully they are intutitatvely right.

So what is this research I keep referring to?

Began by clarifying what we want.

Why staff advocacy of the NHS vs Trust?

This is much harder but worth it.

Research on what matters to the public shows that perception of the NHS based on 4 things:

- Who vote for

- Age and ethnic background

- Performance of A&E

- Amount of bad mouthing from staff.

Obviously there are 2 of these we can influence directly.

Then we looked at the drivers of these outcomes and what managers can practically do to improve them.

We've also looked at the Healthcare Commission data on correlations with patient satisfaction we started to see that excellent Trusts are already onto this.

The Social Partnership Forum have been key players along side colleagues in the Healthcare Commission, the Service, NHS Employers and critically staff themselves.

This gives us all a more solid platform and we are already working with the Social Partnership Forum and the Healthcare Commission on how we can update the staff survey going forward.

This way it will reflect well what matters and can give service line information back to managers and clinicians in a timely way.

As with research on patients - further refinement needed.

Firstly we want to make the10 very memorable and we're currently working with staff on how we can theme them so they are really easy to remember under 3 or 4 headings.

And finally, the research on what matters to the public.

This is more difficult but there are some clear themes coming out of the existing research.

Overwhelming commitment that the public want the continued funding of a national health service.

Also a continued commitment to one of the original 1948 principles that treatment should be based on need rather than ability to pay.

But also a reminder of the perception that there is more we can do to tackle waste and provide a safe and accessable service.

In summary:

Being responsive nationally means using this insight as a screen for new policy and practices.

Being responsive locally means having clearly defined pathways for how you will listen and respond to local needs.

For all of us it is important to look at the 3 side by side.

Our challenge is not to improve one or the other, but all 3 together since they are so interdependent.

It will also be important to tackle how much of this needs reflecting in the Commissioning Framework if it looks like staff satisfaction is a lead indicator for patient satisfaction.

Which brings us to the 2nd of our 4 themes - that of engagement.

As I went through my 3 month induction at the beginning of the year many of the locations I visited told me that clinical engagement is one of the biggest challenges we face.

The staff research also showed this.

Clinicians often acknowledged that managers are in a difficult role but that they can be more business rather than patient focused with very little time for real listening and engagement.

Managers in return often described clinicians as dedicated and committed, but stubborn, slow to change and sometimes protectionist.

Interestingly, all the clinicians and managers we spoke to described that they would find it far more satisfying to work with more collaboration, and with staff involved in change early on.

There is real evidence around the country of this being put into practice.

The patient is being put into the heart of improvement efforts using techniques such as lean thinking.

I have also been struck by work being done by colleagues in the South West.

They took the data on what matters to patients, public and staff, and are using staff conversations and conversations with patients to work out what they need to do to be responsive.

Too early to measure improvements from this but what I particularly liked is that it is a simple approach which looks like it has the chance to be embedded as a routine rather than a one off event.

John Bewick tells the story very well so I'm going to hand over to him.

(show video).

Which brings us to the 3rd of my 4 themes.

1. - Be responsive

Engage people in taking action is that enough?

2. Of course not - staff want to know that what we're all doing is making a difference.

Research proved what intuitively we all knew.

Ultimately, most of us have chosen to be here because we care.

Evidence showed us that an average 70% of NHS staff are very values driven.

This means they are twice as likely to value a way of working based on shared meaning, questioning, creativity, collaboration and empathy.

This may be one reason that anecdotally there have been discussions around the morale in the NHS.

What staff told us was that there is a recognition that the 'old' way was not sustainable but that recent reforms (and language we've used to describe them) have made it look like we've lost sight of our core purpose and values.

This is why there is such an opportunity as we move to this new phase to refresh the values so that what the NHS does for its people and society at large is strengthened and facilitated.

Many of you are well onto this and the research points to a very clear way forward.

It is about creating a new reality with the best of both and using the definition of a new reality to create a shared purpose and values that enable collaboration across the system.

David Nicholson has already started to engage leaders from across the system to achieve more coherence in where we're going and how we're doing it.

There has been 3 cross- system leadership events this year with progress at each one and more to follow.

The Next Stage Ara Darzi Review can also be a catalyst in moving us forward.

As part of this Ara has asked David Nicholson to lead work on the NHS constitution.

This could be a chance to refresh the purpose of the NHS and our enduring values informed by the evidence of what matters to our patients, the public and staff.

And finally the fourth theme.

The conversations are aimed at making actions and words line up.

Not through special initiatives but through our everyday work.

The way that we lead - am showing 3 but there could be more.

What's really important is that People Matters is one of them alongside commissioning and systems management and finance, operations and performance.

What will this mean?

Still work in progress. But this is an early draft.

How can we simplify what we do in workforce so we can focus on what matters?

On People Matters early work suggests there are 4 things that matter.

This could be the basis of an operating model and improvement plans with clear metrics.

Benefit of an operating model is that if you can write it down you can teach it.

Most of the answers exist some form or another.

What FTs, PCTs and SHAs are saying is that the big issue is finding the time and resources to write this down and then use it.

This could be our chance.

We have also aligned the work in the Next Stage Review so that it aligns to this model.

Overhaul of Workforce Planning, Education and Commissioning and Education Funding and acceleration of clinical leadership.

I've explained what we're doing to get more coherence across the system.

This is a great prize but it does not stop here.

How internally coherent are you?

Let me explain what I mean..

Firstly, how clear are you on what you stand for?

And how well reflected is this in your objectives, your role and how you spend your time.

I joined the Health Service because I want to lead something that is important to me.

That is coherence.

Secondly, how well do you know the whole system?

It is important that you are intelligent in the way that you understand the upstream an downstream consequences of your actions.

Thirdly, how much effort do you put into building relationships and your own self awareness?

Memorable leaders take people to place that they would not have gone to without them.

This is unlikely to happen without passion.

And finally, resilience.

How much are you looking after your health, your nutrition and your sleep?

The more internally coherent you are - the better suited you will be to this next stage of the journey.

In summary the acid test will be to look at your objectives and state of mind.

Responsive

How much time have you put aside in your working day to listen and respond to what matters

Engage

What is your next breakthrough on engagement

Purpose and Values

How often do these appear in your objectives and what about your colleague

Three conversations

How clear are you on the emerging models for care so that you can drive the clinical change through the people matters process

Personal Leadership

How good is your PDP, what are your own personal transformational breakthrough

I'd like to finish where I started.

Congratulations on all of your achievements during the last two stages.

I'm proud to be here and glad to be part of the next stage where I'm confident that the hand of history is on workforce and the role we will play in the next decade.

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