How do you even begin to solve the HR problems of the NHS? Not only is it the UK's largest employer, it is arguably the only one where non-employees worry about the perceived lack of people and money as much as the 1.3 million staff who actually work there. Get it wrong, and you do not just disengage your own workforce; everyone else knows about it too.

Clare Chapman, director general of workforce, former HR director at the UK's second-largest employer (Tesco), ponders the question. It is exactly one year ago this month since she swapped shopping trolleys for trolley beds to take charge of the highest-profile HR job in the country. Her appointment followed a dreadful six months for the service - revelations that it was £512 million in debt, ex-health secretary Patricia Hewitt being booed off stage at the Royal College of Nursing's (RCN) annual conference, and job cuts exaggerated by the press. Six thousand losses ballooned to 8,000, and then to 13,000. By 5 January 2007, the day Chapman moved into her Whitehall office, The Times trumped them all, saying 37,000 jobs needed to be axed to keep within the NHS salary bill budget. RCN general secretary Beverley Malone, meanwhile, was calling for "a recovery strategy not redundancy notices; nurses being valued as assets not overheads".

"The only place you can start is by looking at what you've got," Chapman answers matter-of-factly, expertly meeting a big question with a simple answer. "I spent my first three months touring hospitals simply to understand the system. What I quickly found was that, unlike Tesco, where performance is measured quarterly and occasionally every three years, reforming the NHS would be a 10-year project.

"My job boils down to one simple thing," she continues, "working out what improves the lives of patients and employees, then seeing to what extent the NHS is designed to do this."

Chapman's clarity of thought is disarming at first but makes perfect sense in the broader picture of the changing NHS. Next Stage - Our NHS, Our Future, the interim report by Lord Denham, was published in October and sets a template for the next decade. At the heart of it is improving patient quality of service. "I've joined at a time where my background in recruiting to capacity for service is entirely useful for the NHS," she says. "Improving patients' lives is often what employees want to make their jobs better, so service provision should solve both problems."

This is Chapman's first interview since taking up the role - "there was no point before I had anything to talk about," she quips. She reports to David Nicholson, NHS chief executive, who sits on the health secretary's departmental board. The result of her silence, however, has been to fuel more job cut rumours, mostly due to over-recruitment in the first place. The NHS target for hospital doctors was 74,590 by 2007, but, as early as 2004, there were already 78,000, which rose to 82,000 just one year later. And if there's one thing Chapman learned from Tesco, it is how not to employ more staff than is needed.

"I can look you straight in the eye, and say that the years of simply hiring more doctors and nurses has now ended," she says resolutely. "I do believe we have the capacity in the system to provide a first-class NHS service. We've got to move away from the overall growth story. Today the story should be about improving service."

But hang on. Can she really improve service with the same or fewer staff? This is something politicians have consistently failed to reassure voters about. Can Chapman do any better? "The media hasn't taken the trouble to ask me this direct," she says. "It's fair to say that when the first NHS reforms were announced three years ago, we spent more time talking about the levers of these reforms than we did about the care of patients. But I'm not facing the uphill struggle the media might suggest I am. In the past year just 2,300 forced redundancies were made, and 82% were non-clinical. If I am to be responsive, these sorts of cuts have to happen. When you go through any period of change, you must learn new things, and this is what I'm having to learn now."

She describes change as the "increasingly pluralistic way health services are being deployed - where care can sometimes be delivered by hospitals, at other times by the social care system and others" - all of which, she says requires "better managers, those who understand how to lead staff across a more complex system." A leadership development plan has already been introduced to spot "good people earlier" but, as service becomes the benchmark, Chapman says her priority has been to involve staff more in designing their own working practices. "It's a very simple story to tell to staff. It's a lot easier giving staff a picture of where we have come from, where we are at now, and where we are going At the same time, doctors and nurses were saying: 'involve us early in the design of services because that way, they'll be designed properly, and that way, we feel more equipped and engaged to do our jobs better.'"

Chapman has already launched a pilot project in the South West, called The Staff Conversation, which formalises these feelings, and is using feedback from frontline medical staff to take to the Healthcare Commission with a view to using it to overhaul staff satisfaction surveys. "We know nurses are more optimistic about their role than they have ever been (satisfaction is up from 64% in 1996 to 79% in 2005)," she says, "but what I want to know is: are we making their lives better?"

Her mission, she admits, is under the almost constant threat of derailment as MRSA, hospital closures and a whole host of other stories hit the headlines: "I do get pulled into these, but my focus is clear. There is what I call my elective work - stuff I want to do, like engagement - and what I call my emergency work - pensions, frontline pay, training. The latter are all important, but only as a means to an end. If you're not careful, they can take up an awful lot of time and I'm seeking to ensure that the emergency does not predominate."

Under tight new recruitment rules, Chapman says managers have been instructed to "seek vacancy freezes, and redeploy existing staff wherever they can". She believes that with a culture of "managers not being told how to manage" she is already seeing dividends, mainly in falling vacancy rates. But one criticism Primary Care Trust (PCT) bosses have had to face is financial mismanagement, not least when it seems to undermine one area Chapman wants to improve - training.

Training is not something that seems to be consistent. "We've got the UK's largest talent pool, and as the patient experience comes to matter more I'm making sure we put leadership training on the curriculum for all clinical staff," says Chapman. This may be the HR aim, but a string of budget-balancing health authorities, notably Hampshire and the Isle of Wight, have been caught 'raiding' training budgets to juggle their overall financial books (it took £20 million). Could a group-wide edict from Chapman simply prevent this expedient behaviour?

"I wouldn't want to," she says resolutely. "You can't give managers authority to make their own decisions, and then take it away from them." It seems a curious reply. What does she really mean? "Where hospitals have taken action there has been a need to balance books. Hospitals that really know what impact training has on service will not cut their budgets. This was something I learned at Tesco, and the benefit of training was something I became very articulate at defending. That will continue to be the case here."

Unsurprisingly, instant results are not something Chapman can claim for her first 12 months. "What I can say is that the past 10 years of capacity building - the NHS has grown by 280,000 in the past decade - has provided the groundwork to enable me and my team to embark upon the next era of the health service to use this built-up capacity to enable staff to provide more value." In fact, on more than one occasion Chapman refers to being there at the "perfect time". It is easy to see why. The broader NHS transformation plan is already there, and she sees herself as the person to see it through. "The NHS has been well versed in terms of the supply of talent - the numbers of doctors qualifying each year - but has not always known what the demand for these doctors is. Now, PCTs have to define their own strategies and visions, so they are having to talk this language."

Predictably enough, there will be no quick fixes. "Emergency-type work will yield improvements within one year," she says. "Elective work is practically a 10-year project, although in three years I think you'll start to see some differences." That is a big promise, but Chapman certainly gives the impression she will still be there, making sure the work she is starting comes to fruition. Last month the DH produced its operational framework document, which, says Chapman, puts staff satisfaction as one of three national parameters.

And Chapman has by no means finished her staff tour. Rather than munching mince pies on Christmas Eve and Boxing Day she was visiting more hospitals, seeing for herself the sort of tragedies that seem even worse when they happen over Christmas. "I'm doing a job I really want to do," she says. "Seeing staff help people makes doing a tough job so much more worthwhile. We have many people that want to make the NHS better. It's almost a privilege to enable this to happen."

CV
2007: Appointed director general of workforce, NHS
2004: Joined the Qualifications and Curriculum Authority
2003: Became a non-executive director of First Choice Holidays
1999: Appointed group personnel director of Tesco

PREVIOUSLY: VP of HR for Pepsi Cola International's central Europe
0perations; and dean of Quaker University, Quaker Oats Incorporated,
where she established the company's worldwide learning institute

blog comments powered by Disqus