Viewpoint: The King’s Fund Annual Leadership and Workforce Summit

Viewpoint: The King’s Fund Annual Leadership and Workforce Summit

NHS Professionals proudly hosted a breakfast panel session at the King’s Fund’s tenth Annual Leadership and Workforce Summit in March 2023.

Featuring a panel of experts and an audience of health and care professionals, the hour-long session focused on flexibility, inclusion and a greater sense of belonging in the workplace – all set against a challenging backdrop of rising demand, capacity pressures and post-pandemic fatigue.

Here we present the session’s main themes including a range of comments made by our panellists.

The panel

Anne-Marie Archard, Senior Consultant, The King’s Fund (Chair)

Karen Bonner, Chief Nurse & Director for Infection Prevention and Control, Buckinghamshire Healthcare NHS Trust

Andrea Williams-McKenzie CBE, Deputy Chief People Officer and Director of People and Organisation Development, Guy’s and St Thomas’ NHS Foundation Trust

Helen Ives, Chief People Officer, NHS Professionals

Theme one: the changing face of flexibility

The concept of ‘flexible working’ existed long before the pandemic, but since then it has become a key talking point in the world of workforce as more people seek a healthy work-life balance.

But what does it look like and why is it important in today’s health and care workforce?

Highlighting a central theme of the day, Karen Bonner said the definition rested on the individual.

She told delegates: “Everybody has a slightly different take on what flexible working looks like. I don’t think we do it well in the health service, and that's the honest truth. Sometimes I think we think about managers making the decision about flexible working, when sometimes with my teams, I put it back to them to say: this individual would like to work in this way, how can we help to support them? I think it's really important that we think about flexibility according to what the individual’s need are, as well as the organisation’s.”

Andrea Williams-McKenzie argued that the conversation around flexibility has evolved, and how equality across different staff groups matters.

She said: “Certainly for us and Guy’s and St. Thomas’, I think we have very quickly arrived at a point where we recognize that flexibility will help us with recruitment and retention, but also to deliver what the organisation needs to meet the work-life balance needs of our staff. I think we’ve actually progressed the whole discussion around flexibility.

“Some years ago, it was around job sharing, whether you can work part-time, or whether you can work compressed hours. Now it’s moved on to hybrid working and working from different sites that may not be your home, but they are much nearer.

“We've been looking at it through the lens of equity. So often, your support staff that are office-based have more flexibility than your perceived operational staff, particularly our nurses.”

Extra pay can often be seen as the main driver for temporary staff, but the initial results from a major new survey of NHS Professionals Bank Members suggest otherwise, reported Helen Ives. Data from 10,000 responses showed that greater control over inflexible shift patterns and more choice over when and where to work were the top two motivations, followed by a desire to deliver care simply and directly, one-step removed.

Data like this only underlines the need to question traditional ways of working, Helen argued.

She said: “How are we going to think differently about the way we deploy people, structure roles and organise teams?  How we've done it so far won't work anymore. I think flexibility is the business imperative at the moment, alongside inclusion and wellbeing.”

The issue of roster flexibility was discussed later in the session by Andrea Williams-McKenzie, who said a pilot at Guy’s using self-directed rostering had helped to reduce absence among clinical staff and boosted applications for internal promotion.

“Our staff are more in control of their lives. They feel that they can take holidays and not feel guilty. Our Bank 6 and 7 roles are being filled internally because staff feel regenerated and they have the time to focus on themselves and they have time to learn,” she said.

“Just enabling that flexibility in the nursing workforce has been formidable and we're now looking at how we extend that work into other parts of the Trust. We're also looking at using some AI software to help managers roster in a way that it meets the business needs but also brings in work-life balance. It helps to reduce the burnout and increases that sense of value, and being listened to and cared for by the organisation.”

Theme two: preventing burnout

Burnout is now a key concern across the health and care workforce and for Karen Bonner, having dedicated rest areas and regular check-ins was key, especially as the NHS transitions from pandemic to business-as-usual (BAU).

She said: “I have a huddle every morning with all the senior nurses, and we talk about breaks and wellbeing and ensuring those happen on the ground. We have wellbeing days - they're not ‘duvet days’, but I’m sure some people sit under the duvet as part of them!

“As we get into BAU, and finances get a bit tight, these are things where sometimes a little bit of investment makes the biggest gain. What’s really important is to really pay attention to our staff’s wellbeing because there are clear signs of burnout and fatigue. It’s complex, because saying to some people ‘go home and have a break’ makes them more anxious because they then feel they're not doing their job. You have to really understand how people tick and then recognise and support individuals. 

“We do not talk about mental health enough and it's still quite a stigmatised thing. We should make it more comfortable for people to acknowledge when they're feeling tired or fatigued. And it's not something they should be ashamed of admitting.”

Andrea Williams-McKenzie also spoke of how ‘small things’ can make a big difference, such as checking someone is ok, if they don’t seem their normal selves in a meeting or call. Helen Ives spoke of the need for a person-centred culture that helps people feel safe about saying what support they need at all stages of their career.

Helen told the audience: “This goes back to decisions that you make as a board or a group of senior leaders, about the kind of culture you want in your organization. I don't think you can just look at look at individuals when you think about culture - you also have to look at the system and the conditions.

“Being in the NHS there are conditions in the wider system which drive us through a public service mindset – for example clearing waiting lists and reducing handover delays - and those drivers are very strong. I think it takes really strong collective leadership in the face of that to stop and think about how sustainable it is to keep driving, and ask what we could do differently.

“If we drive people so hard that they don't have time for their passions, their joys and their interests - the things that keep them going and keep them well - it isn't sustainable.”

A comment made shortly after the session by Karen Bonner neatly captured the essence of the workforce wellbeing challenge in healthcare: “We focus so much on patients. But we also need to focus on the people.”

Theme three: creating a sense of ‘belonging’

A sense of ‘belonging’ to a team or organisation plays a part in overall workforce wellness and performance, especially for flexible staff. Like wellbeing, small gestures can often make the biggest difference.

Karen Bonner said: “It can be really difficult, especially if you're not always [working] in the same area. During the last three years we saw teams come together, work flexibly and move around. It's something we can do…there is something to be learned from it.

“It's really important for people to be well orientated when they arrive, and feel that they've got a voice in that team at the beginning of the morning, or at the start of the shift. It's acknowledging the individual, introducing them to the team, showing them around and ensuring they're part of the conversation.”

Helen Ives shared more early results from the latest NHS Professionals Bank Member survey, in which the majority of respondents said they felt part of their team and treated equally to substantive workers. However, she said further analysis was needed to explore why a minority didn’t feel this way, especially as the flexible workforce tends to have greater representation from minority ethnic groups.

She added: “We need to think about how much we are relying on Bank Members in our workforce, because they are truly part of our whole workforce solution.”

The leadership ‘shadow’

Style of management and leadership are also relevant to wellbeing and belonging, the session heard. Echoing speakers from other summit sessions, our panellists argued that consistently compassionate leadership brought the best results. However, they said more work was needed to embed this approach into all parts of the challenging health and care environment.

Andrea Williams-McKenzie described leadership style as ‘the shadow we cast’ and said that part of a compassionate style was listening to staff and interpreting available data such as surveys and exit interviews. Another important dimension was creating a ‘permissive’ culture around professional learning and role-modelling a commitment to CPD, so that staff felt confident about taking time out for educational activities.

Leadership was also about asking the tough questions, especially in the context of equality, diversity and inclusion, she said.

“Are we really leading in an inclusive way? Are we enabling everyone to feel that they belong? Are we recognizing the diversity in teams, but also the diversity of thinking? When you have the diversity of thinking, that's when you can really deliver great services and develop great products and initiatives.

“I think there is there is a lot of work that we need to do with our leaders in terms of belonging, but also really dialling up compassionate leadership, because I think compassionate leadership is about inclusion and belonging.

“It’s constantly reskilling and upskilling our managers and challenging them in how they're thinking… Senior leadership has the aspirations and the strategic case. But the change happens in our middle managers.”

Karen Bonner added: “I think we all need to take a long, hard look at ourselves as managers. You need to hold the mirror up to yourself and ask yourself really honest questions about your leadership, and we don't do that enough.

“We have to ask ourselves about the inclusion agenda. There's still a lack of diversity in senior leadership. Empathy is part of compassion, but actually compassion is about what you actually then do with that suffering. Put yourself in their shoes, yes, but what's the intentional bit that I'm going to do to make the biggest difference to that individual?

“We don't always pay enough attention to what's going on, in the sense of looking around the room and thinking about who is in this space? How do people really feel in an organization? What does it feel like to be here?

“I think those are the things for managers and we may have to go on an uncomfortable journey. Unless you're willing to do that, things will stay the same.”

Part of this ‘discomfort’ may involve managers and leaders admitting when they too are struggling, said Helen Ives, adding that compassionate and inclusive leadership is ‘the single biggest thing that we can do.’

“It’s the courage both to say to yourself, I'm not okay, I need some support, but also as a leader to genuinely, deeply and appreciatively inquire, and make it safe to hear responses that you may not actually want to hear,” she said.

Panel chair Anne-Marie Archard added: “I don't think you can underestimate the impact of a senior leader saying how they feel and being vulnerable. That’s very powerful.”

Theme four: young at heart

A final theme in the session focused on the need to diversify the age balance of the health and care workforce. Both the panel and members of the audience agreed more needed to be done to attract younger generations into care, and to find ways for younger and older staff to work together more productively – with ‘buddy’ schemes as one positive example.

Helen Ives said: “I think this goes back to inclusion. We need to think about how we are including younger people in our attraction strategies to the NHS, recognizing that those younger people come with different backgrounds and ideas, and that one attraction strategy will not work for everyone.

“The young people of today have very high expectations and aspirational standards about their choices in life. We need to speak to that in ways people recognize, and in a myriad of attraction strategies, rather than post an advert out and hope that it works.”

Andrea Williams-McKenzie highlighted secondary school and college outreach work at Guy’s and in her previous roles in Government, but she suggested this should be ‘more ambitious’ and extend to primary schools.

She said: “We need to start much earlier, to really bring a new generation into the workforce and understand the range of careers they can have in the NHS. The number of career pathways that we have in the NHS is just fantastic, but we don't market it or shout about it.

“I think there are huge opportunities for us to bring in the younger generation and their creativity and use of technology, to help us cut through the fluff and deliver smarter, more intuitive care to our patients.”

Making it easier for younger members of staff to switch roles and workplaces could support efforts to retain talent in the NHS in a competitive marketplace, argued Karen Bonner.

“This new generation aren’t going to want to stay in one place. They want multiple jobs, multiple careers. We talk about turnover, but we worry about people moving around. But actually, how do we enable [moving around] to be easy for people? Because they will move out.

“When I was 25, I wanted to work everywhere in London, I want to work in every organisation. How do we make that easier? Because that's what these younger people want. And if we want to keep them in the health system, we need to make it easy for them.”

Harnessing the potential of alumni schemes was another important avenue to explore and could dovetail into work on integration, according to Andrea Williams-McKenzie. She felt such a scheme could be set up in London at pace, adding:

“We need to steal some of the good practice from other sectors and import it into the NHS. The creation of an alumni group is something we can do very quickly. Then we're sharing the talent across the NHS, and certainly across London, which is what we should be doing. It’s a huge opportunity and I think the ICSs have a key role to play in that.”

Key session takeaways

  • The definition and scope of flexible working is variable and should always focus on the needs of individuals and how to make that work collectively for the organisation
  • Pay is not the main motivation for flexible workers – a greater sense of control is the biggest driver
  • Wellness and mental health needs to stay in focus as we return to business-as-usual; sometimes it’s the smaller gestures of compassion towards members of staff that can enhance wellbeing and nurture a sense of belonging
  • Leading with compassion requires action as well as empathy, and leaders should check in with themselves and each other regularly on whether they are doing enough on key workforce issues such as equality, diversity and inclusion
  • There is an opportunity to attract and retain a younger workforce into health and care and combine their skills with the experience of older members of staff