Item five: HR — a positive contribution?
Resolution submitted by the RCN Greater Liverpool and Knowsley Branch
That this meeting of RCN Congress agrees that HR management in the health care sector contributes no positive outcomes for either patient care or the workforce in general
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Mike Travis from the Liverpool branch proposed this resolution and began by referring to the huge changes in the NHS and, with a general election looming, times will remain a challenge for the next government. He went on to say that the resolution was not about 'HR bashing' but about being held to account for the targets and policies they set. It is also about working in partnership with both management and staff.
Mike went on to say, however, that the advantages of Agenda for Change had not materialised for most staff due to HR. In particular, the Knowledge and Skills Framework had a patchy introduction, with employers failing to value or fund it. The advent of foundation trusts has not been about enhancing patient care, but more about looking at value and downbanding nurses' jobs he said.
Gwen Vardigans, York branch, who seconded this resolution stated that standards vary and while staff surveys express job satisfaction they also identify many frustrations with HR systems. She also said it would be good to have an HR code of conduct or national standards.
Many felt that poor communication and implementation was the problem, not the HR function itself. Several members gave examples of both good and poor practice, while others pointed out that we should be supportive of HR and the positive contribution it makes to patient care; working together is better for staff and patients.
There were several Point of Order cards raised with members concerned about the wording and intention of the resolution.
For: 35 9.72%
Against: 325 90.28%
Abstain: 32
Background
There is growing consensus that effective HR practices such as recruitment and retention, health and well being in the workplace, and training and development, can make a positive contribution to organisational performance, and that HR management plays an important role in creating a positive working environment.
The Health Care Commission (England) is currently researching links between patients' and staff experience. Early findings show a strong correlation between patients experiencing respect and dignity, and staff who feel supported by managers. Conversely, where staff experienced stress and heavy workloads, there was a connection with patients feeling they had not been treated with respect.
The latest NHS staff survey results (2007) for England found 75% of staff were satisfied with their job but only 39% were happy with the recognition they received. In addition, 33% had work related stress, 13% had experienced violence from patients or relatives, and just 22% agreed that there was effective communication between management and staff. The survey also found a higher percentage of staff from ethnic backgrounds had experienced bullying and harassment. Similarly, a higher percentage of disabled staff (25%) than non disabled staff (21%) had experienced harassment, bullying and abuse from patients/service users. If HR policies and practice do contribute to the quality of the working environment, NHS staff survey results seem to indicate HR in the NHS may not be having the desired effect.
Similarly, the NHS Scotland staff opinion survey (2008) showed 55% of staff thought the NHS was a good place to work, but only 33% believed that communications between management and staff were appropriate. A number of respondents confirmed they had been bullied (16%), harassed (17%), or experienced a violent or aggressive incident (18%), and 52% of those who reported this were unhappy with the outcome.
The International Council of Nurses (ICN) contends that positive practice environments affect nurses and other health care workers, support excellence in services, and ultimately improve patient outcomes, and in 2007 produced a toolkit to help nurses negotiate a positive practice environment. In its Designed to work (2006) strategy, launched to support improvements in health and social care, NHS Wales has also stressed the importance of responsive HR management to the modernisation agenda.
The RCN is currently engaged in partnership work across all four UK countries to improve work life balance and wellbeing at work, and its three-year agreement on the NHS pay deal contains an explicit statement about this. There are of course many examples of where great HR practice complements this.
References and further reading
Wright Patrick M, Gardner Timothy M, Moynihan L, 2003 The impact of HR practices on the performance of business units, Human Resource Management Journal, Vol 13 No 3. Available from the Blackwell Publishing website.
International Council of Nurses (2007) Positive practice environments: quality workplaces = quality patient care, Geneva: ICN. Available from the ICN website.
Analysis of results of the NHS staff survey and the patient survey for NHS acute trusts in England to see if there is an association. Available from the NHS website.