‘Grounded hope’: understanding the perspective of chief people officers

The workforce challenges across the health and care sector are not new, but a louder echo of those areas already problematic in the system before the pandemic. Post pandemic, we see the NHS is struggling with rising demand that it cannot meet, delays in accessing urgent, emergency and elective services across the country, and it is the workforce that are bearing the brunt of the challenges facing the sector.

Ahead of the launch of the government’s new 10 Year Health Plan and an update to the 2023 Long Term Workforce Plan, operational leaders continue to respond to high waiting lists, increased staff absence and challenges around recruitment and retention, to name just a few of the key issues. Focusing on the future of work, this long read reflects the priority work NHS people leaders need to consider, acknowledging the demands of operating within a system that needs to spend less but deliver significantly more.  

As the government announces sweeping reforms to how the work of national teams across the Department of Health and Social Care and the NHS will change and revert to one body, promised additional funding linked to system reform is an ambition broadly supported by staff across the NHS but lacking in detail. The role of NHS staff working across the service has never been more critical, both in delivering care but also as partners in changing how organisations work to make the most of the plans for reform and deliver improved and timely patient care.  

The size of the NHS workforce across the UK (more than 2 million people) means the NHS is one  of the biggest employers in the world, based on number of employees. Staff are employed across a range of settings, from those who provide care in GP practices, hospitals and community services, through to those who provide regulation and support to the service in integrated care boards (ICBs), and regional and national teams working for NHS England. Together, they provide more than 1.6 million patient interactions every day.

As an integral member of NHS organisations at executive level, the Chief People Officer (CPO) takes responsibility for setting and driving the people strategy, shaping organisational culture and leading workforce transformation across the organisational footprint. Leading consistent change across the NHS means being able to balance performance with compassion. CPOs need to recognise that change is critical to improvement but also that strong and positive relationships are needed to deliver improved care and sustain the results.  

Acknowledging the vital role they play, The King’s Fund has brought together a selection of CPOs from across the sector, to share their experiences and understand where partnering would help drive necessary conversations and change. Our first leadership session in the latter part of 2024 was filled with energy. Those who attended recognised the daily challenges that face every NHS people leader but also brought a positive drive to do things differently (better) and acknowledged the need for action beyond discussion. This work aims to build insights across the people agenda and put a spotlight on some of the most challenging issues facing the workforce for some decades.  

Key thoughts from the discussion – ‘grounded hope’ 

The initial conversations generated the term ‘grounded hope’. As one CPO said, ‘What we are exposed to in reality versus thinking about the big picture, feels hopeful… not just fingers crossed, and an artificial belief that things will get better in time.’  

The CPOs in our impact group discussed how they want to see acknowledgement of the adversity staff are facing across the NHS and a strong desire to improve the experience of those who are both currently and considering a career working within the NHS. Participants addressed the reality of their experiences but wanted to push forward to take directive action to change the situation.  

As the conversations progressed, we heard what it is like to be a senior people leader in the NHS right now: 

A better place to work 

The focus on ‘making the NHS a better place to work’ has been driven by the number of qualified clinical staff (as well as other groups) who are leaving the NHS post-pandemic. Despite varied reports about leaver rates reducing ,the numbers of staff abandoning the roles they have been trained to do was ranked as one of the top concerns from the CPO group at the first meeting with The King’s Fund.  

The NHS continues to attract people who want to work for the service across a range of roles, but the average length of service is falling. The type of work challenges, such as the demand of a high and complex case load, the emotional toll of working with seriously ill and dying patients and often the way that the work is organised and delivered, means that people often find themselves wanting to move away from the service as they become more senior. A focus on how the NHS continues to retain staff groups at all levels is critical to move away from the  more reactive recruitment activity we currently see. This will ensure that there is a senior layer across NHS organisations who are well enough themselves to demonstrate compassionate behaviours, rather than going through the motions, especially around their management work.  

Attracting and retaining staff  

The CPOs in our network told us that the single focus during the Covid-19 pandemic was hugely helpful in fostering a compassionate style of leadership, but that has now fallen away as demands have increased. During the pandemic, we saw people volunteering and entering the NHS workforce in a way that did not happen before. Capitalising on building consistent interest in staff roles is critical for future planning – for both the workforce and the system as a whole. 

What was clear from the discussions is the CPOs’ desire to enable their organisations to lead and develop how their teams work collaboratively. With leaders at all levels focused on developing the workplace, while recognising they are currently held back by the real, lived reality of a workforce under pressure, continuing to attract a future workforce means offering a way of working that will suit both more junior and mature team members. It means using this time to deliver staff and leaders development beyond the essential skills required, ensuring that the leaders of the future NHS are being prepared daily through the developmental offers available within their organisations.  

The continuous themes of limited resource and significantly increased demand might resonate with politicians and the public but could well be putting off people who might be considering the NHS as a future career. Paying attention to why people continue to want to join the service means moving beyond the advertising of roles, to really considering what will be attractive to potential employees. If organisations can show how they live their values through frameworks such as ‘well-led’ and other NHS management and leadership behaviours, they will be more likely to attract future candidates. However, this can only happen if the NHS management and leadership standards are positioned as ‘must do’ rather than ‘will do if the time, money and focus allow’. As The King’s Fund has noted, the 10 Year Health Plan can only be realised ‘if the staff feel [that] ownership and the necessary cultural conditions are in place’. 

Prioritising the wellbeing of NHS staff   

The rising level of sickness and absence across NHS staff groups has been a cause of consistent concern, with a change from high levels of short-term absence to a noticeable increase in long-term absences. The discussions with the CPO group focused on understanding the personal demands of an increased workload post-pandemic, and the challenges of working in a service that consistently requires you to do more. Rather than being a moment in time, the working conditions that arose through the pandemic have led to increased demand, higher levels of acuity, and a working pace that creates feelings of stress and tension that seem here to stay. 

The workload increased beyond the pandemic and continues to rise, but the staffing available to manage this increased demand often comprises temporary, short-term or agency staff.  

Recent and urgent budgetary restrictions have meant that boards across the NHS have had to prioritise reducing costs, particularly staffing. This is driving a significant and urgent focus on reducing both temporary and agency staffing but is also having an indirect impact on international staff groups who have arrived to take up roles amid budget concerns. And those staff fortunate to hold substantive employment contracts, are left concerned that they do not have enough capacity to go round. This is a shift in focus post-pandemic, reflecting the need to balance the books.  

It is also critical that the NHS can meet the needs of an ageing workforce who need an achievable job design to support them to stay in work for longer. Paying attention to what keeps the workforce well and engaged and appreciating the ‘dilemmas and trade-offs to be made’, was an energising topic for the group. Giving energy and passion to focus on what is working, what can the different conversation be and being able to feel connected to the national agenda with a range of solutions to the ever-growing demand issues was well received. The group felt strongly about that having energy and passion to focus on what is working, thinking through the role of a different conversation and being able to feel connected to the national agenda with a range of solutions to the ever-growing demand issues. 

The group did not regard the NHS workforce supply challenges – such as changing job roles, increasing demands, and a workforce not being able to keep up with what is expected from them – as insurmountable. They reflected that they often do not have time to consider some of these thoughts and ideas, or to work with those who may be able to consider the issues differently.  

Understanding how to attract and keep ‘generation alpha’ 

As the group started to think about the NHS workforce of the future, demographic change – including how to attract ‘generation alpha’ (people born between 2010 and 2025) and what their expectations would be – was a hot topic. One key issue was the changes in expectations about how this group would want to approach work in the future, and how that would fit with current NHS workforce models. The King’s Fund shared some thoughts on what we can expect from this generation, to get the group thinking about what might be needed from a workforce planning perspective. 

With the generation alpha group averaging 8.3 million children in the UK in 2024, it is a generation likely to be a similar in size to that of its predecessor. Nearly two-thirds of this generation are likely to work in jobs that do not exist today; the level of extended education they have is more significant, and as is clear from the level of digital competence of today’s younger generation, they have been born into a world where smart devices and technological fluency are commonplace. Access to data and technological solutions will change the learning styles and decision-making ability of this population group. Life expectancy for generation alphas is significantly longer than for millennials, which means that many of this generation are expected to live to see the twenty-second century, impacting how they might plan a career.  

As is already evident, the pace of technological change will mean that the ability to continuously learn will remain. The ability to connect and work internationally is likely to become more commonplace without the necessity for travel, given climate concerns. Known to be a group who will likely value flexibility, change and choice in their working lives, Generation Alpha may want to care for others but only in a way that meets their own needs and preferences. It is important for NHS people leaders to understand which organisations (including outside of the NHS) are getting this balance right.  

This focus on how the NHS wants to work has been demonstrated by the emphasis on flexible working and people already wanting to find a way of working that suits their own needs, not just those of their employer. As our employment cycle moves towards preparing for the recruitment of generation alpha young people, does the NHS really understand how it must change ways of working to meet the needs of this generation? Generation alpha will expect employers who can offer them opportunities to move around, take on different projects and work in a way that is socially conscious and aware.  

We know from previous research into what attracts young people into careers in social care that attraction is not the only issue, rather, it is keeping people in their roles for longer than a couple of years that matters more. For those who do stay, they often progress at pace into management roles as well as providing senior assurance of the caring role. The challenge appears to be the gap between what attracts young people into the roles and what keeps them there.  

Although the desire to do a good job that is valued has ensured that the NHS could retain the professions it trains, the salary levels available to tackle difficult and complex roles will need to be reviewed. At both attraction and retention levels, if people can find new roles that pay more but are less demanding, this is where they will move. While job satisfaction and intrinsic motivation remain important, the cost of living and comparisons with other industries are a factor too, with salary increases not keeping pace with increasing prices, which in turn has an impact on the standard of living that could be expected from within certain roles. 

There are already health and care roles for which recruitment is slow or non-existent. Being clear about changes and anticipating them so that strategies can be adapted to meet changing needs is a regular part of what corporations outside the NHS do. It will be critical to agree a shared perspective on the changes taking place and ensure that NHS leaders and staff are working together both at national, regional and local level to inform that picture and take prompt action rather than individual organisations across the NHS making different decisions to fill the gaps.  

Building an approach to managing those roles that are no longer attractive will help to understand how expectations of work are changing, and what CPOs need to do to stay ahead of the changes.  

For the group of CPOs, paying attention to future needs was a clear and imperative discussion point. The demands of today’s work environment interfere with CPOs’ ability to plan effectively beyond the realms of a short-term workforce plan, and the changing nature of work, the people who are attracted to do that work, and their career ambitions are all due to be re-examined. The underlying messages from those who are currently beginning their working life in NHS roles gives a sense that the service is a daunting and difficult place to work. It also requires a significant input without necessarily giving the type of output – from a salary or job satisfaction perspective – that our current generation of young people might want from their working lives. Preparing those who are managing a new generation of employees and need to attract more of that generation into their workplace means preparing them to operate with a different mindset than previous generations may have had. 

Being clear about what is preventing modernisation  

The government’s 10 Year Health Plan is expected to propose three big shifts in health and care: from treatment to prevention, from hospital care to care closer to home, and from analogue to digital. However, these shifts have been promised before, so what will it take for this modernisation to happen?  

Being able to ‘sell’ the work of the NHS to potential staff requires a focus on the big picture. The CPOs recognise that they and the wider system need to be ready to acknowledge the different roles and ways of working that will be needed, and to build a future view of work that can allow staff to feel hopeful that working conditions will improve. This will need a move away from silo-based planning to look at vertical as well as horizontal workforce needs, and this means planning can focus on core priorities. Evolving the type of workforce that is needed for the future means working alongside professional college colleagues to both educate in readiness for the change and ensure that the relevant professions can input into the conversation.  

Financially constrained environments are likely to prevent experimentation and learning, but we need to be paying attention to just that as we look for new models of work and ways of working. Solutions adopted to date have meant reaching out to bring in overseas staff at pace but not taking time to consider, in the longer term, what happens when the money no longer supports the need. Paying attention to what type of employer the NHS wants to be is vital if the service is to attract socially conscious generation alpha individuals to be the NHS staff of the future. This must also happen in partnership across different generations of staff, all of whom will require a range of new and different skill sets.  

The lack of creativity that occurs in a working environment focused on controlling costs, cutting back and managing vacancies will divert attention from the longer-term work needed. Colleagues across the NHS people and leadership space are not talking about growing, changing or enhancing the workforce in ways that will drive system and national change. They are stuck between a genuine desire to offer better care to patients and the public, and the demands of an outmoded regulatory system. The focus is on the money, and meeting vacancy and cost improvement targets.

The group of CPOs involved in this research were keen to tell the workforce story in a different way, ensuring a focus on talent and the future pipeline, and a move away from reliance on international staff or quick-win solutions. The role of the NHS as an anchor organisation – often the largest employer in the local area – must count for how the community coalesce to ensure that the health and care organisations can perform well and has the right staffing groups to service the community needs.  

The CPO group shared some examples of exciting models of collaboration within and across the broader NHS that involved working alongside health and care partners, and expanding how they work together. The promise of the ICB landscape was to address the fundamental problems facing the staff who provide care for our communities. However, working towards a one-model workforce approach remains a slow but enticing future vision. The CPO group felt that acknowledging and changing the perceived dissonance between local, ICB, regional and national approaches to workforce planning is an important area of work, and no doubt one that will be welcomed by colleagues across all areas of the NHS.  

The King’s Fund is paying particular attention to the changing demographics and digital capabilities required within the NHS workforce, as the offering from the digital space to improve functionality progresses. NHS staff must keep pace with the knowledge and skills required for this ‘brave new world’ if they are to avoid a gap in capabilities, particularly digital skills. Time limitations and the urgency of delivery will continue to devour staff time but the focus on the future of work is one that we want to continue to explore with a group of leaders responsible for preparing for that future. Understanding the demands of the future health care world requires moving away from stagnant workforce modelling, to planning that will work for the system and keep pace with young people’s desire to work in areas where they feel they are ‘giving back’.  

The consistent voice from the CPO group about the value of collective voice was clear. Having the opportunity to guide and input around the work, and focusing on opening discussions, was important and necessary to support current transformation activity. The cost benefits of beginning this work now were clear, as was the desire to continue to shape the discussions that need to be had at pace.  

Given the rapid pace of technological change, preparing for the future of work in the NHS is an urgent task. The challenges involved in working for the NHS across recruitment, retention and wellbeing mean that it is often a less attractive place to work. Without modernisation, the challenges and demands of working in NHS roles (with little reward compared with what other jobs might offer) mean that the service is unlikely to attract sufficient staff in the numbers the NHS needs. Changing expectations of work among younger generations will challenge the NHS to think differently about how the system works, and this thinking needs to happen right now. The CPO taskforce continue to meet over the course of the year to wrestle with some of these core challenges and ensure that as employers, NHS organisations are equipped to both deliver health and care and pay attention to the developmental need for change to equip for the future.