Dr Bryan McIntosh et al – Written evidence (FFF0016)

House of Lords Public Services Committee

Designing a public services workforce fit for the future

Evidence submitted by:

Professor Fiona Denney Fiona.denney@brunel.ac.uk

Dr Bryan McIntosh bryan.mcintosh@brunel.ac.uk

Professor Francesco Moscone Francesco.moscone@brunel.ac.uk

Dr Ace Simpson ace.simpson@brunel.ac.uk

Dr Joana Vassilopoulou joana.vassilopoulou@brunel.ac.uk

Professor Dorothy Yen Dorothy.yen@brunel.ac.uk

(Brunel Business School, Brunel University London)

Executive Summary

Years of underfunding and a rapidly changing world disrupted by new technologies, political upheaval, demographic shifts, rights awareness and an environmental crisis mean that public organizations must be adaptive and learning-oriented to remain fit for purpose. In this formal submission to the House of Lords Public Services Workforce Call for Evidence we address some critical questions related to the future of work. We describe challenges of hybrid identities and a leadership focus on compliance, performance and efficiency that often overrides empowerment, care and compassion. An effect of this can be high staff turnover, bullying, discrimination and a disinclination to enter public service organizations, including by managers. We consider the need for culture change, including through leadership training that emphasises both performance and people, which include both employees and citizens.

1. It is difficult to predict accurately how the public services workforce will need to change in the long term, and yet it is necessary to prepare now for the future.

1.1.                      Evidence of hybrid managers – defined as professionals who manage, overseeing the work of other professionals and having a dual identity - indicates that there is little preparation for those who progress into this role.  This is common in the healthcare sector and education, amongst other public sector organisations.  As such, there is little initial training for the consideration of this as a career option (succession planning and talent management), limited on-boarding into the role and even less ongoing support for the role-identity-conflict that is experienced in occupying the liminal space between the ‘no longer’ (a pure professional) and the ‘not yet’ (a manager)[1].

1.2.                      Public services organisations need to recognise that those who progress to management positions are equal parts professional and manager and need better support for integrating conflicting role identities[2],[3].  This means better succession planning and talent identification for those who might be suitable for moving into these roles and investment in advanced preparation for managing the role-identity-conflict that can result.

1.3.                      Public services organisations need to consider the role of ongoing support for those in managerial and leadership positions who act as boundary-spanners between professional and managerial domains.  These are critical positions in terms of the contributions they make to knowledge brokering and strategy formation and implementation as they see both the strategic world as well as the practicalities of the implementation[4].  As such, they are crucial in facilitating effective change but are largely undervalued in terms of training and development. 

1.4.                      New training initiatives are being developed by some universities such as King’s College London and Brunel University London as pilot models for working with those crucial boundary-spanners (mainly academic heads of department and deans) in higher education.

1.5.                      The training is based on preliminary research[5] which identifies the different types and motivations of people in these roles in order to be able to support and develop them.  For training to be effective it needs to be more individualised and meaningful and therefore, in addition to the “how to” information, which is crucial in any new role, the training focuses on providing access to coaching and understanding of how to work their motivations and “type” to the best of their advantage.

1.6.                      Individualised training and support is more likely to be effective in developing those in public services to manage their dual identity and provide  better organizational efficiency.

2. Conventional approaches to training have not enabled enough professionals to enter the public services workforce to meet demand. How might training change to maximise the number of public services professionals and improve their skills?

2.1.                      Middle managers in much of the public service are trained as managers but not as carers. Accordingly, care staff can often experience their leadership as overly managerial, compliance-performance based and lacking humanity to the extent that the public sector reports exceedingly high levels of managerial bullying.[6]

2.2.                      Efforts to improve staff work experiences in the NHS over recent years have included the development of internal mediation services, cultivated a learning culture, and worked with staff and unions to quickly resolve tensions, as well as highlighting the need for more compassion, particularly compassionate leadership, in interpersonal dealings.

2.3.                      In 2012 “Compassion in practice” was launched as a three-year vision[7]An evaluation of the programme in 2016 found that while the initiatives launched under the programme contributed value, systemic issues were posing an obstacle to wider change.[8] A follow up 2014 report “Building and strengthening leadership: Leading with compassion”[9], sought input from influential nurse leaders from across England to “identify key areas that we needed to progress in relation to leadership”. A “Developing People – Improving Care Framework” was subsequently launched by The National Improvement and Leadership Development Board, which has representation from thirteen healthcare related organisations including the Department of Health, NHS Health Education England and the NHS Leadership Academy.

2.4.                      One of four critical capabilities the framework focused on was developing: “inclusive and compassionate leadership, so that all staff are listened to, understood and supported, and that leaders at every level of the health system truly reflect the talents and diversity of people working in the system and the communities they serve”. The relational tensions surfaced in the NHS by COVID-19 despite the release of various strategy frameworks for developing compassionate leadership over the years, reinforces that enacting culture change is not easy in practice. It also offers a narrow opportunity for making further gains in resetting working relations during the time when the issue is highlighted as a recognised concern.

2.5.                      An example of a local level initiative is the CNW NHS Foundation Trust’s developing a 21st Century Leadership Programme (21CLP) (launching in 2022). The programme will include “training in trust values and staff charter”, “psychological safety supervision”, “coaching and storytelling”, and “compassion – self and others”.

2.6.                      Each of 10 modules will be taught at three levels. Level 1 will be for “team members” with content focused on self-development and co-worker relations. Level 2 will be for “team leaders” with content related to leading others and group dynamics. Level 3 will be for “leaders of teams” with more organizationally oriented content. The intention to develop a trust wide change in the working lives of staff by shifting power dynamics away from command-and-control approaches, where rigid hierarchies and divisional silos facilitate the conditions for poor staff morale, towards collaborative approaches, based on giving voice to team members.

2.7.                      The 21CLP is a hopeful initiative. However, it should be coupled with research to evaluate its effectiveness in initiating change. Evaluating the effectiveness of compassionate leadership training initiatives is relevant at the local level and at a national level, where best practice in terms of an effective intervention, could be implemented and drawn upon. The imperative for the NHS to successfully develop training to improve the people-side of its operations is reflected in the consistent and long-term representation of bullying and harassment[10],[11].

3. How might the public sector become more attractive as an employer, particularly in comparison with the private sector? How might it become attractive enough to retain workers throughout their careers while maintaining a level of turnover that brings fresh ideas to organisations?

3.1.                      Within public service employers, career breaks have an impact on women’s career outcomes. However, the causal mechanisms that explain the transfer of women’s relative reduced career outcomes remain disputed. What is not contested is the relationships between career breaks, part-time working, and access to training/updating skills in determining career outcomes[12].

3.2.                      This is a mechanism of transferring disadvantage, they found that restricted access to training for part-time employees and limited opportunity to update their skills following a return from a career break are determining factors affecting the career outcomes of public servants. Exacerbated by the rationing of training for those returning from career breaks. These restrictions are ultimately detrimental to the operational efficiency of the country’s public services. When this is combined with organizational values that prioritize full-time working as the desired and preferred form of working, the situation arises that makes it ever more difficult for those employees who work part-time to access and receiving training[13].

3.3.                      There is a way forward: While absent on a career break, and on their return to employment, employees should be offered ongoing training to maintain their skills. The cost is estimated to be 2.5% increase in current training costs but represent a 14% saving in overall retraining. The skills base of employees who return from a career break should be evaluated and training provided. Indeed, all staff should be afforded support in getting access to and receiving training, and the timing and length of courses should be altered, if needed, to accommodate part-time practitioners.

3.4.                      To provide more opportunities to women with child care responsibilities, accessible training and learning pathways at a national, regional, and local level, and suitable recognition of prior learning should be put in place. Enhanced learning frameworks to support access to education and training so that all employees should be developed, particularly those returning and part-time working. The U.K. government’s policy on Shared Parental Leave and Leave Curtailment came into force on April 5, 2015, to make parental leave shareable, with the objective to challenge assumption that women will always be the parent that stays at home. Lessons from previous experiences of similar legislation in Europe[14]) needed to be applied effectively to reduce this continuing gender penalty in the workforce.

3.5.                      These measures represent an opportunity to enhance skills, particularly those of women with dependent children. It can prevent the permanent loss or curtailed career development of highly trained and skilled members of staff. This is advantageous and desirable for the employer and employees. These recommendations would support the possibility that women, particularly those working parttime, those returning from career breaks, and those with dependent children of all ages, could meaningfully continue to develop their career.

3.6.                      It can directly benefit the financial and operational efficiency of the employer. The retention and return of experienced registered staff can reduce the ongoing expenditure on the training of new staff. Reengaging and retaining experienced staff would further enhance the quality of the service. This notwithstanding, it is also a necessity for the public sector if shortages in key areas are not to become chronic in the near future due to demographic changes.  For staff, these proposals can enhance the work–life balance and positively confront the choice many women are presented: between their career and family.

4. How can providers of public services recruit a more diverse workforce? How should they improve their recruitment of BAME people, people with disabilities, older people and people who use public services and live in the communities that providers serve?

4.1.                     Public service organizations such as the NHS can recruit a more diverse workforce by treating its employees better, with more dignity and compassion and integrating compassion within the fibre of organizational management, policies and practices[15],[16], including by ensuring ”compassionate and diverse leadership” with “a diverse leadership cadre”, an ambition of the NHS Long Term PlanLong Term Plan.[17] In 2020 18.7 per cent of NHS staff reported having been bullied by colleagues and 12.4 per cent reported bullying by managers.[18] Research within other sectors, such as higher education, indicates similar concerns [19],[20].

4.2.                     These findings are worse for BAME staff members, with 28% in the NHS reporting bullying and harassment from managers and colleagues and 16.7% reporting having experienced discrimination (as opposed to just 6.2% of white staff reporting discrimination).  UCU (Universities and Colleges Union) found that 72% of its black members were often or sometimes subject to bullying and harassment from managers[21] .NHS Staff with disabilities are also 8-9% more likely to experience harassment and bullying both from colleagues and managers.

4.3.                     These findings are replicated in other parts of the public sector, including education. They indicate the endurance of poor workplace relations which underpin high levels of employee absenteeism, sick-leave, compensation claims and turnover, all of which erode staff morale, wellbeing and the quality of patient care,[22] as highlighted by reviews of the NHS commissioned in the mid-2000s, including the Francis Report, the Keogh Review,[23] and the Berwick Review[24],[25][26][27][28][29]

5. What role can digital tools play in increasing the accessibility of public services workers to service users, and in improving the quality of their work? How might we anticipate and mitigate any inequalities of access to public services that may arise from the expansion of such technologies?

5.1.                     Digital technology can help increase remote users’ accessibility to public services. This is evidenced in prior works that show that digital technology enabled healthcare services, such as LIVI, are now reaching and serving more users remotely. 

5.2.                     However, older adults may struggle to access digital public services more because of their poorer digital literacy and hesitancy in technology adoption. This means that the other access to public service needs to remain open to ensure equal access. In addition, digital trainings, and support regarding how to such digital public services and e-government services need to be provided, to ensure all users can access digital public services confidently and equally.

6. How can digital technologies be used most effectively for training and up-skilling the public services workforce?

6.1.                     Rapid improvement in digital technology and the constant need to provide services have created a constant demand for highly skilled employees who are informed by up to-date training and practice. For financial and economic reasons, some employers recruit from a restricted pool of newly qualified full-time practitioners as opposed to investing the same amount of funds in staff returning from a career break or who work on a part-time basis.

6.2.                     Investment in training is principally directed at this group. Financial restrictions have been ever present within health care delivery and produce direct and indirect rationing of goods and services. The provision of enhanced digital training is not divorced from this situation. As qualifications and training significantly determine career progression, enhanced digital training up-skills the workforce improves effectiveness and efficiency.

6.3.                     While the pandemic has changed the country’s working culture and developed a workforce that is more willing and becoming more efficient and effective in working from home, it signals the society’s readiness to embrace remote training at home. Digital training package could be utilised to provide on-going career support. These include not only performance-related up-skilling on tools, apps and softwares, but also areas such as care, equality, diversity and inclusivity to promote compassionate and support the change of organisation culture. 

7. Preventative and early intervention services can improve the ability of the public services workforce to respond to users’ needs. How might such services be embedded within any public services workforce strategy?

7.1.                      A user-centred and user-oriented approach needs to start from the beginning so that users’ needs are central to the design and development of future public services. By involving users in the co-designing and co-developing of public services, the process and the structure could be better developed to satisfy and support users’ needs.

7.2.                      Once the services are developed, regularly user review and feedback sessions need to be organised, to identify problematic areas that require fixing and spot opportunities for creating positive user experience. By involving the users in co-designing the services, co-evaluating the effectiveness of the services, and co-developing solutions to better the services, users’ needs are embedded and integral in planning and developing the public services that are fit for purposes and appreciated by users.

8. What have been the effects of the COVID-19 pandemic and Brexit on the public services workforce? Have these events created opportunities for workforce reform?

8.1.                      Covid has made more urgent the need for developing compassionate people skills in the public sector, particularly in managers.  The situation in the NHS is particularly illustrative of this.  Research on the effects of COVID-19 on NHS staff has revealed that the pandemic had exposed a deficit of ‘softer’ people skills in managers, and that “leadership development programmes often neglected the tools and techniques that managers needed to identify, address and resolve challenging people issues.”[30].

8.2.                      Through the COVID crisis many NHS staff experienced their jobs as having a significant a detrimental effect on their wellbeing, with increased anxiety, stress, and exhaustion as they had to significantly adjust their work patterns. Once the peak crisis passed, interpersonal issues that had been put aside to address the crisis have resurfaced with added urgency as occupational referrals and stress related absences rise.  There is concern that as staff came together to address the crisis, they also gave up their voice and power sharing relations. If the NHS pivots further towards command-and-control management, likely to effect staff morale and wellbeing.

8.3.                      The NHS has been striving to address relational issues at a national level by investing more resources in staff occupational health and wellbeing, equality and diversity initiatives, and by working closely with the unions. Improving communication to ensure employee voice and engagement has also been a focus. It is thought the disruption imposed by COVID may represent “a limited window of opportunity” for developing “improved communication, greater organizational agility, creative use of new technology, enhanced employee voice and deeper stakeholder partnerships.[31]

8.4.                      Although the situation with regards to the NHS is particularly stark, it is by all means not the only public service where COVID-19 has highlighted the need to improve leadership for the benefit of workforce health and wellbeing.  Education has also been significantly under pressure and in higher education, universities have had to balance the needs of students, who are usually fairly young and therefore less impacted directly healthwise by the virus, with an ageing staff profile.  UK universities are struggling with both student and staff mental health and wellbeing issues, which have been chronically exacerbated by COVID. Arguably this has created an opportunity to move conversations away from league tables and targets and towards a culture where compassion is embedded in pedagogy and leadership[32].  Teaching methods which embed a compassionate approach are under-researched but early indicators are that they could have a positive impact on student engagement and the BAME awarding gap[33].  Compassionate leadership in higher education is similarly under-researched[34] but there is good reason to believe that this could have the potential to address some of the problems identified herewith.

8.5.                      The origins of poor workplace culture in the public sector is long-standing[35] and an ensuing focus on targets and key performance indicators as proxies for genuine accountability.  Whilst the importance of good stewardship of public finances is not in question, there needs to be an increasing awareness of what have become proxies for this and the unintended detrimental consequences these proxies then have on workplace culture.  A more positive approach to failure and a better reward system which prioritises a culture of compassion over metrics could be cornerstones of public service reform for the better.  

9. What tools do good leaders use to incentivise and challenge their workforces to transform service delivery? Are there any examples of best practice?

9.1.                      Leaders can draw on core principles of compassion and public service, and the work satisfaction that can be experienced from a sense of contributing to the public good.[36] They can also model compassionate behaviours towards their staff. Organizational compassion research has identified that compassion from a leader, signals that those with the power to provide resources that might facilitate coping and recovery, are attentive to situations of distress.[37] Perhaps, the greatest asset of the Public Sector is the calling orientation of its workforce. Yet, this workforce is often under-resourced and poorly treated by managers who can sometimes appear lacking in compassion. Paradoxically, this can be a contrast with private sector organizations where, for example, in organizations stiving for highest employee rankings as ”Great Places to Work” employees frequently describe the top rated organizations as compassionate.

9.2.                      Understanding of compassionate leadership builds on the theorising and findings of the broader discipline of organizational compassion research over the past three decades[38]. Scholars define organizational compassion as comprising four subprocesses: Noticing the suffering of a colleague, empathising with their pain, assessing to understand their circumstances, and Responding in the most appropriate manner to alleviate their suffering (NEAR).[39]

9.3.                      Efforts to compassionately address the suffering of colleagues provide significant benefits at individual and organizational levels. Among these are the hastening of post-trauma healing;[40],[41] enhancing connection, altruism, motivation, pride and loyalty;[42],[43],[44] promoting perceptions of leadership effectiveness and superior decision making;[45] and boosting organizational performance levels.[46] Within the healthcare context research has found that individual experiences of compassion are associated with higher levels of affective staff commitment and positive emotion,[47] improved sleep quality and subjective health, reduced work-related stress and reduced workplace bullying.[48]  Crucially there is good evidence for the impact of compassion resulting in positive healthcare outcomes when demonstrated in frontline caring relationships[49] which would indicate that those in leadership positions in the NHS should be prioritising compassion as a key leadership tool and leading other public services by this example.

10.         Users’ expectations of public services are changing rapidly. How, in your experience, have their expectations changed?

10.1.                 Nowadays, users are expecting a lot more and often see themselves not only as citizens but customers, who have paid their tax and in return request timely, efficient, well-delivered, courteous and respectful delivery from the public services. On top of good service delivery, the consideration of equality, diversity and inclusivity are also expected when designing, restructuring and delivering public services.  Employees are expected to be equipped with not only professional skills, but also care in their services. These emphasise the importance to provide training on customer service skills, interpersonal communications and customer orientation.  Public services are advised to treat users as customers in their service design and delivery and involve users all the way through, which include:

•                     An exploration of user needs, wants and expectations of the services

•                     Co-design workshops to regularly review the service structure and delivery with users’ input all the way through.

•                     Regular user feedback and evaluations in the fields with sporadic checking from the secret shoppers.

•                     Periodic peer review between different service units to ensure consistency and increase quality assurance.