Briefing Note on NHS Highland for New Staff Members

National Health Service Highland (NHS Highland) is a public sector organisation and is classed as being in the Tertiary Sector as it provides a service to the public rather than producing a tangible product. NHS Highland serves a population of approximately 310,000 residents and provides a wide range of services across the largest land area (~40%) of any health authority in Scotland.

NHS Highland is managed by a Board of Executive and Non-Executive Directors and is accountable to the Scottish Government through the Cabinet Secretary for Health and Wellbeing.

The main services provided by NHS Highland are: Healthcare, in the form of General Practitioner Surgeries, Hospital services, Adult Social Care and Dentistry.

The main customers (patients/service users) are the general public within the Highland Region and also to provide services to visitors to the region too. Additionally, NHS highland have internal customers to whom we provide services.

NHS Highland’s purpose and goals are to place quality first to deliver better health, better care and better value. They have “The Blue Triangle” (see fig 1.) which captures the key elements of the Highland Quality Approach (HQA). “The Highland Quality Approach captures the spirit of how NHS Highland is working to improve care and outcomes for people in Highland Region. It describes ways of working, values and behaviour. It recognises how important it is to improve the health of the population and get the experience of care correct for individuals, every time. This will be delivered by focussing on providing person-centred care while simultaneously eliminating waste, reducing harm and managing variation.

This approach places an explicit emphasis on how NHS Highland will make best use all of its resources. This approach is founded on empirical evidence that by focusing on quality and being person-centred, will achieve better health, better care and better value.

The key elements of the Highland Quality Approach are summarised in the blue triangle and include the Mission Statement, Vision and Values. It also describes how services and care will look in the future in addition to how the approach may change the way that services and care are delivered.”

Fig1

External Factors that have an impact on business activities of the organisation are:

Political - In the event of a future YES vote in an Independence Referendum for Scotland, or in case of further devolved powers for Scottish Government to control NHS Scotland’s budget, rather than being part of a wider UK budget, the Scottish Government would decide the overall budget of NHS Scotland and the areas in which it is spent. This would be dependent on the Scottish Economy, which at present is an unknown entity.

Economic - Exchange Rates, costs of pharmaceutical product sourced out with the European Union (EU). If Sterling is weak in relation to the US Dollar, the cost of purchasing pharmaceutical products could be greater and cause a reduction in spend elsewhere in the organisation. Currently, five of the World’s top ten pharmaceutical companies are US- based.

Socio-cultural - The Office for National Statistics (ONS) state that, since 1964, the population of the UK has grown by over ten million (about half of this growth has occurred since 2001), in addition the average age of a UK citizen has increased by four years. This means that not only does NHS Highland need to manage an increasingly growing population; it is statistically more likely that they will have the need to manage patients’ heath for a longer duration, which will become increasingly more difficult for Doctors to accommodate all of their patients and could impact on patient care.

Technological - NHS Highland have adopted the Lean method (Lean is an improvement approach to improve flow and eliminate waste that was developed by Toyota. Lean is basically about getting the right things to the right place, at the right time, in the right quantities, while minimising waste and being flexible and open to change). In the advancements of Technology over the years, scanners and email have increasingly helped to speed up the transportation of documents, meaning jobs can be carried out a lot quicker and also reduces the amount of hard copies of these documents, saving money on paper, postage and printing costs.

Legal - Changes in employments laws can effect terms and conditions that are already in place, meaning policies and procedures need to be adapted to reflect the new laws and amendments to contracts issued. For example national minimum wage increases means the cost to NHS increases to reflect this rise, not only in affected employees salaries but also if there are a variety of contributory pension schemes, the organisations’ contribution may vary greatly between the relevant schemes.

Environment - NHS Highland has a large amount of rural communities and therefore it is difficult to recruit to certain roles in these rural areas, many taking 3 or 4 lots of advertising before there are applicants for the role. The recruitment process for one role like this can take up to one year (one year with no body on post). This means that the delivery of service may be affected, perhaps reduced as the patients/service user’s ratio to staff is mismatched.

Structure of NHS Highland

NHS Highland is a Hierarchical Structure, meaning there are several layers between those at the top and those at the bottom. This works well as it is clear who is in charge of whom and allows the organisation to focus the attention of particular skill sets and resources to achieve maximum productivity.

Four functions within the organisation are:

Human Resources (Employment Services (recruitment), Personnel (advisory service), Payroll, Learning & Development and Occupational Health)

Adult Social Care (care homes, care at home, day centres, mental health teams, social workers and community teams)

Finance (corporate finance, procurement, internal audit, accounts payable & accounts receivable)

Health (doctors, GP’s, nurses, physiotherapists)

Human Resources work with management and employee’s in different ways. Employment services work with managers to co-ordinate the recruitment into vacant posts, personnel offer advice to managers and staff on different policies and procedures, payroll ensure staff are paid correctly and paying the correct tax, national insurance and other deductions/payments.

Managers follow policies and procedures provided to them by Human Resources to carry out effective recruitment and training activities. They also need to liaise with Learning & Development to ensure staff have the appropriate training they need to carry out their roles. Doctors and Adult Social Care staff need to consult one another to discuss care plans to ensure service users are receiving the care required to meet their individual needs. Managers also need to liaise with finance to ensure when they are recruiting, they are only recruiting within their budget and resourcing required equipment at the best price possible, as if they overspend here, other parts of their service may suffer.

NHS Highland has a role culture, meaning staff have clear job roles. This works really well as it is clear from day one, what an individual is employed to do and isn’t expected to be proficient in multi-tasks. It also works well for colleagues as they will know where to turn to seek advice for information/help.

Because of the nature of the organisation and the significant volume of health conditions experienced by service users, it is very important to have specialist expertise.

3 HR activities which support the organisation’s strategies are:

Recruitment – Employment Services support managers by advising vacancy monitoring and how to seek approval for a vacant post, to length of time from date of advert to successful candidate starting n post. Employment Services also advise in employment legislation when recruiting and selecting staff, ensuring all relevant paperwork is in place ensuring all pre-employment checks have been completed and to an acceptable standard prior to commencement so as not to leave the organisation open to any discrepancies.

Learning & Development – The Learning and Development team organise and deliver training to ensure staff are adequately inducted and trained to carry out their roles. Additionally, they ensure staff maintain certification levels, needed to attain professional registrations and maintain training records to reflect the training carried out.

Occupational Health – Occupational Health ensure potential candidates are fit for the role they have applied for as part of pre-employment checks, support staff to ensure that they are receiving any help/adjustments they may need to carry out their roles and assist in return to work health checks if an employee has been on long term sick leave and then advise line managers of the appropriate action to be taken (immunisations update required, ill-health retirement).

3 ways HR professionals support line managers and their staff are:

HR support line managers by advising them on a variety of issues, such as conflict management, performance management and also advise employees on polices such as maternity policy/flexible working practices.

When conflicts arise, line managers generally seek the advice of Human Resources in resolving issues between employees or issues between employees and their managers. When Human Resources and line managers work together, it’s simpler for HR to investigate workplace issues because the human resource staff may have more confidence that the line manager has documented their actions and decisions duly and according to company policy.

Human Resources may carry out Performance reviews with employees or offer advice to line managers on how to carry these out. These help to determine if individuals are up to date on statutory and mandatory training and also help to identify any training gaps and also provide an opportunity for line managers or similarly the employee to broach any other matters. By coaching line managers on how to carry these out helps to ensure there are no inconsistencies and all are carried out in a standardised manner.

An employee may want to apply for a flexible working pattern due to family commitments or nearing retiring age or a pregnant employee may want to apply for maternity leave. HR are able to advise the employee of the policy and the process which needs to be followed in order to apply. For example, time frames. For example maternity leave applications must be submitted by a certain date before the expected week of childbirth, and the manager must reply within a certain amount of time to grant the application, and payroll also need to inform the employee whether or not they are eligible to maternity pay, and how much and how often to expect.