The NHS at 70: reflections from a HR Director

Blog posts

5 Jul 2018

Dean RoylesDean Royles, Director of Human Resources and Organisational Development, Leeds Teaching Hospitals NHS Trust


Both my parents were born in the mid-1940s, the war years, just before the NHS was established in 1948. Now in their seventies, they have pretty much grown up with the security of having free access to healthcare. My siblings and I were born in the NHS, as were my children and grandchild. Four generations all benefitting from universal healthcare. You can see why it’s easy to take the NHS for granted. According to the World Health Organisation (WHO) at least half of the world’s population do not have full coverage of essential health services. 

A big birthday is a time for reflection and for celebration. I have spent almost all of my career working in HR in the NHS and I’m incredibly proud of its many achievements. I know the NHS has its challenges and faults but as it is a time to look forwards as well as backwards, I hope I’ll be forgiven for, albeit briefly, wearing some rose-tinted glasses.

I have no doubt that there will be plenty of blogs and opinion pieces on how clinical services have changed over the years. There will also be reflection on the importance of ground-breaking research, so unusual in a public-funded service but essential for a health service that operates at the limits of science.

As a HR professional, it also seems right to reflect on the way my profession has developed and the opportunities ahead.

In the early days of the NHS the Personnel department was responsible for appointing members of staff, often without the involvement of the services they were working in at all. Then came the administrative phase where Personnel would approve an individual pay award, a new office or equipment, accommodation in the nursing block (or a separate doctors’ block) and even car parking spaces. It seems that car parking has been an enduring problem (enough said!).

Like many large organisations, we have moved to more electronic methods of personal files for employees. However, I still sometimes get the opportunity to look through old paper files, perhaps when a long service member of staff is retiring, and this often gives an important glimpse into the past. In some files you can even find the personnel officer issuing disciplinary sanctions on behalf of, not with, managers.

There is also evidence of the considerable work involved in multiple re-organisations, hospital relocations and regrading exercises including a national nursing regrading exercise. In the last ten years, you can appreciate the work involved in a currently nationally-negotiated system that came in response to multiple equal pay cases, now known as Agenda for Change. It’s a system that operates a common job evaluation system for well over one million people. There is also information on the changing role of trade unions charting the rise of collective bargaining and a move to pay review bodies.

These files give clear evidence of the NHS responding to changing societal norms and demonstrate that the NHS has been at the forefront of areas like maternity leave, flexible working, equal pay for work of equal value, and equality and diversity.  It is something of a truism that those organisations that have made most progress still see themselves with more to do. There has been a remarkable change in the participation of women in the NHS. Medical students were predominantly male 70 years ago, now approaching two thirds of medical students and half of doctors are women. Over 40 per cent of NHS chief executives are female, with women making up the majority of director roles like nursing and HR. 100 years on from women first receiving the vote, there are no industries where women make up the majority of senior roles. Could the NHS be the first sector entirely dominated by women, where women would make up over half the workforce, and at least half of senior leadership roles? I don’t think another sector is even close.

My generational successors probably won’t have the opportunity to look back through paper records in the same way I have and this creates an extraordinary opportunity for HR.

Communication with staff over the decades has been dominated by individual discussion and via trade unions. Those relationships with trade unions have blossomed from old style ‘industrial relations’ to more partnership working with joint problem-solving through appreciative inquiry. It’s a relationship that has its ups and downs but trade unions have played an enormously valuable role in helping to ensure that we have retained a public-funded system, working with professionals to improve patient care.

The Prime Minister recently announced a ‘funding boost’ for the NHS and requested a ten-year plan be produced following consultation with staff. Putting the politics of where the funding comes from to one side, this is a fantastic opportunity to truly engage staff in the future development of services, not just through conversations and meetings but by using crowdsourcing technology to surface more of the views and ideas of all our staff; porters and professors, security staff and scientists, maintenance workers and managers.

This use of communication technology is an opportunity to start as we mean to go on. To use developing digital technology, machine learning and artificial intelligence to help treat and transform the lives of patients. It is also an opportunity to engage health service staff to see this technology as a way of enhancing, rather than just replacing, jobs, to be at the forefront of new career opportunities and, in so doing, help to secure a universal health service, free at the point of need, for generations to come.


About the author

Dean Royles is Director of Human Resources and Organisational Development at Leeds Teaching Hospitals NHS Trust and co-author of An Introduction to Human Resource Management, published by Oxford University Press.

Subscribe to blog posts

Any views expressed are those of the author and not necessarily those of the Institute as a whole.