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Restructuring health workforce ‘better than adding new staff’

NHS staff should gain new skills to adapt to the increasing challenges facing the health service, Candace Imison, director of policy at the Nuffield Trust, told the NHS Confederation conference.

Laying out the plan for reforms to the workforce set out in the ‘Reshaping the workforce’ report, Imison divided the workforce into three tiers.

She said reforms included developing and expanding the supporting workforce, extending the skills of the middle band, and expanding the number of advanced staff, who could even act as substitutes for junior doctors.

Imison described reshaping the workforce as “utterly crucial”, saying that reskilling and upskilling existing staff was better than adding new staff, who would fragment the workforce.

“This is about helping the workforce here today become more flexible,” she said.

She praised existing initiatives for implementing the kind of reforms the Nuffield Trust are promoting. For example, Nottingham City Care re-trained its registered nurses to be able to treat patients in their homes.

In Whitstable, GPs successfully implemented a scheme where they referred patients to paramedics for home visits.However, efforts to replicate the scheme in Kent failed because of a lack of trust between GPs and paramedics.

Imison said that problems to implementing the reforms included limits on new staff’s powers and lack of regulation. For example, physician associates are currently handicapped because they cannot prescribe ionising radiation.

“The most important thing is to begin with a detailed understanding of what it is that the patient needs,” she added.

Imison also cautioned: “We perceive there is a regulation gap at the moment. Professional regulators are not keen to get into these advanced roles, but also the system isn’t set up for it.”

During another session at the conference, Jackie Smith, chief executive and registrar at the Nursing and Midwifery Council, confirmed that her organisation has not yet been asked to regulate the new nursing associate role.

Introducing Imison’s report, Professor Ian Cumming, chief executive of Health Education England, said workforce roles were already changing. “How professionals are trained is not how they are used,” he said, adding that staffing shortages in the NHS make restructuring the workforce an urgent priority.

Prof Cumming said the workforce is facing a shortfall of 25,000 acute care nurses against 2012 predictions due to the need for more nurses following the Mid-Staffordshire scandal, but currently trains just 20,000 nurses in total.

“I would argue when money is tight, that’s when we need to be investing more in education and training,” he said.

Prof Cumming added that high turnover in the NHS was also a problem, saying reforms must do more than “produce more and more staff, and then treat them so badly that they leave”.

He also said staff training should reflect reforms in the NHS and prepare a workforce for the NHS in 2030, not the NHS as it is today.

For instance, training is currently focused around hospital care despite proposals to deliver more care in patient homes and the community, something Prof Cumming said should be “turned on its head”.

He also urged trusts to be more receptive to ideas from other places, saying there was a mentality in the NHS of ‘we want to recreate our own’. “We have got to change that culture,” he added.

Prof Cumming also said that workforce reforms needed to be implemented within 15 months, not 15 years.

Kate Dale, mental and physical health project leader at Bradford District Care FT, talked about a project she had led to treat the high comorbidity between mental and physical health conditions by training mental health nurses to recognise signs of physical deterioration in their patients.

However, Dr Andy McElligott, medical director at Bradford District Care FT, said that although he supported the workforce reforms, they should be implemented with care.

“Twenty-first century healthcare is not going to easily lend itself to twentieth century roles,” he said. “Let’s do it properly, let’s do it at the right pace and let’s do it for the right reasons.”

Dr McElligot noted that health leaders must clarify the new roles, implement them in the most cost-effective way, and that staff should show humility in accepting what they could and couldn’t do.

“The biggest danger is posed by the over-confident practitioner,” he said.

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