Workforce and Training

16.01.20

Transforming services: We need a left shift not a left drift

Dean Royles, strategic workforce advisor at Skills for Health and co-author of ‘An Introduction to Human Resource Management,’ discusses the need to move the treatment of patients from primary to secondary care and how the NHS People Plan can help achieve this.

Throughout my (overlong) career in the NHS, the national policy on modernising the way NHS services are delivered has been pretty consistent. All recent governments; left, right and coalition, have, without exception, all emphasised the need to expand and improve care in local communities so that patients and service users can be better cared for at home and to minimise the length of time patients spend in hospitals, and where possible, avoiding hospital admission in the first place.

The policy initiatives to make the transition have come under difficult guises and names, such as care closer to home or modernising community services, improving primary care and so on. Increasingly, the term “Left Shift” has gained prominence. Treating more patients in primary care, or in the community and reducing referrals and treating in secondary care, thus moving care ‘downstream’ and to the left.

This left shift makes perfect sense. It is often more effective and cheaper and there are some good examples in diabetes care and musculoskeletal conditions, as well as cardio-vascular disease.

When I was growing up, if an elderly relative was in hospital, it was common to hear people say “they’re in the best place”. However, evidence now suggests that this may not be the case. For frail people, excessive hospital stays can lead to a decline in their physical ability, picking up a hospital acquired infection, and risk relationships and continuity of care with existing carers and networks.

Yet, despite decades of relative consistency on the national policy front and national plans, as well as some good local examples of success, this shift to move the primary focus of care has been largely unsuccessful. At best we have well meaning, but piecemeal, incremental initiatives lactate, which leads to a left drift, rather than a left shift. And, if we are not careful, we risk a continuation of this drift with the new NHS Long Term Plan.

In my view, the publication of the forthcoming NHS People Plan is the opportunity to accelerate the pace of change. To ensure we make the left shift. There are some good developments in the draft People Plan around making the NHS a better place to work, more leadership development and culture change. However, for me the key to achieving the left shift is in prioritising and investing in the training and development of staff and in particular, investing in support and unregistered staff. 

Most government announcements about training and development in the NHS tend to focus on registered staff and, of course, it is vital we invest in these staff, but there are around 350,000 clinical support staff in the NHS, significantly more working in social care. 

Imagine the improvement it would have on the quality of care, where and how care could be delivered and the improved outcomes for patients, if we invested in support staff training and development in a nationally led and coordinated way, really investing in the training, development and education of these support staff. Enhancing their skills and qualifications, enabling them to move more freely between secondary, primary, community and social care. 

We have the opportunity to significantly redesign the NHS workforce focusing on skill mix, not primarily as an efficiency measure, but as a means of transforming how care is delivered, improving the outcomes and quality of care for hundreds of thousands of patients.

We know the majority of our support staff are caring, compassionate, skilled and enthusiastic to improve services. They want to grow and develop. Investing in their development not only enhances care but develops them as a valued team member and helps create a pipeline in to regulated and professional roles. With a new government and a new NHS plan, this is an opportunity to invest in the core NHS workforce we must not miss.

Dean always welcomes feedback. Please get in touch with him on Twitter @NHS_Dean, or email him directly: deanroylesltd@gmail.com

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