Reshaping NHS workforce is ‘urgent and essential’

Reshaping the NHS workforce to meet changing and growing pressures is “urgent and essential”, the Nuffield Trust has said in a new report.

The report, ‘Reshaping the workforce to deliver the care patients need’, says that reshaping the workforce must include existing staff as well as training, and is vital for delivering the Five Year Forward View, which focuses on shifting the NHS from treating to preventing problems.

It predicts that in the future, patients will take an active role in their care and almost all care will be supplied by non-medical staff, with medical staff acting as master diagnosticians and decision-makers.

Candace Imison, report author and Nuffield Trust director of policy, said: “Our research shows that reshaping the NHS workforce can offer huge opportunities – for patients, through improved health outcomes, and for staff, through more rewarding roles and better career pathways.

“But we stress in our report that this is not simply a ‘nice to do’ – it is urgent, and essential if the health service is to find a sustainable balance between available funding, patient needs and staff needs, and deliver services fit for the 21st century.”

However, Katherine Murphy, chief executive of the Patients Association said that if the proposals are implemented then it is important that all practitioners understand where the boundaries lie between the various roles, and that staff at every level are regulated to ensure that patient safety is not compromised.

“The nurses and carers will need to recognise when to refer on patients to more high-qualified or experienced staff,” she said. “Care should be taken to ensure that patients are not confused by the emerging new roles and responsibilities, and that they know who is caring for them. Patients will need to be given information about the care that they can expect from different levels of carers and nurses, and to be made aware that they perhaps will not always be treated by a doctor.”

‘No headspace’ for workforce restructure without more funding

The report warns that changing staff roles without careful planning could increase demand and cost while undermining quality of care, and that financial pressures on the NHS mean there is “no headspace” to make the staffing decisions required.

It says that training budgets are being cut when they require expansion. The Nuffield Trust called for the Health Education England (HEE) budget to be ring-fenced to ensure this, and for HEE to work with NHS Improvement and the Care Quality Commission to ensure that workforce development aligns with healthcare policy.

Other recommendations include introducing national competence frameworks for staff in extended and advanced roles, reviewing legal indemnity arrangements for primary care staff and expanding the limited role of physician associates.

The Nuffield Trust also said that local NHS boards need to make workforce development and planning a central part of their local sustainability and transformation plan, supported by senior and frontline staff and links with local training bodies.

Janet Davies, chief executive and general secretary of the Royal College of Nursing, said: “Care has changed from being based on short term instances of illness or injury, to being overwhelmingly about managing long term complex conditions.

“Health service roles and the way people are trained for them must reflect this new reality and building a workforce to deal with these new challenges requires serious investment.

“Flexibility and expanded nursing roles will be vital to the NHS’s future and so it’s crucial that a training and funding system is put in place that reflects nursing’s future contribution.”

Daniel Mortimer, chief executive of NHS Employers, which commissioned the report, said he was “delighted” with the findings and that the NHS would now seek to “take forward” the report’s recommendations.

Saffron Cordery, director of policy and strategy at NHS Providers, added that there is a huge workforce challenge in the NHS but with that also comes opportunity.

“Today’s report rightly makes it clear that this is not just about training more staff, or even about creating new roles, it is also about developing, training and equipping the existing workforce, especially the vast non-medical workforce,” she said.

“This should result in a more stable substantive workforce with reduced reliance on temporary staff and outsourcing. This will help improve continuity and better patient care by closing the gap between what patients need and the skills available to care for them.”

A recent Public Accounts Committee report criticised government policy for contributing to shortages of clinical staff across the NHS.

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