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Workforce strategy: facing the facts

Dean Royles, director of human resources and organisational development at Leeds Teaching Hospitals NHS Trust, lays bare the four truths the NHS needs to confront if it intends to develop a workforce that is truly fit for the future.

Health Education England (HEE) has commenced a consultation on a draft health and care workforce strategy for England. Good. A workforce strategy for the health and care system is something many of us have been calling for for some time.

It’s a widely-held view that the delay in producing a strategy stems from a lack of clarity on which national body is responsible for workforce planning. This in itself is a concern, but we should be pleased they have now started the ball rolling. The consultation is welcome as it is an attempt to bring the whole system together, but it is hard to see where important system players like NHS Digital, local government, Skills for Health, Skills for Care, employer bodies and trade unions have contributed and influenced the draft.

The draft strategy reiterates a number of existing initiatives like new roles and more spend in training places. However, I believe it underplays the implication of ending bursaries and the impact of a more ‘market-based’ approach to education; it has not embraced the change in how we now develop new skills for staff, nor really the future digital skills that our workforces need. In fairness, it looks like a workforce supply draft strategy.

This may be because HEE has taken the lead. To be effective and meaningful as a strategy it will have to address the demand side of the equation. If we keep planning for current challenges and problems, we will never create a sustainable future. The current workforce crisis in the sector is more of a product of an inability to implement agreed, sensible service changes and improved patient pathways than it is about poor workforce planning. Adoption of new ways of working that the ‘start-up’ ecosystem is teaching us is yet to be considered. For many professions, a job is not for life: it’s for the time that the person wants to do it for. This will inevitably exacerbate the tension between sector workforce plans and organisational workforce plans.

As the health and care system responds to the consultation, I believe there are four truths we need to confront.

Truth 1: The social care workforce and the NHS workforce are inexplicably linked

The draft strategy (136 pages) devotes over 30 pages to the NHS clinical workforce, five pages to the adult social care workforce, and two paragraphs to the non-clinical workforce.  The most startling aspect of the document highlights that there are 42,000 clinical vacancies in the NHS and 88,000 vacancies in adult social care – more than double the NHS vacancies. 

What we need is an urgent clarification of what these vacancies would be if we had all our patients in the right place. If our delayed transfer of care (DTOC) and medically optimised patients were in more appropriate care setting, these numbers would be very different. Have we significantly underestimated the size of the recruitment challenges in social care?  How much do we need to grow the social care workforce and skills to keep people well and supported at home? If we are not crystal-clear about this, the strategy will be answering the wrong question and opening the health system up to still further challenges.

Truth 2: Workforce planning is not a variable balancing planning statistic

The draft document rightly points out that service, finance and workforce need to be aligned. In practice, what happens is that organisations are set a central, usually yearly, financial control total. Incentives to achieve this control total make it a ‘must do.’ The organisation then makes an assessment of likely service demand and activity and the workforce number becomes a balancing figure between the two. This is not alignment.

Realistic expectation of the available workforce needs to inform control totals and possible activity. A 10-year, radical, patient-led workforce plan is incompatible with an annual financial control total. The delivery of health and the workforce required to achieve this needs to be addressed not just as an organisational priority, but as an imperative linked to quality – not simple financial outturn measures.

Truth 3: Digital developments such as artificial intelligence (AI) can be the drivers and the enablers of change

We are in the midst of a fourth industrial revolution. Like the three revolutions before, the digital revolution is a catalyst for change to our society and the way we see work and complete tasks.

It has been argued the change it will herald is akin to the moving from an agricultural society to a manufacturing society. Innovation is rapid, robotics, paperless patient care, telemedicine, point of care pathology testing, 3D printing and genomics are changing the way we work today.

Reviews in technology and digital skills are highlighted in the draft, but the workforce strategy needs to have this centre stage. We should be worried if organisations’ digital leaders are not knocking at the HR director’s door wanting to influence this consultation.  NHS Digital needs to be seen as part of the ‘system’ so that a workforce strategy is central to the digital strategy and vice versa. Digital skills are becoming utility skills that are expected, not nice-to-have, desirable skills.

Truth 4: The ‘back office’ is part of the frontline

It can’t be right for a national system-wide workforce strategy to effectively exclude the non-clinical workforce. It’s been said that the NHS is the UK’s largest employer of IT and informatics staff. The average EU-wide public sector organisation spends 3.2% of its budget on digital. In the financial sector this is more like 15%.

The digital revolution is transforming the way hands-on care and diagnostics are delivered from clinician to patient. The way we provide services and pay our bills impacts our local economies and the health of our population. Seeing the non-clinical workforce as something we can sort later will undermine the credibility of any strategy. Furthermore, just like clinical staff, this essential part of our workforce needs to feel valued, supported and respected. This part of our workforce is being directed to consider itself as part of the healthcare solution; at the same time, it feels excluded from a workforce strategy. We can’t miss this opportunity to help this part of our workforce move from a badly identified silo to part of the patient care solution. The term ‘back office’ is designed to undermine and belittle. We must stop using it. At the time of the WannaCry attack, the informatics back office became the frontline of services across the world.

The NHS constitution highlights that the NHS belongs to the people. ‘The people’ includes NHS and social care staff. Employers, providers and trade unions should have high expectations of a workforce strategy that will take us through to the NHS’s 80^th birthday. The strategy should celebrate the now, and the next 10 years not be reflective of a workforce profile that we needed a decade ago.

(Top image c. sturti)