It is well-known that current market headwinds are blowing existing clinical workforce strategies off course. Malcolm Lowe-Lauri takes a closer look at how Health Education England is tackling these issues to successfully develop the future of the NHS and social care workforce.
Health Education England (HEE) is developing some exciting thinking on the future NHS and social care workforce. This is drawn in large part from the workforce itself, through HEE’s call for evidence, deliberative events and round table exercises. But it is proving understandably difficult for respondents to see beyond the present dilemma of continuing pandemic management, urgent and emergency care, and the need for elective recovery. To secure these it inevitably looks like a matter of finding more people.
So how do we reconcile a vision for the future workforce with this present predicament?
The vision for a future workforce framework under development by HEE is impressive. Drawing on the workforce itself, representative bodies, individual respondents and workforce experts, it is building a strong future vision.
This is framed by the future nature of health and social care work, recognising and planning for some inevitable uncertainty. The vision understands the need for health professionals to be digitally enabled and digitally expert, to be supported by flexible access to education, training and development, and to address patient needs in individualised ways.
But it is also clear that this is not a magic path to the provision of diagnosis, treatment and care with a reduced clinical workforce. There is a lot in the emerging literature to give insight into how clinical work is changing. There is very little to suggest this will cut the numbers. Rather, as the clinical expert works on solutions which are increasingly tailored to the individual patient, more rather than less work will be needed. It will be more about deploying new science and technology, alongside careful consideration of the patient’s environment and behaviour, while trying to hold the workforce growth to a manageable level.
As Dr Navina Evans, the CEO of HEE, says, “We’re getting clearer on where we want to go. We now need to connect this to the current NHS dilemmas.” But how do you get attention for this in the middle of the current challenges? If you are an ICS preparing your elective recovery plan, your modelling needs the workforce numbers behind it. A good few of these are currently more aspirational than substantial. For this, for urgent and emergency care, for cancer and for social care delivery alongside recovery activities, we need a bridge from the present to the HEE vision. And that can’t be a sort of zero sum workforce race which creates winners and losers and drives continuing variation in standards of service across the country.
1 Maximise use of the existing workforce
Using the existing workforce, in terms of both the most effective deployment in an ICS and top of licence working. From our work, it has been interesting to see the capability of the AHP workforce, for instance, and the opportunity to use physios and radiographers (to name but some) closer to the patient’s environment in primary and community care. In many cases this is about consolidating gains made during the pandemic.
2 Bringing secondary care expertise of clinical specialists
Bringing secondary care experts alongside primary care allows for a much earlier conversation about patients at risk of further illness. This can be based on an ability to risk stratify patients and population segments from data we already have. As an orthopaedic surgeon said to us recently, “anything which stops people getting to my clinic.” To use a plumbing metaphor, if we are only looking at ways to drain the bath we will never relieve the workforce of the pressure of the taps left uncontrollably open. Secondary care experts deploying their expertise to help primary care colleagues can plan with their patients to control the taps.
3 Higher education providers must quickly flex their education and training curricula from the classroom to the workplace
There is a mountain of talent in the health care workforce which remains unused. I would urge educators to take the initiative with their local ICSs to work out how they can certify enhanced roles with quick support packages. The current health and care workforce does not have the luxury of waiting for increased training numbers to roll through traditional courses. Understandably, people will say what about the regulators? But that is where HEE, NHSE and the DHSC can play themselves in. “Part of our role is to create the receptive context for regional and local creativity” says Navina.
Of course, all this can link to the pipeline of new recruits. But that is the point. The long-term plan becomes much more attractive when it links to shorter term impact. Then workforce planning gets everybody’s attention.