Speak to clinicians, leaders or staff anywhere in the NHS and the one thing everyone will agree is that in the medium to long term, the workforce shortage is the greatest challenge facing the health and care sector in the UK today. The reasons behind it are many and varied but a long-standing and consistent failure to plan the workforce is undoubtedly one of them. As we look to the future, it is critical to recognise, and address, the underlying causes of this failure, or their impact will be amplified by recent events, severely limiting the quality, access and level of care we can provide.
The NHS People Plan, published earlier this year, sees a much greater role for systems in workforce planning in future. At present however, many if not all, know little about the true number of staff they need, the skill mix required, and importantly, have no reliable means of modelling this. Of-course, data collection, analysis and planning is undertaken by Trusts, Systems, Health Education England, NHS England, NHS Improvement and Skills for Care; which help to describe the future requirement for staff, but our experience suggests these don’t reflect real need, are over-simplistic and not dynamic.
This was acknowledged to a degree in the latest People Plan which notes that “systems must strengthen their approach to workforce planning, including playing a greater role in planning, fully integrating this with service and clinical strategies and financial plans, and reviewing these plans in-year in response to changes to demand or services.”
To achieve this, at least four key issues need to be addressed:
1. Regulators expect workforce plans to be costed into long-term financial plans
This first, and arguably most significant issue, makes workforce a function of what is affordable, rather than what is required to meet the health and care needs of the population. HR professionals have highlighted this concern for years but most recently in 2019, when Trusts and Systems were asked to produce comprehensive workforce plans. The Netherlands has a different approach, however. Years ago, it ceded medical workforce planning to an independent body, Capacitaatsorgan, which produces an annual costed report of the interventions required and the government selects those it can afford in a transparent process. The Netherlands now has one of the lowest doctor vacancy rates in the world.
Critics of this approach will say that training more staff than local systems can afford is foolish, however we know the world faced a future with a shortfall of 30 million health professionals before COVID-19. This number has increased materially as a result of the pandemic due to burn-out and increasing demand. The worst that can happen would be a domestic oversupply, increasing competition for roles, although that feels very unlikely.
2. Workforce plans are static when they should be dynamic.
The real world is Volatile, Uncertain, Changing and Ambiguous (VUCA). Before the pandemic the pace of change and innovation was at an all-time high and increasing. COVID-19 has simply accelerated it, showing how quickly changes to the care model and workforce roles can be made. Although the immediate requirement in the first wave of the pandemic was on demand for critical care skills, the demand for elective services and mental health are now unrecognisable from those used nine months ago. How will those workforce needs be addressed? Add new care models, BREXIT, changing demography, long COVID-19 and service reconfiguration to the equation and it is easy to see why workforce planning without a dynamic model is no better than shooting in the dark.
In the summer KPMG asked 30 Directors of Workforce from Trusts and Systems across the country whether they had revisited their workforce plans to take account of COVID-19. In every case except one, their current plan was the one submitted to regulators and HEE in November 2019. All 30 agreed that the assumptions within those plans were no longer valid (notwithstanding that most agreed they were also incorrect at the time as described above) yet none had revised their plan, in part because they didn’t have the means to do so easily. As a result, Trusts and Systems will go into next year not knowing the number of staff they need to train or recruit and the DHSC will go into the Comprehensive Spending Review (CSR) with no real sense either.
3. Systems don’t currently plan workforce across health and care
Even though work in these sectors frequently overlap and boundaries between them are notoriously blurred, the two continue to plan in isolation and compete for talent. This is such a waste. Local Enterprise Partnerships, working with Higher and Further Education providers, could offer those with entry level qualifications the opportunity to pursue diverse and fulfilling careers across the two sectors going someway to reducing the high turnover in the care sector.
4. Systems cannot underestimate the impact technology on their future workforce
Finally, as highlighted in Mark Britnell’s recent book “Human: Solving the global workforce crisis in healthcare”, systems consistently underestimate the impact technology will have on their future workforce. Analysis by McKinsey & Company in 2018 and the Bank of England in 2019 suggest that around a third of all healthcare activities could be automated through the widespread adoption of existing technology, but technology doesn’t feature in most trusts and systems workforce plans at all. This is short sighted. Within the next 3-5 years, administrative and clerical roles are likely to be transformed and potentially decimated by technologies like Robotic Process Automation (RPA), Artificial Intelligence, Patient Self-Service, Electronic Patient Records, Control Towers and the adoption of Powered Solutions. At the same time, demand for other workforce groups like data scientists and care navigators will likely increase.
In other sectors, companies are developing what they call “job corridors” to rapidly upskill their staff into new roles, why can’t we do this? Workforce plans need to be more closely aligned with digital plans or they will continue to be grossly inaccurate.
If we are serious about tackling what everyone knows is biggest issue facing the sector, we must address the four points described and every Trust and System will need an agile workforce planning capability. The People Plan has placed great faith and responsibility in systems to do this, but they will need to be supported to do so.