As part of the Connect Health Change webinar series, we present the Q&A summary from our panel who discussed Workforce capacity – solving the supply and demand puzzle.
Connect Health “Change” brings you the latest in a series of webinars to make and embed transformation in healthcare. Aimed at system leaders and clinicians across the NHS, the webinars provide practical solutions to the challenging issues we are all grappling with.
Today’s health and care workforce has been through the most gruelling two years in NHS history. Workforce shortages are having a serious and detrimental impact on services and will hinder efforts to deal with backlogs. There are 110,000 job vacancies across NHS trusts and many thousands more in primary care and social care.
Unsurprisingly, morale and wellbeing has been damaged and the recent NHS staff survey highlighted that only 27% NHS workers feel that there are enough staff in their organisation to allow them to do their jobs properly.
In this webinar our panel considered where we are now, what alternative solutions could be considered and will look to the future. It will bring together those on the frontline delivery of services and patient perspectives, together with expert opinion and emerging evidence.
Delegate feedback included:
- The range of views and approaches on the topic were great
- Excellent presentations
- Excellent to learn about the steps taken to ensure safe staffing levels
Watch the Webinar in Full
Chaired by:
Ashley James, Director of Practice and Development, the CSP
Q&A
David Furness, Director of Policy and Delivery, Independent Healthcare Providers Network (IHPN)
Question 1: What do you see as some of the opportunities and threats of handing more responsibility for workforce planning to ICSs?
Answer: Some of the opportunities are about actually doing something that’s more tailored and more relevant to particular localities. Making sure that you’re seeing things in the round and of working with local authorities because, if you’ve got an issue with things like housing for Healthcare professionals, that may well be a topic that you can tackle most effectively by collaborating with other agencies in a local area. The ICS vision at its best really is one in which you can bring all the different kinds of relevant interests and contributions to the table and have a really honest conversation around how can we get the best for patients in our system with the resources and capability that we have. The challenge is to then make sure you’ve got all the right organisations at the table, that interaction with the non-statutory sector will be key in developing that.
There are two big overarching Dynamics. One is that you know you can’t, at ICS level, magic up many more training places for doctors or nurses because those decisions still have to be taken at a national level. We’ve got a difficult integration of Health Education England into NHS England so it could be a while before that’s firing on all cylinders because those types of national merges are tricky. Then it’s not always apparent to me what levers you pull as an ICS if you don’t feel like you’re getting the level of collaboration and contribution that you want to have in terms of making sure you’re using your scarce Health Workforce as effectively as possible across your area of responsibility.
Overall, there are lots of opportunities but definitely some challenges to resolve.
Question 2: Isn’t there a danger that relying on employment of overseas staff will deplete their own health systems such that their governments may ban ‘poaching’ of health care staff?
Answer: Yes, absolutely – this needs to be approached very carefully and ethically as well. Equally, some countries (e.g. Philippines) have intentionally created over supply of nurses with the intention that they will work overseas.
There’s a huge role for some negotiation between governments about what’s acceptable and of course we mustn’t forget that lots of the people who’ve come to work in the NHS from overseas over the last decade or 15 years haven’t been from countries with far less developed Health Systems, they’ve been from places like Spain and Portugal. The different political environment has made a difference there but I do think that’s rather different from some of the stereotypes about essentially offering people a better standard of living and then having them leave their domestic health system and therefore leaving it in a worse state. There are codes of conduct that are rigidly enforced by government and that’s exactly the right thing to be doing, I think it’s definitely got to be part of the mix of solutions that we look at to close the gap between supply and demand. The ethical approach is key.
Michelle Wayt, Assistant Director of Development and Employment, NHS Employers
Question 1: What can employers/managers do to understand their local labour market?
Answer: NOMIS is a great tool which is available and is provided by the office for National statistics for England and Wales. It publishes statistics on a national, regional and local level about the population and the labour market which an individual organisation can go onto. They can see what the unemployment is like in that area, where there’s inactivity, etc. It splits it down to age ranges, if people have got care and responsibilities, the diversity of the population in that area as well. This means that an organisation can focus their efforts on that area, whether that be for older people, for younger people, students and they can actually focus their recruitment activity in that area and try and target their vacancies towards those people in the community and they can obviously ask their local staff as well.
Question 2: How do we recruit more people into the NHS and healthcare in general?
Answer: We are seeing more local targeting is having a better approach. Working with schools, colleges, universities, community groups and sharing the range of roles that are available in healthcare and the different ways into those roles is beneficial. It does take some time but can provide really good results. Also using Instagram, TikTok to reach younger people is also effective.
Question 3: Do the NHS have enough money to employ more staff e.g they were to come from abroad to fill the shortages?
Answer: NHS England does have some additional funding for Trusts to support international recruitment. Each region has an IR lead in the regional NHS England Team who can help.
Question 4: Is physiotherapy on the shortage list for overseas recruitment?
Answer: It is currently. The list will be reviewed shortly. However the new immigration points system means that Physios can normally meet the requirements without being on the list.
Ben Wanless, Consultant MSK Physiotherapist, St George’s University Hospitals NHS Trust
Question 1: What’s driving the digital agenda?
Answer: I suppose people think about access and standardised care but don’t go deep enough into the cost savings. There are many constraints around Workforce but organisations also have budgetary constraints, with our managers in the Health Service expected to deliver the same results with a lot less money. There are certain elements of a patient pathway that could be improved, and we’ve spoken about some of them today, but not all of it can be delivered digitally. When people think about digital and how effective it’s going to be they just forget or they don’t think enough about how important human relationships are in the delivery of healthcare, and because of that they ask “why can’t we just give this person an app and they’ll get better” without thinking if this particular problem in this particular setting you will need human interaction, you need that relationship and you need that holistic care wrapped around this patient.
Question 2: Burnout is a big factor in driving people to leave their jobs as the work is so emotionally demanding and the support for such is often ignored. I hope to see this discussed as we know a great deal about how to create work environments that make burnout out less likely – and yet we appear to keep (unintentionally) creating exactly the kind of environment that would lead to burnout. Is this viewed as relevant by the panel and what might be done about it?
Answer: Completely agree. St George’ Physio department have completely redesigned our job plans and clinical templates because of this. It’s a difficult concept to sell to some managers, especially in an MDT workplace, but it’s essential to have longer appointments for therapy and give therapists more non-clinical time to allow them to thrive.
Question 3: You say savings are not statistically significant however there just aren’t enough consultants and clinicians to support patients.
Answer: I agree, this just means we need to not jump in two footed but take a careful, considered approach to implementing digital.
Dr Chris Tomlinson, Senior Sports Physician, English Institute of Sport, Lilleshall/Chief Medical Officer British Gymnastics
Question 1: What are the risks of diversifying the workforce and how can we educate patients of the benefits?
Answer: We are all slaves to our own unconscious biases and we all work with colleagues who are incredibly passionate, incredibly well trained within their particular area of expertise, who are much better at doing the things that we’re not so good at. I think the way of selling this is to talk about the benefits of exercise and the benefits of skilled professionals who can deliver exercise programs, it’s about education and explanation. Patients who are knowledgeable tend to be much more amenable to getting the best person to treat them rather than looking at a name or a title.
Andrew Cuff, Consultant Physiotherapist and Head of MSK, Connect Health
Question 1: What is ‘good’ physiotherapy?
Answer: Physiotherapy is a profession so it’s hard to have good ‘physiotherapy’. I particularly think about it with reference to an inclusive workforce, Sports Therapy, Osteopathy, Chiropractics etc. If you look at the evidence around interventions for MSK conditions, they’re all fairly underwhelming and, largely, when tested in fairly controlled manners they don’t really demonstrate much improvement.
We need to think differently about care, and how we provide care, and there’s opportunities around holistic care. We’ve been fairly reductionist over a number of years so, we need to be really thinking about personalised care, and involving the person in terms of what their treatment and what their management looks like going forward, but also just thinking about how to reconceptualise MSK more broadly. We need to think less about necessarily interventions and more about how we enable someone to have value in life, how do we start addressing some of the social factors, how do we support things such as self-management, helping to support people to make informed choices and fully understand why the symptoms are occurring at that time.
If I had the answer to what great ‘rehabilitation’ looks like however, it’s still fairly underwhelming compared to where we want it to be but I think that gives us a mandate to think differently and one way of doing that is thinking about new ways of looking at Workforce and new ways of interacting with people.
Summary question for speakers
What is the one thing you would change to improve the workforce crisis?
David: There’s no one big solution here and actually what we need to focus on is retention, on tech, on recruitment, on growing our own and a lot of those solutions are within the gift of people running organisations and working organisations as well. We are doing ourselves and patients a disservice if everything is waiting on a plan that will never arrive in the form we’d like it to, so let’s look at the whole mix of solutions.
Michelle: I would love to see a funded workforce plan with numbers in it that the ICS’s can work towards and the universities and colleges can support apprenticeships and traditional degrees with.
Ben: My suggestion, or want and need, would be that we standardise and robustly support the evaluation of real world data when it comes to implementing digital for some of these workforce issues. At the moment we have to rely on the evidence and the research we have and that takes years to build and often they’re five/six years old and talking about text messages and if smartphones become popular. Digital moves too quickly to wait for some of the research, we’ve just got to get better at using population Health Data in a standardised way and presenting it so we can all benefit from the positive outcomes we are seeing.
Chris: A national recognised system which touches on the other points of workforce planning but also pathways and outcome measurements countrywide.
Andrew: Let’s stop over treating people that have got a good prognosis and secondly what are you doing now in clinic or in your service that you weren’t doing five or ten years ago and what have you stopped doing?
Watch the webinar again, which includes further insight from the speakers including a full Q&A session, and read more about the speakers here:
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