HPMA President Dean Royles blogs on how there is a window of opportunity to rethink the way we do Workforce Planning.

The need to redefine what we mean by integrated workforce planning.

The former Health Secretary Jeremy Hunt has been appointed as Chancellor of the Exchequer.  For the past few years, he has been Chair of the Health Select Committee, where he has promoted the need for a long-term workforce plan for the NHS. Could his new appointment be the opportunity we need to fundamentally rethink the way we think about and undertake workforce planning in health and social care?

In the NHS, workforce is increasingly highlighted as the most pressing issue facing those planning NHS and care services by politicians, managers and regulators. And rightly so. However, the overall approach the sector takes to the way service planning is administered is a huge part of the problem.

I was on a Microsoft Teams conference call last week looking at the future of system working in the NHS. It was pretty upbeat and optimistic until it came workforce planning. One of the participants said, ‘a unified workforce plan is the Holy Grail of the NHS, and we have never needed one more than now’. Preach!

We have got ourselves into a trap on how we think about workforce planning in the NHS, and I don’t believe you need the cunning of Baldrick to state that some simple things could be changed that make a difference.

For several years, we have had a view of integrated workforce planning that seeks to align finance, service (activity) and workforce. And that makes perfect sense. It is important that these three triangulate. However, the trap we have fallen into is that the workforce plan part of the equation has become a crude balancing figure of the other two. For example, the annual NHS planning round goes like this -Senior NHS officials meet with the Department of Health and Social Care and The Treasury. Ministers demand that something be done to address waiting times, backlogs, or both.

Officials say that this will cost more money, and negotiation takes place on how much more taxpayer money it will take to do the required additional activity.  The centre then set an ambitious activity target for the NHS, such as 3 percent more elective activity than the previous year or a reduction in long waiters – usually both! A separate part of the centre crunches the numbers and then sets an organisational or system financial control total of X amount more money, less mandated efficiency savings. With these two givens (activity and funding), the workforce figure is then that which is affordable within the control total envelope, irrespective of whether more staff are needed or, indeed, whether the workforce supply is available. There is no scope to alter the service target or the financial envelope. Any push against this approach is met with a response that the workforce must be affordable…I know, I know you can feel my pain, and I feel yours! Operating and planning in this way will never fix the workforce crisis. This model doesn’t work and doesn’t set out what is needed, only what is affordable. And, of course, affordability is important, but that is not the same as need.

Surely a better way would be to identify the amount of additional workforce that is required to do the work (the service target or ambition), taking into account current vacancies, use of bank, agency and overtime. Then, determine what is reasonably available in the pipeline. Once that is clear, we can determine how much of the additional capacity can be afforded. In this way, we can then be clear about the gap and, importantly, be honest about whether it is finance or workforce that is the underlying problem. I can only assume that the anxiety some have with this approach is that the articulation of needing more staff than funding provides will create a growing demand for more funding. And that is difficult expectation management to undertake. This could be why the government rejected the recent intervention by the House of Lords and the Health select Committee to produce longer term workforce plans. Conversely, I don’t think this perceived pressure on budgets will be realised as currently as we lack the supply of workforce even if we could afford more. But we cannot address the supply problem if we don’t understand the actual demand.

Now I know some will argue that workforce planning is more than just a numbers game; it is about the need to work differently, different skills, training and redesigning jobs. And I agree, but it would make far more sense to do this work in the context of the latter rather than the former.

And I think it goes even further than that.  I think we need a rebasing. The advent of Integrated Care Systems ( ICSs) allows us to identify the size and shape the skills and competencies our local populations need. A population health-based approach to workforce planning. This longer-term approach could outline the model of a health and social workforce to meet local populations’ future health and care needs. We could then be transparent with the public about how long it would take and explain better what contingencies will be put in place to deliver care as safely as possible in the interim.

Without these fundamental changes, the NHS and social care establishment will grow, based on the type of jobs we have traditionally had and at a rate faster than we are to grow the establishment leading to growing vacancies.

It is an old adage but let’s not waste a crisis to outline what the health and care workforce of the future could and should look like.