New Year. New Plans. New Hope. A blog by HPMA President Dean Royles.

The new year is traditionally a time to look ahead, to set ambitions for the future, to make the personal changes that we hope will improve the way we live, enjoy life and appreciate what really matters. We know that the success of New Year resolutions is not guaranteed and sometimes our ideas and ambitions fail before the first week in January is over! We also know that our ambitions are more likely to succeed if they are supported by a well thought through realistic plan.

It is a massive understatement to say that the NHS has had a pretty turbulent few years and this winter is already promising to be one of its most challenging. With or without industrial action, increased activity and demand is building the pressure in the NHS. On top of Covid and a record number of vacancies the pressure on staff is almost intolerable. Workforce planning in the NHS has had more critics than a local Christmas pantomime, but these criticisms seldom suggest solutions other than the need for a national workforce plan for the NHS. We know we need more staff in health and care but struggle to see where the short, medium and long term solutions will come from and how they will be funded.

In his mini budget in November the Chancellor and the former Health and Social Care Secretary announced plan a long term plan for the NHS and social care workforce. This is good news – in part. It has been rumoured that a plan has already been developed in NHS England but is struggling to receive sign off due to the anticipated cost. In my view, it will be an unforgivable error if the plan doesn’t include social care. A well thought through workforce plan should provide two essential things the NHS needs right now; a sense of what the future workforce looks like, where, when and how it will come on stream and, just as importantly, if the plan is credible, it will provide the much-needed hope that all those that work in the NHS and social care need. Hope that there is light at the end the of the tunnel. Hope that things can and will get better. Hope that the pressure in the system will reduce. Hope is essential.

The worry many have is that a long term workforce plan will simply lay out the numbers of staff needed to serve an aging population, new treatments and technology and rising demand, without a clear plan for how this will be achieved. There is a fear that the Organisational Development aspects of reforming the health and care system will be overlooked and under-appreciated as a catalyst for change. Many also fear that a longer-term workforce plan will face further delays as government worry that publishing a plan will simply rise the demand and expectation for more funding. It an obvious and natural fear, but we can’t keep saying that the key challenge facing the health and care sector is the workforce if the real issue is a lack of investment to appropriate fund it.

However, I’m still full of Christmas cheer and in the spirit of giving, I thought I would lay out some low or no cost solutions to help address the workforce crisis.

Reform and reduce clinical placement time

The rate limiting factor in recruiting more registered nurses isn’t a lack of university spaces it is the requirement for more clinical placement time. This is time that student nurses spend in on the job training. This requires supervision by existing nurses. There is only so much effective supervision that experienced nurses can give. Effective supervision takes time. This means that universities limit the number of universities spaces so they can comply with this mandated clinical placement time which is mostly proved exiting nurses working in NHS Trusts. The current requirement is for 2300 hours spent in clinical placement. I understand a reluctance to reduce this time requirement as a perception in a drop in the quality of training. However, New Zealand, Australia (1000 hours) and the USA amongst others all have far fewer hours allocated to placement time. It seems odd that we seem so reluctant to reduce these hours because of concerns about quality and yet seek to recruit international nurses with less placement experience! Surely it is the quality of the clinical training time rather than the quantity that is essential? A reduction of a few hundred hours could increase the quality and the quantity of clinical supervision and significantly increase the pipeline of registered nurses in UK universities.

Increase the apprentice route for registered nurses for existing clinical support staff

We all know the absolutely essential role clinical support staff like Health Care Assistants play in the experience and quality of care. Go on any ward, clinic, care home or GP practice and read the thank you cards, and it is evident that the caring nature of these staff is greatly appreciated and valued. The NHS like all large employers has an Apprenticeship Levy and yet millions of pounds of this levy is not spent each year. This is millions not spent on training each year. Utilising this unspent levy to dramatically increase the number of support staff on the Nurse Apprenticeship route would also increase our homegrown supply of nurses. These staff already have the experience of working in a care setting and a caring disposition so essential to patient outcomes.

Retain now to avoid future redundancy

Systems consistently underestimate the impact technology will have on the future workforce. Over the next few years not only will administrative and clerical roles be increasingly transformed by technologies like Robotic Process Automation, Artificial intelligence, and Machine Learning but a significant proportion of healthcare activities could be automated in areas like point of care testing and smart monitoring systems. We have the wherewithal to understand and plan for this change and we must retrain existing staff now with the new skills they will require to be effective in the future. Imagine the transformation that could take pace if we focused as much on this area as we do with compliance on (sometimes questionable) mandatory training. In other sectors, companies are developing ‘job corridors’ to rapidly upskill staff into new roles. Aligning digital plans with workforce skills has to a central focus of any national workforce plan.

Many will find my final suggestion controversial. For years now we have been trying to increase the number of substantively employed staff and reduce the number of agency staff, partly through cost and partly through perceptions of poor quality. However, this should be challenged, and we should instead…

Increase the size of the contingent workforce

Increasing the size of the contingent workforce (through bank and agency) would bring costs down ( as the supply/demand dynamic changes), provide greater flexibility for employees and importantly allow staff to be more effectively deployed to where they are most needed. The establishment of Integrated Care Systems (ICSs) as statutory Boards aimed at better integrating health and social care and ensuring more effective system working can only succeed if we better integrate the workforce. Every week patients are moved to different care settings due to a lack of appropriately staffed beds. It is currently easier to move patients to where staff are than it is to move staff to patients. This can’t be right. Increasing the size of a system wide contingent workforce should significantly improve this practice. This could also be a key component of how the CQC could better regulate across systems than within individual organisations.

For those of us working in the people profession 2023 will once again be challenging but if we continue to advocate for staff and patients and to raise our collective voice, we can also help to navigate a new future and to continue to make a difference. We can help to brig hope.

A heart felt thank you from me and the HPMA team for all you do, each and every day. Happy New Year.

Dean Royles

President

HPMA