Numerous examples of innovative thinking now exist within the NHS and typify a new approach to workforce development.
These are characterised by
- Developing generic roles which cut across traditional boundaries
- Substituting technology for people to improve productivity and reduce errors
- Optimising building design
- Ensuring systems are centred on the needs of the patient
- Developing services provided by fewer qualified, but appropriately trained, staff
As new hospitals and other facilities are developed as part of the NHS modernisation programme there needs to be parallel development of the organisation and the workforce to support new models of care. The involvement and engagement of clinicians and other staff is an important factor in the process. Modernising the way services are provided means redesigning roles around the needs of patients and in turn role redesign needs to be linked to robust workforce planning. Staff will be required to review the way they work not only to ensure that the needs of patients are met but also make effective use of their skills
The NHS is charged with providing a high quality service to patients at an acceptable cost. If it is to achieve this goal, it will need the right number of staff with the right skills utilising appropriate technology at the right time.
Workforce planning is the process by which future workforce needs are both assessed and quantified and, because of the time it takes to train staff and the cost involved, a change in the way workforce planning is done throughout the NHS and the DoH is taking place both nationally and locally. This means that there needs to be a greater integration of service, workforce and financial planning and a better understanding of the needs of other health and social care organisations.
Effective, long term planning processes are therefore required at both a national and local level. These processes will minimise the risk of costly shortages (or surpluses) of staff with particular skills and significantly reduce the instances where healthcare provision is sub-standard or delivered at an unacceptable cost. Poor workforce planning, therefore, can have a major effect on health and social care outcomes.
Simple, transparent systems with clear lines of responsibility and full involvement of all key players is required with recognised objectives set out and achievements monitored. The key players include:
- NHS Trusts
- Workforce Development Confederations
- Postgraduate Deaneries
- Other education providers including Medical Schools and University Departments of Nursing
- Department of Health
- Care Group Workforce Teams
- National Workforce Development Board
- Workforce Numbers Advisory Board
Following the Publication of a Health Service of all the Talents (DH 2000) and the new structures put in place following HR in the NHS Plan: more staff working differently (DoH 2002) there are now arrangements that enable bottom up planning, top down planning, patient pathway planning across the whole service and integrated funding arrangements.
In turn it is also recognised that effective long term workforce planning will help to significantly reduce the instances where healthcare delivery is either prevented or delayed due to staff shortages of skilled healthcare workers or delivered at an unacceptable cost.
A project, sponsored by the National Workforce Information and Planning Programme Board on behalf of the National Workforce Group is being developed to inform workforce planning and policy assumptions through the development of more effective long term (with impacts being 10-15 years away) planning processes at a local and national level. Further information can be accessed via www.nationalworkforce.nhs.uk .
There is also recognition that there is a need to apply 'lean thinking', an approach used in manufacturing industries, to healthcare planning and design and what impact it can have on staffing and care delivery. This includes, how can we optimise the use of technology to reduce running costs and how it impacts on the design of buildings for healthcare?
In addition there is a requirement to gather evidence on how technology and service redesign is affecting productivity and enabling staff to take on new roles. Again, for example, the Hospital at Night is one such approach that has been evaluated positively.
It is increasingly being recognised that it is important to acknowledge the links between workforce development and the utilisation of new technologies. The National Programme for IT, for example, will fundamentally change the way staff work on a day-to-day basis, how they interact with patients and where they work. This will require a major programme of IT training as well as a fundamental change in culture. Parallel investments and an integrated approach in both workforce and IT are needed to ensure that there is balance in the overall modernisation programme.
Resources
The Efficiency Map (DH's Productive Time Team) - a document that maps out the key initiatives underway, or in development, to modernise service delivery, pay and workforce strategies, and IT systems within the NHS. For further information go to: Efficiency Map
Connecting for Health - Education and training
Delivering the NHS Improvement Plan - Workforce Contribution
See the NHS Employers website for details on their Large Scale Workforce Change Team
