NHS Voices blogs

Workforce and tackling population health key to future of health and care

Director of the Welsh NHS Confederation reflects on the short and long-term challenges facing the health and care system and how to address them.

29 April 2022

As the health and care system in Wales faces ever-increasing levels of demand against a backdrop of limited capacity, it unquestionably becomes more important than ever that we prioritise population health and tackling health inequalities. The importance of prevention and keeping people well shouldn’t be understated or undervalued as the system tackles current pressures.

This week, the Welsh Government published its ‘ambitious plan to end long waiting times and transform planned care’. The plan acknowledges the need to continue to build on the experiences and learnings of the pandemic. Over the last two years, we’ve seen countless examples of new innovations, largely brought about by staff on the ground working creatively to serve the needs of patients, which must now be embedded into the health and care system in a sustainable way. We want to see care delivered in new ways that best serve and support our communities in both the short and long-term 

The long-awaited plan to address waiting times was both welcomed and criticised, with past and present NHS staff saying “I don’t think we can work any harder”. This response is not insignificant, considering the workforce is the number one constraining factor limiting the health and social care system’s capacity. Of course, it’s not the only factor, but it’s at the top of the list. We must show that we value and appreciate the staff we have, supporting and nurturing them to be the best they can be.

We need to attract workers to the health and care sector now, today. Unless there’s a very large increase, thousands not hundreds, in the care workforce by the winter the hospital system will again be in crisis. Prospective workers need to know they will have training and development opportunities, fair pay and will not be overworked. This is more salient in social care, where the market is near collapse as members of staff leave en masse for other sectors with less high-pressured roles and better pay, such as retail, hospitality and tourism. In the context of the current cost of living crisis, this has been amplified further. This is a societal issue that we must work with Welsh and local government colleagues to solve.

But it’s not just making health and care a more attractive sector to work in that’s the problem – it’s also about retaining the existing workforce. Many staff on the frontline have been working relentlessly for the past two years, often with minimal respite (which is not to say there weren’t times of high pressure before the pandemic). The latest analysis from the Health Service Journal shows data suggests a ‘worrying acceleration’ of people choosing to resign from their jobs. Although this is NHS England data, findings can be used as a realistic representation of what is happening or might happen here in Wales. It should be noted that part of the increase appears to be driven by thousands of staff who would normally have resigned in 2020 choosing to leave in 2021 instead, however figures are still higher than long-term trends.

The most useful learning from this analysis is the data on why staff are choosing to leave or leave early – this is then when conversations can shift to addressing specific problems. There seems to be a huge increase in staff pointing to work-life balance as a reason for leaving their role in 2021. This will no doubt have been exacerbated by the increased demand on staff during the pandemic, but also perhaps a societal shift in mindset on the subject. For many of us, Covid and everything that came with it taught us what really matters most.

What we must also never let slip from our minds is the need for whole system working. This may feel like an over-used phrase, but the future of the health and care system is reliant on all sectors working closely together. So often we see the impact of demand and pressures on our hospitals, especially when the monthly NHS performance statistics are published. But hospitals, or secondary care, are only one piece of the puzzle. We need joined up working across primary care, social care, community care and secondary care and the wider determinants of health - education, environment, housing, transport, arts and leisure. These areas have an enormous part to play in community wellness – keeping people well at home and preventing health issue deterioration and escalation can reduce hospital visits – so growing and maintaining a sustainable social care workforce and system is essential to achieving long-term goals.

As we approach the local government elections on 5 May, we look forward to working with newly elected politicians to achieve effective whole system working, to ensure we have a Wales in which people feel able to look after their own health and wellbeing and that of their families.