The NHS Confederation's second event at Labour Party Conference was chaired by the organisation's deputy chief executive Danny Mortimer, and chief executive of NHS Employers.
Joining him were Anita Charlesworth, director of policy and economics at the Health Foundation, Dame Donna Kinnair, acting chief executive and general secretary of the Royal College of Nursing, Sheena Cumiskey, chief executive of Cheshire and Wirral Partnership NHS Foundation Trust, and Dr Paul Williams MP, who sits on the Health and Social Care Select Committee.
Danny Mortimer opened the session by commenting that the importance of the workforce challenge is often recognised, but that the conversation rarely goes beyond paying lip service.
Dame Donna Kinnair gave a nurse’s perspective and pointed out that when nurses turn up to an understaffed shift, there is no accountability, yet the nurses are the ones who carry the burden. Nurses in the UK don’t earn as much as their international counterparts, and should not be expected to reach into their own pockets to pay for additional education. She asserted that the apprenticeship model cannot be a way to minimise the education of the workforce.
Dr Paul Williams MP added that instead of seeing a bolstering of the community workforce, staff have been dragged from the community into hospitals. He cautioned that legislating for things like safe-staffing levels might have this unintended consequences; reinforcing one part of the workforce might weaken others. He also added a pragmatic caution that we as a sector can always make the case for more, but the reality of government is often constricting, as will especially be the case in the wake of Brexit. Pay may continue to stagnate and we will struggle to recruit internationally.
Sheena Cumiskey emphasised that the workforce is the key to delivering vibrant and effective health and social care, and outlined a few ways to improve retention. She stressed that people want to feel valued and to feel part of a team, and that such a working environment can be created by giving staff the right numbers, equipment, training, knowledge and partners.
Offering staff flexible working conditions through things like e-rostering can also help to improve wellbeing, and ensure that we get the best out of our staff. She added the need to encourage people to want to be part of the health and care workforce and to see it as a positive sector in which to work, and the need to ensure the standardisation of positive working experiences across the NHS.
Anita Charlesworth continued this theme, and said that the short-term focus must be on improving retention. She urged the government to invest in continuing professional development; reinstating it as a priority for frontline staff would be a tangible sign that there is a reciprocal relationship between employer and employee. There is a need to cultivate a cultural expectation that staff will develop and progress their roles; people tend to have this expectation, but the system is not well set-up to accommodate it.
She also pointed to parts of the country and areas of service that would greatly benefit from a more local and more diverse workforce. These changes would not only improve retention, but also the quality of service. On a broader scale, she said that we have not been good at thinking holistically about the workforce across health and care, and that we need a much more long-term approach that moves away from silo planning. From her perspective as an economist, the NHS is a huge portion of the employment market, and employment failures in the sector contribute to the wider social and economic challenges facing the country.
She also pointed out that the number of staff is not the most important metric; a ward with fewer, more experienced staff has a very different feel to one with more staff who perhaps belong to agencies or lack experience.
There was general agreement on the panel about the need to move towards a more generalist workforce. Training still directs staff towards specialisation and the status it brings, but Dame Donna Kinnair commented that we need to meet the needs of patients and to treat them in multiple ways. Sheena Cumiskey added that social isolation is an example of one of the challenges an ageing population will present, and we need to think about how our workforce can link into community care. She ended by underlining that the NHS should not see itself as an island.