Our second event at Conservative Party conference was chaired by Danny Mortimer, deputy chief executive of the NHS Confederation, who was joined to talk about the future of the NHS workforce by Anita Charlesworth, director of policy and economics at the Health Foundation, Dame Professor Donna Kinnair, acting chief executive of the Royal College of Nursing, and Richard Kirby, chief executive of Birmingham Community Healthcare NHS Foundation Trust.
Dame Donna began the session by stating that piecemeal policy making has failed to meet workforce needs. There are problems with supply, but also with retention as nurses vote with their feet; more people are signing off the register than are signing on. She called for formal legislation to remedy this. She has heard nurses say “I can’t do the job I want to do”, “I don’t get the pay I need”, “I can’t afford my own education”, and “there isn’t enough continuing education”.
There is no time for nurses to reflect and do the things that would improve service for patients. Having been a commissioner, she said that she’s seen a lot of waste where everyone’s got prescribing skills but no one is prescribing but GPs and pharmacists. She also warned that if you educate and train people to a lesser degree, you get what you pay for. She called for mindfulness that a degree is still the quickest way to train a nurse, even as other routes become more attractive.
Richard Kirby said that we need generalists rather than specialists; people who understand physical and mental health who can treat patients in multiple ways. You need to create teams of professionals with the skills and confidence to make decisions on a range of treatments, a point with which Dame Donna Kinnair agreed. He added that we need to encourage people to work in health and care, and to get them interested early on.
We need to make it easy to get into the NHS workforce through things like post-school apprenticeships. He highlighted the need to allow people to develop the scope of their practice while on the job, not requiring them to leave, go back into education, and then come back, as well as allowing flexibility and changes in the type of work people want to do. He made the point that some legislative change will be necessary if we want to integrate nationally, but the local systems should be allowed to develop their integration models first.
Anita Charlesworth stressed the importance of focusing on retention in the short-term: we won’t be able to train fast enough to plug the staffing gaps, so we must keep hold of the staff we have and ensure we maintain similar levels of migration. People value opportunities to develop, and she made the case for investing properly in continuing professional development. Doing so would be a sign from the Health Secretary that he understands workforce issues.
She also said it is necessary to put in place a proper system that deals with workforce planning for health and care, that considers and works alongside other areas. She hoped that the 10-year plan would properly accommodate out-of-hospital services, saying that although we’ve made changes incrementally, it’s off pace with what we need and we should set out much more clearly what the future direction should be.
She added that discussions about workforce sometimes seal off the NHS workforce from its auxiliaries; siloing off the workforce is not useful for anyone. She asked how it can be that there’s a generation of people educated and motivated to work in mental health, but we’ve developed a system that doesn’t facilitate them getting these jobs. Brexit has prompted us to think about what we should have been doing anyway, which is training more staff. One of the biggest impacts on people coming to work here is what happens to the value of the pound; if the pound remains low in value it would make it much more difficult to recruit internationally.