I was lucky enough to be invited to Paris a few weeks ago, to present our recent report on Reshaping the healthcare workforce to an OECD workshop snappily entitled: Towards a more efficient use of health human resources: What lessons can we learn from innovations across OECD countries? The title of the event might be rather dry, but the contributions were not. Three presentations really stood out.
The first was a presentation making the case for change in the workforce. It included compellingevidence from a recent survey of health workers, including doctors and nurses across 22 countries, asking them whether they felt over or under-skilled for work that they were asked to take on. There is a significant mismatch between the skills of the workforce and the work they are expected to undertake. Seventy-six per cent of doctors and 79 per cent of nurses reported being over-skilled for some parts of their work, while 51 per cent of doctors and 43 per cent of nurses felt under-skilled for other parts of their work. The scale of the mismatch is startling. Being under-skilled raises issues of quality and safety, while over-skilling suggests inefficiency and can lead to job dissatisfaction and turnover. The findings underline a key message in our research; that the skills of the current health workforce do not match the work that needs to be undertaken. Better aligning skills to work can create more rewarding careers for staff and improve patient experience.
The second was a presentation laying out findings from new international research into nurses in advanced roles, particularly in primary care. A large number of countries are expanding the scope-of-practice of nurses in primary care. This includes nurses working in advanced roles as ‘generalists’ to take on some of the GP work and fill gaps in the GP workforce; nurses working in advanced roles as single-disease specialists particularly for chronic disease management; and nurses undertaking health promotion and prevention activity.
But the overall numbers of advanced practice nurses are still very small. Even in the United States, where they have had advanced nursing roles for over 50 years, nurse practitioners only account for 5.6 per cent of the registered nursing workforce. The next highest were Canada and the Netherlands – 1.4 per cent and 1.5 per cent of all registered nurses.
I can’t tell you how many nurse practitioners and advanced nurse practitioners there are in the UK. The title itself is not regulated and registration as a nurse practitioner is not required by the Nursing and Midwifery Council – so there is no UK based data. Out of Australia, Canada, Ireland, the Netherlands and the United States, the United Kingdom is the only country not to regulate advanced nursing roles.
The International Council of Nurses believes that all nurse practitioner and advanced nurse practitioner roles should be regulated. The authors of this new research warned that not doing so risks a lack of role clarity and has safety implications. They concluded that regulation supports the uptake of new, advanced roles if it reflects the changing competency and skill levels in a flexible and timely way. While officials in this country have resisted regulating advanced clinical roles, our research confirmed that regulation could help to clarify roles, but also make skills more portable and enhance trust from other staff.
The last contribution to make me sit up and think was Judith Shamian’s (President of the International Council of Nurses) announcement, in the final panel session, that there was no workforce crisis in nursing. She argued that the crisis is financial. Countries are not choosing to fund and train the nurses we need. She also argued for countries to do more to grow and develop healthcare staff from the people currently lacking employment, using the skills escalator model we describe in our report.
The NHS has a serious shortfall in current nursing staff. Current estimates are that over 21,000 nursing posts are vacant. While training commissions for nursing have increased to try and address this shortfall, the impact of changes to nursing bursaries on staff recruitment and the impact of Brexit on staff retention raise the very real prospect of a growing workforce crisis in nursing in the UK. Rather than reduce agency spend, there is every likelihood it might increase.
The NHS also faces a £22 billion funding gap, exacerbated by spend on agency staff, but shows no signs of making significant investment to address the workforce shortages. Indeed as our report showed, the investment in broader workforce development is being cut.
All three contributions speak to the untapped potential within our current and future workforce. In a time of significant resource constraint, it is a waste of human capital that we just cannot afford.