Tomorrow the Nuffield Trust publishes a new research report, Reshaping the workforce to deliver the care patients need. Throughout this week, we will be unpicking the major themes from the report in a series of comment pieces from our researchers and expert guest contributors. Kicking off the series is Danny Mortimer, Chief Executive of NHS Employers.
I've had the privilege of working in the NHS for 25 years now. I worked in nine different trusts across England before taking up my present role at NHS Employers. Over that time, and in those very different places and settings, I've always been in awe of the talent of my colleagues, but also frustrated (often with myself) that the NHS doesn't make the best use of that talent.
Since I've taken up the role as Chief Executive of NHS Employers, I've spoken often of my view that the solutions to many of the workforce challenges facing the NHS can be found already somewhere within the NHS – if only we knew where to look.
After some time working as a porter and care assistant, my field of contribution to the NHS has been largely HR (or 'personnel' when I was a lad). Throughout my time in HR in the NHS I have witnessed and often assisted in the development of new roles that have benefited patients: generic workers in Stoke, nurse consultants in Bath, radiographer consultants in Chichester, physician's associates in Hertfordshire and cardiac nurse practitioners in Nottingham, to name but five. In my experience, these developments have often been born of the drive and vision of talented clinical colleagues, the support of their teams and the willingness of a board or group of organisations to take a wee bit of a risk – whether it's financial or otherwise.
These developments aren't unique to any of the places I've mentioned: indeed they've often been adapted or borrowed from elsewhere, and there are, I know, countless examples of innovation. At the same time, these roles have often been isolated, or the innovation hasn't caught fire either in the locality or more widely across the NHS.
Enabling change (in regulation of prescribing, for example) has been painfully slow and often opaque. Where advanced or specialist roles have reached a critical mass – neonates, emergency medicine, non-medical endoscopy – our patients and teams have benefited enormously from their skill and professionalism. Yet other areas of care have not seen the same development: where is the critical mass in our care of older people, for example?
A thorough look at where we are in terms of workforce development has therefore been long overdue, and that is why NHS Employers agreed to fund research by the Nuffield Trust drawing on the already strong practice across the NHS. For employers, and for the national health system's leadership, the question about where and how best to invest in developing the workforce has remained only partially addressed for far too long. In their report, launching tomorrow, Candace Imison and her colleagues at the Trust explore where we get the biggest bang for the taxpayers' buck, and the greatest benefit for our patients and clients. Do we invest in new roles to meet new models of care, or do we engage with our existing staff to develop new skills and competencies in their current roles?
The team at the Nuffield Trust explored this question in their research and Reshaping the workforce gives a clear steer that, with some notable exceptions, it's the development of the current workforce in their existing and extended roles which provides the greatest opportunity. Our biggest risk remains, however, that we see workforce change as a substitute for clear service strategy. Without thinking through the redesign of services and roles in parallel, both new and extended roles can increase demand, fragment care and supplement rather than substitute.
The report recommends further research, specifically making a national development needs analysis and impact assessment a national research priority. This has been a key deficit for us, and one of the reasons why many of the innovations haven't been replicated elsewhere.
Importantly, the Nuffield Trust highlights the conditions that need to be in place to offer the best chance of large-scale workforce redesign flourishing. They make very clear what needs to be done at a local level with fully engaged teams, and what commitments are needed from national policy makers and from service and professional regulators.
There is then a clear challenge to boards and local leaders, as well as our national leaders and regulators. We have known of the problems of workforce planning for far too long; leaders need now to take control of workforce development in their locality across the health and care system within their priorities for system transformation. They need to use all the available evidence to develop meaningful plans to find a sustainable balance between service needs, rewarding roles for staff and available funding. The Reshaping the workforce report is a huge step forward in supporting them with this action. Much of what they will want to do, they can steal or borrow from colleagues, but anything they do must be rooted in the needs of their communities, clients and patients.
Find out more about the evidence base for reshaping the workforce at an exclusive session at the NHS Confederation Conference on 16 June, hosted by Prof Ian Cumming (Health Education England) and with a presentation from the Nuffield Trust's Candace Imison.
You can follow the rest of our series with #NHSworkforceweek.