Today 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. In this blog, report author Candace Imison explores some of the main opportunities identified in the report.
The recent Public Accounts Committee Report sounded an important warning bell about current shortages in the NHS workforce and the poor planning at local and national level that contributed to this. In 2014 there was a shortfall of 50,000 clinical staff, 5.9 per cent of the NHS clinical workforce. This shortfall put significant pressure on staff and organisations and drove a spend of £3.3 billion on agency staff in 2014/15.
However, an equally important, and much bigger, gap in the 1.3 million strong NHS workforce is the skills gap. Staff have largely been trained for a model of acute, episodic and single-disease-based care. But those placing the greatest demands on the health service are people with multi-morbidities, many of whom are old and frail. The innovative new care models anticipated by the Five Year Forward View will not become a reality unless there is a workforce with both the right skills and the right numbers to deliver it.
How do you go about re-equipping the workforce for the new demands placed upon it by a changing demographic and model of care? That is what we explore in our new report, Reshaping the workforce to deliver the care patients need.
The good news is that, despite the bleak backdrop of poor finances and workforce shortages, we found considerable grounds for optimism. There is evidence that developing and extending the skills of staff, particularly non-medical staff, can deliver more patient-focused care; improve the quality of care; make better use of resources; improve team working; provide new and more rewarding career pathways; and help address workforce gaps.
Drawing on a review of relevant literature, interviews with a wide range of stakeholders and a number of case studies, we identified three significant areas of opportunity.
Support workforce
There are considerable opportunities to grow and develop the staff who are not professionally qualified, training them to take on more caring responsibilities and reduce the workload of more highly qualified staff. This part of the workforce is highly flexible, and short training times mean that numbers can be grown relatively rapidly. The additional training can also provide the first step towards more formal professional training, opening up new pathways to health care roles.
Assistant practitioners are a good example of the potential of support roles. In Taunton and Somerset NHS Foundation Trust, assistant practitioners – higher-level support workers who complement the work of registered professionals – have been recruited to support its radiology team amid a shortage of radiologists. The practitioners have helped to streamline the service, eliminate hold-ups for ultrasounds and biopsies and enable the unit to offer more one-stop clinics, decreasing the number of visits to clinic per patient.
Extending skills of registered health care professionals
Extending the roles of the non-medical workforce provides opportunities to manage the growing burden of chronic disease more efficiently and effectively. It also provides the opportunity to enrich the work of professional staff. There is some evidence that these new ways of working can release some savings and help bridge workforce gaps, particularly in primary care.
They also create opportunities to deliver a more complete package of care for patients. For instance, the Nottingham CityCare Partnership utilises ‘holistic workers’ to support their nursing and health care services across the city. The ‘holistic worker’ is a new breed of health care professional that is able to assess a patient’s complete care needs by receiving training beyond their registered profession. Each worker is registered in one area: nursing, physiotherapy, occupational therapy or social work, but goes on to expand their knowledge and skills across all four areas. As a result, each professional is able to provide cohesive support to their colleagues and a rounded experience for patients.
Use of these roles has allowed for a more efficient use of resources, with professionals able to do more for patients within a single visit.
Advanced roles
Advanced roles – which we’ve defined as those that require a Master’s degree in advanced practice – offer opportunities to improve clinical continuity; provide mentoring and training for less experienced staff; offer a rewarding, clinically facing career option for experienced staff; and help to bridge some of the gaps in the medical workforce. The roles can be developed relatively rapidly in about three years.
For example, Sheffield Teaching Hospitals NHS Foundation Trust has developed the advanced clinical practitioner (ACP) role. It has 70–80 ACPs working across a range of services and has established a faculty to standardise training and supervision requirements, among other things.
Although a comprehensive evaluation of ACPs in the trust has not been carried out, anecdotal feedback from junior doctors working with ACPs and other staff has been positive, suggesting reductions in delays for patients in some areas.
Change is vital, but will not be easy
Changing the way people work is not easy. It takes skill, resources and persistence. Careful attention needs to be paid to role design, governance and effective change management. The financial context makes this agenda particularly challenging. But this is not a 'nice to do'; it is essential if we are to provide a sustainable balance between funding, providing the right care for patients and ensuring rewarding and satisfying careers for staff. The workforce is the NHS’s most precious resource. Every board and Sustainability and Transformation Plan should ensure it gets the attention it deserves.
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.