Human: Solving the global workforce crisis in health care

Mark Britnell describes the practical achievements he has seen around the world that could enhance our capacity to care by 20% – if we reframe the debate on workforce planning.

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Published: 11/03/2019

Please note that views expressed in guest articles on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust.

I was sorry to have missed the excellent Nuffield Trust Summit a couple of weeks ago. I was working in chilly Kazakhstan helping them build their new universal health care system, but kept an eye on the #ntsummit Twitter feed. It was great to see such a distinguished and balanced group of speakers and I enjoyed many of the comments from delegates, especially from my old Birmingham colleague Professor Kieran Walshe who stated that he had been to a “profoundly depressing session on the NHS workforce crisis. It’s really not good, and without major policy action, it will get worse”. 

I couldn’t agree more. Over the past decade, working in 77 countries, I have come to the regrettable conclusion that no country consistently gets workforce planning right. Yet we are hurtling towards a global crisis. The World Health Organization estimates we will be globally short of 18 million health workers by 2030 – roughly a fifth of the total capacity to care.

The richest country on the planet, America, is forecast to be 105,000 doctors short by 2030 and needs 1 million extra nurses by the middle of the next decade. India is currently launching the greatest movement towards universal health care in the history of humankind, but is approximately 3.9 million health workers short. When China announced the relaxation of its one child policy to combat a rapidly ageing society, it didn’t fully appreciate that an extra 180,000 obstetricians would be needed. In Japan, the number of nurses tripled from 550,000 to 1.7 million by 2013 yet, incredibly, it is now seeking to add an extra 250,000 nurses over the next decade. Germany expects to need an extra 300,000 nurses by 2030.

Around 2016, I realised that the previous fixation over money (usually the lack of it following the Global Financial Crisis) was giving way to a new fear, a Global Workforce Crisis. So I thought I should write about the practical achievements I have seen work around the world so that, as humans, we could urgently take action to create an extra 20% capacity to care. Ten countries (covering half the world’s population) and ten solutions are offered in the book:

  1. Reframe and reposition the debate about workforce planning to one of productivity, health and national wealth creation. In this respect, Singapore is developing advanced joined-up strategies.
  2. Encourage governments to switch from under-supplying health workers to over-production, safe in the knowledge that the jobs are needed. There are various actions that can be taken and Scandinavian countries have made decent progress.
  3. Encourage the large-scale adoption of new models of care that can boost productivity by 16%. The integrated system in Clalit, Israel is delivering results because the HMO is technologically savvy and joins up primary and secondary care.
  4. Patients should be active partners in their care. In the Bronx, New York, the Montefiore Medical Centre has used remote patient monitoring to reduce hospital admissions for the elderly by over 30%.
  5. Communities can be carers. The radical experimentation in Germany that allows older patients to pay relatives or friends (once trained) to become home carers has resulted in greater patient satisfaction and reduced hospital admissions.
  6. Allow health professionals to practise at the upper limits of their licence (not to be confused with working at the top of your capacity). Buurtzorg in the Netherlands allows nurses to extend their roles producing productivity gains of nearly 30%.
  7. Create a new cadre of care workers who are supported by technology and seamlessly straddle health, social care and human services. Silver Chain in Australia has pioneered the concept and practice of the ‘holoporter’ that is delivering good results.
  8. Harness the digital possibilities offered by artificial intelligence, cognitive assistance and robotics. The move from face-to-face to cloud-based consultations is growing rapidly. Ping An Good Doctor in China is connecting patients nationwide with credentialled clinicians.
  9. Transform organisations from bureaucratic hierarchies to flat, agile learning organisations. Digital disruption will call for new team-working and staff re-education. Up to 36% of health care tasks could be automated by 2030. We aren’t prepared.
  10. Motivate and manage health care teams in fundamentally different way. I estimate that less than 30% of staff have meaningful appraisals (let alone clinical teams) so we need to overhaul our rudimentary approaches to better support and care for staff.

So, I do not believe we have to sleepwalk into this problem. With concerted, coherent effort we can orchestrate ten large-scale changes to enhance the capacity to care by 20%. But we have to entirely reframe and reposition the debate about workforce planning to one of productivity, health and national wealth creation, especially as Britain faces a very different future post Brexit.

Mark Britnell is Global Chairman & Senior Partner for Health, Government & Infrastructure at KPMG International. His new book “Human: Solving the global workforce crisis in healthcare” is published by Oxford University Press and available from 18 March 2019.

Please note that views expressed in guest articles on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust.

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