Rigorous workforce planning that more closely matches clinical and general workforce supply to ever-changing demand could be the difference between success and failure for NHS trusts in the years ahead
In the wake of recession, European car makers are scrambling to restructure or consolidate in response to more than four years’ of falling demand and profits. Last year, with declining sales and many of its factories running at partial capacity, General Motors agreed to a new workforce deal that makes the difference between the Vauxhall car plant in Ellesmere Port, Cheshire, surviving and the closure of a sister factory in Germany.
‘NHS trusts have largely struggled to effectively match the ebb and flow of service demand to workforce supply’
A visionary proposal from management, staff and the union Unite tipped the balance in favour of a UK deal. An extra third production shift will be added at the Vauxhall factory to ensure 24-hour a day running, along with an agreement to introduce weekend working to guarantee the plant works at full capacity. The workforce agreed a four-year pay deal, including a pay freeze for two years, followed by rises of about 3 per cent in years three and four based on increased productivity and market share.
What can the NHS learn from this? It is a basic truth that workforce planning in the NHS has lacked rigour in matching clinical and general workforce supply to the ever-changing demand for a variety of healthcare and service needs.
On average, close to 60 per cent of healthcare spending is spent on the clinical workforce. Yet we are comparatively ineffective in estimating workforce needs accurately, or developing strategies at service or organisational level that dynamically keep supply and demand in balance. This can often lead to suboptimal patient care, poor control of workforce costs and inefficient service delivery. This is the last place to be in a world of continuing austerity, and the number one priority to deliver the mantra of providing high-quality, accessible, cost-effective care. We need to have the right number of the right clinicians in the right places, like clockwork, every time.
Workforce planning in the NHS has traditionally been difficult. Part of the reason for this is the oil tanker nature of professional education and training, which never moves as quickly as the market does. NHS trusts have largely struggled to effectively match the ebb and flow of service demand to workforce supply.
An inexact science
‘NHS organisations are going to need to work together and independently to be more in tune with the labour market’
No one doubts that complex workforce planning is an inexact science − after all it is not that long ago that a decade-old planning decision to raise medical school enrolment by 50 per cent resulted in an over-recruitment of trainees for some specialist training. This led to a second problem: an excess of qualified doctors in certain specialties. Because the NHS generally guarantees doctors employment for life, it has no easy way to eliminate the excess.
One consequence of this is to accept that, as in every other area of life, we will never be able to forecast future needs perfectly. In practice, this means NHS organisations are going to need to work both together and independently to be more in tune with the labour market and to respond to trends over shorter time frames. They will almost certainly also have to introduce much greater flexibility into their workforces. Contentious nationally driven policies to differentiate workforce terms and conditions between different regions of the country, together with local innovation from trusts are likely to aid this process.
Additionally, all over the NHS workforce flexibility is being improved by enhancing the skills and capabilities of health professionals who are not doctors. The roles of specialist nurses, the deployment of nurse practitioners and physician assistants has broadened considerably in recent years.
In the future it is likely that the demand for specialist services will be concentrated in fewer, larger centres of excellence and routine hospital services will increasingly be localised. It is not rocket science to assume therefore that both legally and professionally the scope of practice for non-medical professionals will expand even more rapidly.
What is safe and appropriate for nurse practitioners and physician assistants to do will vary but because these health professionals can be trained much more rapidly than doctors they can offer an especially attractive way to increase workforce flexibility.
There is a lot to learn from the Ellesmere Port car plant and its battle to win a future in a tough market environment. The path ahead for all trusts involves difficult decisions about how to radically change the roles of professionals, control the pay bill and super-lean the workforce, while flexing staff up and down in response to quality, service and environmental demands.
An ability to combine strategy and agility in delivering workforce change is likely to be the single most important factor between success and failure in the years ahead. Any trust that does not take steps to tackle this challenge now is likely to find that it is unable to manage almost two-thirds of its spending effectively.
Stephen Eames is chief executive at Mid Yorkshire Hospitals Trust