One of the main challenges with national plans long in gestation is that expectations are raised to heights the authors alone cannot possibly reach, writes Michael Wood

Those tasked with drafting the NHS People Plan have earned deserved praise over the past year for their recognition of the scale of the workforce challenge facing the sector and their openness to developing new solutions. Fingers crossed then for a final report that shares more equally with local leaders the responsibility and the rewards of evolving new approaches to our current staffing woes.

The local people plan

Recognising that concerns about the workforce are top of the list for front-line NHS leaders – both in terms of the immediate delivery of services but also in enabling the strategic development of our integrated care systems and sustainability and transformation partnerships more generally – the NHS Confederation has also been looking at what we believe the new operating model for workforce development in health and care should focus on.

Our central recommendation, set out in a newly published manifesto, is for ICSs to become the default level at which accountability for system-wide skills and workforce decision-making is based. Such a devolution of a critical national competence may be rare in the NHS but this act would reflect the direction of travel for the NHS long-term plan, mirror the more localised skills landscape in which our sector is struggling to compete, and match the variety of tools other industries and employers are able to wield. Taken together, this is an approach that can combine the strength and security of the NHS brand with an agility that belies our size and scale.

Managing upwards

Such a shift naturally requires a body of evidence behind it. Through roundtables with leaders from within our sector and with our external training partners we heard about both the scale of ambition to transform health and care and what could be achieved locally if systems had the workforce powers to match. By undertaking a public consultation in 2019 we sought and received wider support for a much-strengthened role for the ICS in workforce, people and skills. As ever though, the devil is in the detail.

The manifesto focuses in particular on empowering local systems in several key areas of workforce development, including strategy and planning; supply and retention; and system deployment. In practice this means giving local leaders increased autonomy over the development of the local system architecture, responsibility for managing strategic external relationships and, critically, the control of dedicated funding streams.

Every tier has a role in place

The timing of the manifesto is important. Confidence in the sector’s ability to identify, plan and deliver nationally the health and care workforce needed for the future is falling rapidly, just as local leaders are collaborating on skills in new ways and with a range of different partners. While our primary focus is system-led, every tier has a clear role in addressing this.

The manifesto makes clear that the role of the “centre” in workforce remains vital. Financial resourcing at a system level is critical of course but just as important to our local leaders is being clear and transparent about the roles, and funding, of the national workforce organisations. Add to this an explicit intention to make social care part of the overall workforce policy narrative and the need for free-flowing sharing of good practice and we can begin to narrow the gap between expectation and reality on the ground.

Similarly, it is at organisational level that we often see the innovations shaped which can support greater system development. We believe the role of NHS and social care organisations as anchor institutions is an important one that helps inspire, develop and best utilise the local workforce. An ICS should support its constituent parts to realise this potential.

We can influence labour markets, but we cannot manage them

Of course, one of the critical reasons why we believe an ICS is best placed to act on workforce is because of changes taking place outside our sector in the wider labour market. The NHS Confederation will shortly be publishing guidance for all ICSs on how to influence their local labour market, becoming a much more intelligent customer at a time when local skills provision is changing, regional employment is at a record high and our traditional industrial base is diversifying. If the manifesto outlines the tools our sector needs, the guidance will explore how they can be used to best effect. It is true that this guidance will likely stretch some way beyond what the NHS People Plan considers “home turf” but it certainly matters.

In developing this manifesto, we wanted to balance the principles of subsidiarity, pragmatism and influence, giving the NHS and social care leaders the best chance of securing lasting local change. The NHS People Plan should not lead to simply another internal NHS argument about who does what. The real progress will come from how we influence, not what we control.