Staffing is the issue keeping NHS leaders awake at night — and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, will make sure you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce. Contact me in confidence.
The NHS workforce crisis has no quick fix. It has been brewing for years, with the number of staff in the system increasingly unable to keep pace with the uncontrollable growth in workload and patient acuity. There are numerous levers trusts are now being expected — or rather, explicitly told — to pull to boost substantive staff numbers, including making more use of the apprenticeship levy and collaborating to boost international recruitment.
The NHS has also rightly refocussed efforts in improving staff retention — it was reported last year that NHS Improvement’s national programme to improve workforce retention resulted in the lowest nursing turnover rate since 2014. The final People Plan is yet to land but we know retention targets will be an important part of it.
With these wheels in motion, it was disappointing to see Department of Health and Social Care proposals, apparently briefed to The Times last week, setting out plans to fast-track pharmacists and paramedics through a conversion course to become doctors. This isn’t the first time this has been hinted at; according to the Pharmaceutical Journal Sir Simon Stevens said at NHS Expo last year that post-Brexit flexibilities could enable professional regulation to be loosened and allow pharmacists to retrain as doctors. It is an idea which rears its head every so often, to then be batted back down.
The idea of making medicine a more accessible career isn’t a bad one, as the NHS needs to boost the number of doctors and ensure a better geographical spread, but the way to do isn’t to rob already hard-pressed professions of their staff. Not only does this create staffing pressures elsewhere but it also has an impact on morale and feeling valued. Pharmacists and paramedics are essential staff and members of a multidisciplinary team in their own right.
The Times article suggested there is a surplus of pharmacists, which currently isn’t the case, and there is even greater pressure on those with advanced clinical training. The long-term plan for the NHS is clear about the need to make better use of pharmacists’ skills to support urgent care and keep patients out of hospital; it doesn’t say the best way to do this is to turn pharmacists into doctors. The same can be said for paramedics — the long-term plan is also clear of need of “skilled paramedics” to treat patients outside of hospital.
In a letter to the Times, president of the Royal College of Surgeons, Derek Alderson, argued the spin doctors’ suggestion in this piece amounted to “robbing Peter to pay Paul” and said raiding “equally hard-pressed professions” is not a solution to plug workforce shortages.
Moving healthcare professionals around as if the NHS is a game of chess isn’t a long-term solution to the workforce crisis — far better to drill down into how multidisciplinary teams are used, boost medical school numbers and ensure all staff are able to work at the very top of their license.
An expensive sleep
On the subject of staff retention and culture, it was reported this week that Royal Wolverhampton Trust has spent £17,000 to install sleep pods in the accident and emergency unit, doctors’ mess and maternity department at New Cross hospital. It isn’t alone in this endeavour — trusts around the country were allocated £10m by the government last year to spend on facilities to improve doctors’ rest and experts have welcomed this change in attitude towards sleep and rest.
One doctor suggested this money would be better spent on proper rest rooms, which more staff could use.
However, as pointed out by a junior doctor, the reality for many medics is a lack of time during a shift to even use a sleep pod, and of course the issue of lack of proper rest break facilities extends to nurses and other frontline staff too. As argued by Michael Farquhar, consultant in sleep medicine at London’s Evelina hospital, the sleep pods grab the headlines but the principles behind their installation are what’s important.