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

Over the last few years there has been a U-turn in the centre’s attitude towards the NHS workforce – the focus on the need for more staff and the need to retain them is now a high-ranking – and for some a top – priority. The argument that there are too many nurses in the health service as a reaction to the Francis report on the Mid Staffordshire care scandal is unthinkable in today’s environment.

On the horizon for the workforce is the People Plan, in theory on the cusp of being published, which will be the first major workforce strategy in 20 years. When speaking to those involved, nearly everyone praises how it has brought people round the table in a way they haven’t seen before. Although this collaboration will not solve the workforce crisis alone, it shouldn’t be underestimated.

Its publication will be a talking point for the year ahead — below I explore some of the themes to expect. With the sustained focus on the workforce, it might not be too overoptimistic to think that things, surely, can only get better.

Culture change

Making improvements to NHS climate will be a key part of the People Plan and for the NHS in general. Baroness Dido Harding, chair of NHS Improvement, has raised the issue of poor culture multiple times and has said if NHS boards took culture and staff management as seriously as finance, the service would shift from a “rotten culture quite quickly”.

Many trusts are seeking to make headway. For example, Sir Jim Mackey, chief executive of Northumbria Healthcare Foundation Trust said his organisation had embarked on a staff happiness programme. There is also clear interest from government on measuring morale within the NHS, with proposals for a national measure being considered.

National staff survey results are expected in February and all eyes will be on the bullying and harassment metrics, as last year NHS staff were clear more needs to be done to address the issues of discrimination and bullying within the NHS.

Flexible working

Linked to culture is the opportunity for flexible working for all in the NHS. This will gain even more traction this coming year. I have spoken to numerous staff in all different areas of healthcare who have left their jobs because of lack of flexibility and their employer’s unwillingness to consider it. 

Workforce patterns are changing for good, as highlighted by a recent General Medical Council report on doctors’ career choices, which revealed more medics are moving away from traditional training paths.

Also, as part of the junior doctors’ contract refresh a flexible training mandatory role was agreed as part of the negotiations with the government. The idea was to create a champion for less than full-time training and other models of flexible training for medics and cut down on undermining behaviour and poor communication for those looking to work in this way.

However, it is unclear what support for staff wanting to work flexibly at smaller organisations and non-hospital settings will be available. Introducing true flexibility in the NHS will be a challenge for an organisation without any breathing space and will require, in some cases, redesign of care pathways to ensure patients receive timely care.

International NHS

Expect international recruitment to dominate the conversation in 2020. It is known the government and the national regulators consider it to be the biggest lever when it comes to securing more staff. It is highly likely more detail on making international recruitment more consistent and ethical in the NHS will be in the People Plan and many trusts are focussing efforts on recruiting staff from abroad.

There will be more cajoling and performance management from the centre, and encouragement of trusts to collaborate on this.

Brexit is naturally of huge concern to health and care as the government’s new “refined visa points system” is still in limbo and experts have repeatedly warned about the impact tightened immigration restrictions could have on social care.

The impact leaving the European Union will have on the NHS workforce will take longer than this year to unravel but what is certain is the new system will see more international staff entering the workforce and it needs to be ready to properly welcome, support and in some cases retain them.

HEE leadership

2020 will be another year of change for Health Education England. At the end of last year, it was announced its chief executive Ian Cumming would be stepping down after eight years to take on roles in the West Midlands Ambulance Service and Keele University.

This was proceeded by other recent changes in personnel, with Mark Radford joining from NHS Improvement as its chief nurse and Sir David Behan as chair.

It’s unclear who could take over the leadership of HEE, but perhaps more interesting will be to track its relationship with NHS England and Improvement, as it was revealed in October 2018 HEE would become accountable to NHSI.

What happens with the chief executive appointment will be a clear sign of the direction.