The NHS Workforce – why recruitment can’t be the only answer

The EU referendum brought intense spotlight on the future of the NHS. Both sides spoke of increasing demand for services, high staff vacancy rates, and increasingly severe financial challenges. With 130,000 NHS workers originating from the European Union (10% of Doctors and 5% of Nurses), Brexit could have a significant impact on the service.

The workforce will quite literally be on the front-line of many of the health service’s challenges – but despite what some campaigners claim, increasing recruitment activity isn’t always the answer to our workforce challenges. Regardless of Brexit, workforce transformation is needed now.

The workforce of today matters

With an annual NHS budget in excess of £110bn, 70% of its expenditure on workforce is a hugely material cost. The Five Year Forward View sets out the direction for the NHS and how it will transform in the coming years. Its intent is clear: transformation must be quick, it should take place within five years, and it should be delivered within a strict funding envelope. However, given the long timescales required to train medical staff (for example, 10 years to train a GP and costs circa £500,000 according to the BMA), delivery of the Five Year Forward View will come far sooner than our ability to bring in many of the new roles required to enable the required transformation.  

In conjunction with this, 70% of the workforce today will be the workforce in 10 years’ time. This means, to deliver the future transformation in a cost effective way, it is time to start thinking about supporting that existing workforce to accelerate the required transformation, rather than expecting the workforce of tomorrow to deliver it.

Recruitment is not the silver bullet

Simply put, recruitment is not the only answer to our workforce challenges.

For providers and commissioners, workforce transformation can be a daunting task, requiring significant planning, direction and, importantly, investment. Whilst the ask is no doubt challenging, there are a number of key fundamentals that will support and enable successful workforce transformation.

Key for anyone focusing on workforce is:

  • The ‘as is’ state: Understanding your current workforce profile – getting a handle on the numbers, staffing ratios and challenges currently being faced.
  • The ‘future’ state: Modelling what the future looks like – assuming no change to current ways of working, will enable understanding of what the key challenges will be.
  • The planning from ‘as is’ to ‘future’: Building a case for change - creating consensus within and across organisations of the need for transformation.
  • Delivering the ‘future’ state: Delivering collaboratively – engaging with providers and commissioners at a regional, national and local level to ensure successful delivery.

A clear baseline and workforce strategy are key

To take a particular example, the Healthy London Partnership (a portfolio of 13 transformational programmes working across the capital) has published the London Workforce Strategic Framework. This report acts as an enabler for change, to ensure a sustainable future for the NHS. It seeks to ensure the current and future workforce both aligns with and drives the successful implementation of new models of care and associated ways of working. New roles, new skills, collaboration and versatility will be key.

With the uncertain environment facing the NHS, the health service workforce is going to be front and centre in facing major challenges and delivering ambitious transformation. The exact challenges posed by Brexit are still unclear, but focusing on the workforce of today and tomorrow is the right thing to do. Understanding the challenges they face, building a case for strategic change, and working collaboratively to deliver that change – are all crucial to delivering better care across the system.

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Alex Goodman Principal