A sustainable NHS workforce

31 May 2016

Article by Philippa Watkins, National Assembly for Wales Research Service

Without the right staff in place the NHS will be unable to meet the future healthcare needs of the population. But do we know enough about where services are heading to effectively plan the workforce we need?

According to NHS organisations and health professionals, having a sustainable workforce is the biggest challenge facing NHS Wales in the coming years. There are well-publicised concerns about staff shortages in some areas, and whether the right numbers and roles of medical and healthcare staff are being recruited and retained to provide care in the future.

While there is a strong media focus on the role of doctors, there is a clear need for a wider, multi-disciplinary approach – caring for the ‘whole person’. Developing the skills of existing NHS staff will be an important element in this.

Primary care

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There is a strong policy drive in Wales to re-focus healthcare provision towards community-based and primary care services rather than hospital (secondary care) settings. Where historically there has been a focus on treating illness, there is now much greater emphasis on the NHS’s role in prevention and early intervention.

Is the workforce in place to support this shift? Concerns about the supply of GPs, particularly in rural areas, continue to be highlighted. The Fourth Assembly Health and Social Care Committee’s GP workforce inquiry (2015) made a number of recommendations aimed at improving GP recruitment and retention. But while it is clear that GPs will continue to play a pivotal role, the last Welsh Government’s primary care workforce plan emphasises that the long-term sustainability of services will depend on maximising the contribution of a wide range of professions. Health and social care organisations echo this point, highlighting the value of ‘therapy, diagnostic and pharmacy professionals, social workers and paramedics in early intervention and prevention services’.

The Welsh Government’s primary care workforce plan describes the need for a robust, system-wide approach to workforce planning, but acknowledges that there are gaps in information about the existing workforce. There also needs to be further clarity about the future picture of services to be delivered in the community in order to fully understand the type of workforce required in the longer term.

Acute and specialist services

The sector also continues to raise concerns about the sustainability of the medical workforce in acute (hospital) services. Local health boards report that some specialties are difficult to recruit to (for example, emergency medicine, psychiatry and paediatrics). The shortage of adequately-trained medical staff has led to some services being considered unsafe. In 2015, for example, there were plans to suspend consultant-led maternity services at Glan Clwyd Hospital in north Wales due to staffing issues. However, despite these difficulties, the overall numbers of doctors in Wales has grown year on year. Between 2005 and 2015, for example, the number of hospital consultants increased by over 40%.

The medical workforce is only one part of the picture though – doctors account for approximately 8% of the NHS workforce (but around 20% of the cost). Alongside the overall rise in the numbers of doctors, there has been a levelling or reduction in other staff groups, for example among scientific, therapeutic and technical staff.

Equipping the existing workforce

There is a clear direction of travel for healthcare provision, which is increasingly one of a multi-disciplinary, multi-agency approach, aligned to prudent healthcare principles (‘only do what only you can do’). As highlighted in the last Welsh Government’s primary care workforce plan, new ‘advanced practitioner’ roles and extended skills for non-medical staff are likely to play a key role in meeting the challenges of increased demand and an ageing population with complex health and care needs.

We know that 80% of the workforce for the next 10 years and beyond is already working in NHS Wales, and therefore redesigning and developing the existing workforce will be critical.

Workforce reviews

Professor David Greenaway’s ‘Shape of Training’ review (2013) looked at potential reforms to postgraduate medical education and training across the UK. One of the report’s key messages is the need for more doctors who are capable of providing general care in broad specialties across a range of different settings. Representing the four UK countries, a UK Shape of Training Steering Group was subsequently established to take forward the review’s recommendations on the basis of a four-nation consensus.

In March 2016, the Welsh Government published the report of its NHS workforce review. This considered workforce and pay issues in the context of the financial challenges facing the NHS, as identified in the 2014 Nuffield Trust report, A decade of austerity in Wales? The workforce review said that there is no strategic vision for what the NHS should look like in Wales in ten years’ time, and that this inhibits the planning of new workforce models, skill mixes and roles. The review further noted that if this is true in the health service, it is even more the case in an integrated health and social care service.

The NHS workforce review recommended that – to plan the workforce – the Welsh Government should develop a clear, refreshed strategic vision for NHS Wales as a matter of urgency.

Key sources

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