The future NHS workforce

13 May 2016

There has been no shortage of reminders recently that the NHS faces significant workforce challenges in the years ahead. Just this week the Public Accounts Committee published a report calling for more strategic use of existing staff, rather than simply recruiting more; the ongoing wrangling over junior doctors’ contracts requires no rehearsal here. The NHS faces a heavily front-loaded funding settlement over the course of the next Parliament, alongside a need to make £22 billion of annual efficiency savings by 2020-21 (see Table 1). It was with this challenge in mind that Reform’s recent roundtable – led by NHS Employers CEO Danny Mortimer – was conducted on ‘The Future NHS Workforce’.

There was consensus that much of the solution to making better use of NHS staff lies in greater engagement. There is growing evidence that improved communication between senior leadership and frontline staff leads to more constructive partnerships, and thereby better outcomes for patients. In this respect, the quality of relationships within the NHS is essentially equivalent to value for money. Of particular interest is an apparent generational gap between senior leaders and younger ward-level staff – in expectations over the type and degree of engagement that should be undertaken between staff at different levels of seniority, for example. Attendees agreed that there is a growing cultural rift here that must be addressed. Despite NHS staff consistently reporting vocational pride in their profession, low morale is recognised as a serious challenge. In late 2015 nearly a quarter of NHS Trusts cited staff morale as giving them “most cause for concern” – more than any other option.

Another centrepiece of the debate was how to achieve the right skills mix in the future NHS workforce. Attendees broadly agreed that nurses and pharmacists should be entrusted with greater clinical responsibilities. The prospect of achieving greater value with the same headcount – while also boosting morale by adding to the impact individual staff members are able to make – was seen as a welcome inevitability.

As Reform has recently argued, this would enable government to move away from the conflation of higher staff numbers with better quality services, and focus on making the best use of the existing workforce.  Attendees pointed out that the current regulatory framework is likely to present barriers to significant reform in this respect. As government increasingly steps back from treating larger workforces as better workforces – for example in policing – we may, however, see more thought given to how this can be achieved in healthcare.

Perhaps the key question for the future will be the extent to which central government is able to facilitate initiatives at the local level.  As the NHS moves towards greater integration of services – with significant rebalancing of community and acute services, and more local steering of priorities via health trusts – we will likely see the emergence of a markedly different workforce. Rob Webster, outgoing CEO of the NHS Confederation, reminded us last month that “the NHS is made of people”.  If the full range of those people can be granted the flexibility they need to deliver local services, a more optimistic picture of workforce morale might result.

Alasdair Riggs, Research Assistant, Reform

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