According to Simon Stevens dealing with the elephants in the room is one of the priorities for this year.
As we all know, eating elephants should be done one bite at a time…and in terms of our health and care systems perhaps the toughest part to chew is strategic workforce planning.
In the workforce redesign team – part of the new care models programme support offer – we are helping vanguards to think this through differently. So what are the problems?
Currently we tend to:
- take a single-organisation view rather than think of the future health and care needs of local people and what skills will be needed to support them across the system;
- think short term – such as focusing on getting the right number of training places for the near-term rather than the skills and workforce models to meet future needs;
- put design of the future workforce in the ‘too difficult’ box and leave it for another year to solve.
And when we spoke to vanguard teams, they asked us: “How can we solve such a complex problem and not disrupt current services?”
Vanguards are of course about leading the way in development of new ideas and some have already got some way to answering the question.
Their approach is based on modelling future population health needs and considering what skills will be needed to provide care to meet these.
The new care models programme workforce redesign team ran four workshops to share this thinking in March and April. 42 out of the 50 vanguards attended the sessions, with additional representation from integration pioneers, patients and other stakeholders.
The sessions explored how to model your future population health needs using readily available data; understand the impact of service transformation – such as increased provision of care in community settings; build the right skill-mix of roles to support care delivery; and then what workforce actions such as recruitment, training or transfers may be needed.
The most heartening news was that vanguards discovered, in the main, the staff they have are the staff they need – though they may need skills development. They also learnt it makes sense to work on system-wide strategic workforce planning at the outset of any vanguard planning process.
We really want to spread the word about this approach and see it being widely adopted. If you would like list of the available workforce modelling tools to help you with this please contact Sharon Dixon from the workforce redesign team – firstname.lastname@example.org.
Is that the elephant eaten?
Unfortunately not – understanding future skills is one thing, reshaping the workforce for a local system is another.
The next challenge is culture – how do you have the difficult conversations in your local area? How do you focus on what is right for the patient without getting drawn into old or established systems? How do you genuinely put the patient outcome before the needs of your organisation?
So, in order to work through these questions, we gathered the vanguards together to think this through – using a simulation based on realistic future health and care system scenarios to explore the culture, behaviours and practicalities that should be in place to enable successful workforce redesign.
What we learnt was that it is possible to make rapid changes – and develop roles and people without the distraction of organisational change. What was absolutely key was having a clear and shared vision for multidisciplinary, place-based working, with shared values, performance and risk management arrangements to support it.
Getting this right will require bravery from clinicians and managers and continued engagement with staff and working with our unions and Royal Colleges. And there is a direct correlation between integrated working, caring, and improving staff experience of providing care – by addressing those long-term ‘elephants’ and enabling staff to use the skills they trained for.
A great example of this is action is in All Together Better Dudley – a community provider vanguard – where they now have 46 new multidisciplinary teams that include staff from health, social care, pharmacy and local voluntary organisations.
They are using a ‘teams without walls’ principle – based around GP practice registers – and staff now assess and address the health and social care needs of their patients together. This is reducing the number of different staff working with the patient, improving patient experience and staff morale.
None of these models are perfect, but by combining data and good conversation we think this gives you the best chance of devouring the animal.
- We are here to help, so if you have any other ideas or experiences of workforce redesign you think it would be helpful to share with vanguards or the wider system, please let us know.