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It’s all about the workforce, Dumbo
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.
Thank you for this work. As a patient with a Rare, Long Term condition, a child of parents in their 90’s and a Granny to young children I get to see quite a bit of the NHS in action. I SO support the idea of charities working within these teams. So often we are the only ones with the knowledge, experience and time to deliver relevant support to people. All too often clinicians appear to feel threatened by us, as if they fear we will tread on their toes in some way.
”According to Simon Stevens dealing with the elephants in the room is one of the priorities for this year.”
I read thru’ the transcript of Mr Stevens’ speech and saw no references to elephants, grilled, boiled or even roasted – there was a reference to horses tho’.
Really, you could have started off by very briefly mentioning the names of the elephants you discovered in the long grass of Mr Stevens’ address.
”The next challenge is culture [You wrote]– 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?”
GREAT, I thought. One thing to be sure of will be lots of consultations with ‘patients’. Not their so called Patient Leaders [Self-appointed Career reps of other people who didn’t elect them] real Patients and Public (P&P).
What a disappointment :
”So, in order to work through these questions, we gathered the vanguards together to think this through – using a simulation … ”
Why bother with P&Ps when a computer program will do?
Still ”Caroline has worked for over 15 years for NHS Trusts as an HR Director ..”
Yep – Human Resources, where people are reduced to the same status as tables and chairs, vans and beds – Resources.
Is that attitude the real inedible elephant in our NHS?
If it is, then it does need grilling and roasting, and there are plenty P&P OUT here who will be only to willing to help turn the spit, and collect the fat.
Very interesting and inspiring article Caroline, great work that can, does and will ‘make the differnce’
You and Simon Stevens appear to be living in a parallel universe.
The reality is that the dangerous shortage of Doctors and Nurses ( first identified three years ago and which has worsened since then as recently confirmed by the results of the investigation carried out by the Public Accounts Committee) ) ensures that none of the so called “improvements” for which he and his highly paid colleagues in NHS England and it’s various and ever increasing off shoots, claim to have made will do nothing to improve patient outcomes.
I think you have hit the nail on the head with culture and no system being perfect. Your emphasis on patient outcomes seems to Americanised. when you consider closing the heart units at Blackpool and Wythenshaw and transfer the whole thing to Liverpool. people from around the areas are right to be concerned that a single hospital in Liverpool could cope with the amount of patients needing treatment. Then of course there is a big question about relatives visiting and cost of travelling which seem to have been overlooked. On the face of it people will see it as deep cut to a vital service. This will be resisted very ferociously.
Given the Five Year Forward View, arguably considering the workforce to be only paid staff is insufficient and perhaps even misleading. If we look at people’s whole experience of health and social care, a major part of it is done by unpaid people – self-carers, self-managers, parents, carers, etc. If strategic workforce planning is to be about the ‘whole system’ and citizens and communities are truly the “renewable energy” of the NHS, perhaps workforce development and planning should include them as well as paid staff.
This is great news about the realisation that we have great staff and many with the skills albeit needing some development( although more of them in different places) we really should not be adding any more new roles! Or new names for the same staff. It is confusing for patients and a distraction from transforming the workforce.