Choppy waters ahead Choppy waters ahead

Over the past month or so, we have heard 3 key national messages relating to workforce – but what do they mean when we look at them together? 

— The NHS December 2021 vacancy data recorded an increase in the number of vacancies;

— We then saw, despite huge efforts from health & care colleagues, a rise in the number of patients waiting for treatment and particularly increases in the number of 52 week (311,528) and 104 week (23,778) waits;

— And finally, its reported that Trusts will need to find efficiency targets next year of around 5 percent – so what does all this mean in the context of workforce.

I am fortunate to speak to many health & care leaders each week, and I hear a real sense of determination, yet anxiety on the recruitment and retention challenge.  A 0.5 percent increase in nurse vacancies doesn’t sound significant, but when that now represents over one in every ten roles (10.3 percent vacancies), it cannot be denied that it creates a problem for safe staffing.  It isn’t unique to nursing of course – the number of total vacancies nationally increased by 1.3 percent (comparing December 2020, to December 2021), with the highest increases in vacancy gaps in London, the South West and the North East & Yorkshire regions.

The immediate challenge for workforce leaders, is how to balance todays problem, whilst having a strong focus on the next 3, 5 and 10 years ahead – true strategic workforce planning which includes commissioning the right number of training places for the future, role redesign, the implementation of automation and virtual roles (humans and machines working together), and effective retention plans to keep the hardworking talented people we do have; not an easy task but supported by perhaps that on valentine’s day, the NHS England Chief Executive said that ‘the experience during the Omicron wave must be the final reminder, if one was needed, that a long term plan for the workforce is essential’ – Amanda now being the third influential leader to stress the importance of strategic workforce planning with Sir Simon Stevens in January 2022 saying that ‘the interconnectedness between health and social care means that we are actually thinking about a workforce of 3 million plus, and the materiality of getting it wrong over a five or 10-year period is bigger in this sector of the workforce than any other part of the economy’ and of course Jeremy Hunt MP in November 2021 candidly stating that ‘no one on the front line has the remotest idea if we are training enough people for the future’ – so the time is most certainly now and it will take influential workforce leaders to guide their peers, and Board colleagues that this is the priority; particularly in the context of many other pressures and expected performance levels.

This week, it was reported that health organisations will be required to deliver efficiency targets to the tune of 5 percent, with one reporting that targets of that level have ‘never been delivered by the NHS’.  Whether that’s true or not, I think it is widely acknowledged that the pay bill represents a significant percentage of each Trusts operating budget, and therefore it may be naïve to think that efficiency savings won’t come from ‘workforce’ – however, in the context of the other challenges mentioned above, it is hard to see how Trusts will reach such levels of savings, when the workforce gap can realistically only lead to higher usage of temporary staffing spend in the immediate term, which we know comes at an increased cost.  Health care leaders will therefore need to ensure a greater alignment between the money, the people, and the activity if they are to safely navigate the choppy waters of the next twelve months.

The focus on dealing with todays risks will be at the forefront of many minds, including those of regulators who will rightly want to seek assurance, and reassurance that safe and effective care is being provided – but equally, those organisations who can carve out the capacity and capability to deliver an effective strategic workforce plan may find themselves in a better place in twelve months’ time than those that don’t. 

Put simply, the vacancy gap will only change if we can make a new and existing employment offer compelling, and that means doing things differently; the waiting list will only fall if we have the right workforce, which will mean longer term planning, role redesign and innovation, and any efficiency targets will only be delivered, if there is a plan which focusses longer than a year at a time.  As ever, these things are never easy, but remembering that nothing is delivered in the NHS without our people is the best starting point.