How can we fix the healthcare workforce deficit?

With growing workforce pressure across health and care, understanding and capitalising the power of data is essential when defining your workforce strategy, such as designing your recruitment and retention plans, and addressing often deep-rooted issues on agency expenditure. Understanding the root cause is the key to success of those plans.

• What drives your workforce deficit?
• How confident are you that your recruitment and retention plans are informed by data and insights that give greater credibility to its success?
• How many recruitment and retention plans purely focus on the vacancy gap and turnover trends, rather than what your data is telling you?
• How often do we look at what is driving agency spend, rather than just looking at the financial values?

Working closely with health and care organisations gave us insight into the wants of workforce intelligence teams, and they do not just want the data; they want, or more so need, better analysis and insight interpretation of that data to enable them to support their decision making.

How many health and care organisations still report sickness absence data with predominantly a look back, rather than how that data could support greater interventions to reduce it going forward? Or turnover rates at a high level by staff group, as opposed to gaining a real understanding of why people are leaving and where are they going? How often is poor rota management a driver for agency spend?

We know from organisations such as the Healthcare People Management Association (HPMA), that skills around workforce planning are lacking across the human resources profession, and it’s an area where there is a lack of capacity and capability that needs developing. The analysis of data will be integral to understanding not just the current position, but also to supporting the NHS, including integrated care systems, plan for the future, be financially sustainable, and ultimately provide safe care.

Gaining an in-depth understanding of how many people leave an organisation, and importantly why are they leaving, and where are they going, must be a priority. It is acknowledged that many organisations already undertake exit interviews, but candidly from my own experience, the uptake of interviews undertaken as a percentage of the number that leave will almost universally be low. In addition, many organisations will report high level findings about why people leave, but it is questionable what action is taken to address the actual reasons why people leave, or whether the interviews are meaningful.

If we genuinely want to support the drive to reduce the vacancy gap, we must also address the drivers of the deficit - for example, how many HR professionals have ever considered delving into the turnover data to explore variances between gender, job role or nationality?

Late last year, the IFS published their report (which staff members leave the NHS acute sector), which analysed the leaving rates of consultants, nurses and midwives, and healthcare assistants (HCAs) between 2012 and 2021. Interestingly, the report didn’t just focus on numbers that leave, as is the traditional approach; instead, it looked at:

• The characteristics of individual staff members
• The local economic conditions
• The characteristics of NHS Trusts

This approach allowed the report to consider how the leaving rates of each staff group vary by these characteristics when holding all other factors constant. We already know that those organisations with low turnover and high engagement benefit from better patient outcomes.

Fascinatingly, the report uses the available data (from the electronic staff record) to review leaving rates between men and women in the same staff group – finding that they are larger than the differences between those in different roles of the same gender. Why is this important you might ask? Well, put simply, if we do not use the available data to gain meaningful understanding of the drivers of the workforce deficit, surely it is impossible to develop a solution which addresses the root cause. In addition, the analysis of available data can be used to future-proof workforce plans, based on past trends identified – how many health and care organisations currently undertake this approach when developing recruitment and retention plans?

For example, the IFS report finds that female staff are more likely to ‘leave’ the NHS in their 30’s – most likely driven, in part, by those taking maternity leave (the IFS report looked at those taking unpaid maternity leave, or leaving before or after having children). Why is this data useful? It has the potential to support workforce planning, acknowledging that over the next decade, organisations can expect to lose significant working time from women currently working in their late 20’s.

In addition, when looking at job roles, a male healthcare support worker is far more likely to leave in their 20’s than their female counterparts – but where do they go? We must get past the anecdotal comments I have heard on many occasions that they are going to work in supermarkets, or for delivery companies – it may be true, but these statements are said with little evidence or data to support them, largely because the real drivers of the workforce deficit are poorly understood and/or challenged.

What consideration is given to the stability index for job roles on the basis that a HCA with a tenure of less than 2 years is 62% more likely to leave than a HCA with a tenure of 5-10 years. The default position for most Trusts will simply be to recruit more HCA’s, which sounds like an obvious solution, but short sighted if they are investing in training HCA’s, and in most cases, they’re likely to leave within 2 years of starting.

On leaving rates by nationality, it is reported that for nurses and midwives, EU staff were 43% more likely to leave than their British counterparts (this could be impacted by Brexit), while non-EU nurses and midwives were 28% less likely – in the context of retention, it could be argued that recruiting nurses and midwives from non-EU countries could bring greater stability to the workforce, but;

• How is this data being used in existing recruitment and retention initiatives?
• How do we best use this data to think about temporary staffing cover?
• How do we use this insight to develop forecasts on temporary staffing usage?
• How do we use it to better manage rotas?

To improve workforce planning and to start to making progress towards genuinely reducing vacancies and improving retention, we recommend health and care organisations consider the following five actions:

1. Invest in the data literacy skills of your workforce team to develop their ability to understand, analyse, and interpret data.
   
2. Make the best use of the available data and actively use it as a driver of tangible change.
3. Stay curious – take the time to truly understand the drivers of the deficit through multiple lenses to then take informed action.
4. Go back to the basics of the workforce deficit drivers – look at rota principles and ask yourself:
   1. How compliant is your organisation?
   2. What sustainable improvements could be made with governance, grip, and control?
5. Use the data to forecast. Too often we look back at data, but the reality is that we can’t do anything about what has already happened. Draw insights from it to better inform the future.

KPMG have supported several health organisations review their drivers of the deficit, with robust savings identified. In addition, we now also support organisations with their analytics training programmes.

So, what are the drivers of your workforce deficit?