Workforce – what’s the plan?

27 February 2018 Alex Gild

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When my board reviews our assurance framework – a document identifying key risks to the trust’s strategic objectives – we all agree that workforce is our most significant risk to sustaining safe, high-quality mental health and community services in Berkshire. And this has been the case for some time.

That’s saying something isn’t it? It’s saying our principal risk is not just about the money.Alex Gild

I don’t think my trust is hugely different in this perspective to others. Increasingly the focus for the NHS is on workforce sustainability risk – and arguably it should be, more so than funding.

We have to ask ourselves a question in the NHS, as local system partners or in our own organisations, wherever we decide to prioritise service funding. Can we employ and retain the extra people needed to deliver those new or expanded services to meet demand and provide safe care?

As we face up to the challenging NHS funding outlook over the next few years, the reality is that we must also factor in a medium-term view of workforce availability. The risk to sustaining services is driven by issues such as comparative pay perspectives, the prohibitive cost of living and housing, filling clinical training in-takes, Brexit uncertainty, increasing demand pressure on services and a continuous negative media focus putting people off joining the NHS.

These are just some of the significant inhibitors to attracting and retaining staff. And, unless we do something about it, this workforce risk could threaten delivery of the NHS’s forward view intentions.

While the ‘macro’ work gets in motion concerning national and regional workforce planning, locally we and our local partners are the ones with the potential answers or ideas. So it is time for some serious team creative thinking. What can we in finance do to help address these problems?

We need to support improvement in the accuracy and reliability of workforce plans, and our understanding of the consequent financial impact. If the majority of NHS expenditure is in our pay bill, we collectively need to get the baseline right and project with a much greater dose of reality.

A clearer, more explicit view of future workforce gaps at organisation and local system level in the medium to long term would help signal the changes needed in service models and workforce to sustain safe high quality care to patients.

We have resources tied up in historic pay budgets that will often not be spent as planned. There are high vacancy factors in some services because we can’t recruit. And the use of agency staff in some service models has implications for quality.

Multidisciplinary teams often hold the key to changing service models to address projected people and skills deficits. But unrealistic or inaccurate near term workforce planning potentially hinders their ability to do this.

Draft workforce plan submissions are due early this month. These plans need to be clear about the challenge, but also signal how things will change.

In the here and now, there is the matter of how we protect, develop and sustain our existing workforce – retention really is mission-critical. One approach is lean management and associated culture change. I’ll talk more about that next month. Until then keep thinking about people, because that is what our brilliant NHS is made of.

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