The NHS Workforce Crisis

Apprentice Style Training and Competency-based Jobs with Automatic Career Progression is the only Way Forward

A patient safety organisaton in the US tweeted about the international healthcare workforce crisis last week, from a perspective of nursing. “We are in the midst of a global nursing shortage. The U.S. will experience an extreme scarcity of nurses in the near future. Factors include high turnover rates from burnout, shortage in nursing faculty, increase in workplace violence and more.”

There’s something oddly reassuring that it isn’t just a UK NHS problem (at least you feel it’s not all our fault). But really, it just makes it worse. We are competing in a global market, with the supply lower than the demand. Local NHS organisations are uniquely not set up to address this in a classic demand/supply way, as the pay and conditions are set from the top. Which means that the only way we can recruit internationally (even UK trained nurses are part of this international market – very able to work abroad if they wish) under the current silo professional model is to keep increasing nurse pay and conditions. Not something I oppose, but you can only go so far on staff pay when you want to invest increased NHS budgets into more care as well as recruiting and retaining staff.

In this week’s BMJ, a commentary from David Oliver describes some basics on conditions – like having breaks, and being able to have a drink of water or tea whilst on shift. It paints a stark picture regarding breaks, being able to have time to drink or eat. Many staff are apparently dehydrated on shift. This is again, not just a UK phenomenon, with 45% of clinical staff dehydrated whilst at work.

With 1 in 8 nursing posts in the NHS vacant – worse in some areas – and a similar pattern in other professions, we cannot just stand by and do nothing. It will simply get worse.

So yes, we need to improve pay and conditions. But we also need to think outside the box.

What are the competencies those nurses and doctors need to fulfill their tasks? How quickly would it be to train people to do 80% or 90% of those roles? These may be Health Care Assistants (HCAs), for example, who can learn on the job. This is relatively easily done. The problem is that HCAs, like care assistants, are not well paid (in fact care assistants are worse paid). And there is no clear career trajectory. They reach a ceiling of competencies they can do without going back into formal training – to do more they would need to go to university and train to be a nurse, or a physio, or a paramedic etc. Another set of silo professions.

Better would be continuous on the job training. So that their work place is always attached to a university, and their continuing professional development (CPD) is based on an agreed professional development plan (PDP) on what they want to do. What competencies are needed to be obtained in the next year, two years, three years etc, to allow this person to take on more responsbilities and move up the banding, with automatic career progression within a supportive NHS organisation?

If we could streamline training to match the competencies needed in a workplace setting, rather than focus on professional job titles, and allow automatic career progression with the obtaining of these competencies, then we would have a much larger pool of people to fish from from an employment point of view. We would get school leavers, people changing job mid career, people whose children have gone to school and want to get back into the workplace. And with automatic career progression, we would get more people with local links to an area – who are more likely to stay in a less glamorous location or role.

We have a 19th and 20th Century way of training the workforce, whilst we have a 21st Century health care system to deliver. An ageing population, a workforce that is more dynamic, and international, more focussed on portfolio careers. So let’s redesign training and career progression in the NHS to be more dynamic and suitable for portfolio careers, and give local people employers that will develop them and progress their careers seamlessly.

PS – I wrote before about doing something similar with social care and the NHS together before. If health and social care were fully integrated (Health and Social Care Trusts, anybody?) then we could do this easily, too.

PPS – Let’s get on with some pilots NOW.