Make it work…

training primary care NHS make it work

The thebmj.com has an interesting piece by Professor of healthcare and workforce modelling, Alison Leary.

To paraphrase; there’s nothing new in a workforce crisis, supply-side solutions are unlikely to work and;

‘… we need the courage to let go of activity as the primary measure of success in health, and instead consider outcomes for patients and workers when we think about workforce planning.’

Alas, Prof Alison stops short at the ‘what’.

Therein the problem for us all, ‘how’.

Everything we’re; doing, planning, expecting, regulating and demanding is predicated on the basis… we have sufficient staff. We don’t and won’t, ever.

That ship has sailed. We are in uncharted waters. There is a local, regional, national, EU and global shortage of health workers.

We can play pass the parcel… recruiting from here, pinching from there… up-skill, and as Alison says; ’employ reductionist approaches to the division of labour… and measure productivity by the number of tasks…’

… but when the music stops… the painful truth… there ain’t enough people.

The Long-Term-Plan ducked ‘workforce’ and sailed into the future assuming, somehow their boat will safe-harbour, at a place of fully trained, lovely people.

Bonkers. We need to figure out how we can catch up, where it’s feasible and how to do things entirely differently, where it’s not.

We’ve all been impatient for it… in fact it has only taken about three months to pull together the newly published, Interim People Plan. Does it have the answers?

Well, there is no magic wand and we have to become a lot better at ‘the people thing’ and much better at opening our minds to ‘changing things’.

The IPP is disarmingly frank about the state of the workforce;

‘… there are around 40,000 reported vacancies in substantive nursing posts (… around 80% of these shifts currently covered by bank and agency staff), and … further pressures in primary care.’

I’m guessing, the assumption is, the Autumn Statement will fund the costs associated with the Plan’s roll-out.

If Tory leadership shenanigans create a shake up in leadership and Treasury thinking… all bets are off.

The Plan takes a wide sweep at the issues and comes at the problems in three layers;

• Stuff we have to do now,

• Stuff we have to be getting on with and…

• Stuff that prepares us for the full People Plan, later in the year.

The medical workforce and allied healthcare professions and even volunteers and carers are all in the spotlight.

Even Mum’s Net is being roped-in to help recruit return-to-nursing.

However, nursing shortages occupy centre stage, (Page 20). The complexity of Uni places (graph on page 24), placements (5,000 more by September), synchronisation, acceptance rates and funding.

Top of the ‘stuff-to-do-now’ list is retention. Here is the problem, encapsulated in a single Tweet yesterday, from nurse Charlotte Flannery;

‘I asked if I could drop back 2 bands to work, anything, apart from term-time, Mon-Thurs lates, although school holidays are ok, but was told no, as everybody wants to work that. Instead, I’m doing bank for more money on the same ward! It’s crazy.’

Can the Plan fix this bone-headed crazy?

The Plan doesn’t hide from the issues but they are complicated and so are the solutions.

Over 20 things to deliver this year, more than 30 by 2020, many devolved to organisations already working at full-stretch, many distracted and overburdened by regulation.

Supported by an organisation, itself, in the turmoil of reorganisation.

Major responsibilities are devolved to STPs, on their way out and ICSs, on their way in… it’s a risk.

Workforce is a self inflicted problem; poor decisions and poor organisations making them. We have become a poor employer and alas, suffer from poor leadership. Page 12;

‘A… survey of board papers … reveals a limited focus on people issues’ .

DiDo will need a big in-tray.

My advice; get clarity, sweep away the confusion of HEE, get some NHSI/E regional frameworks up and running pronto, go prospecting for best practice like you’re looking for gold-dust but share it like confetti.

Do the quick-wins, show you mean it. Get the boiler room going on the structural changes, encourage innovation, accept failure, ask for help, celebrate success.

My experience has been; the NHS is what happens whilst you are making plans.

That’s code for; we’ve got a plan, there’s more than enough to go on, let’s get on… make it work.

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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.