Think tractors…


Just, relax.

Relax… that there is no DH+ Mandate. The LongTermPlan is the mandate.

Relax… about the Green Paper on the future-funding of adult social care. Damien Green, trusted Teresa May ally and official kite-flyer has written what is likely to happen.

Don’t relax that there’s no workforce plan. An interim something was scheduled for April… not happened.

Why? I think the answer is; it has become such a critical, neglected problem no one knows what to do.

The nearest we’ve got is DiDo’s opaque rumination at an RCP conference… about Soviet tractor production.

Note to DiDo;

… the Soviets started 50 years behind everyone else, were resource-rich but had no experience of modern production methods.

They turned to Ford, General Electric, Siemens and the remarkable, Detroit based Albert Kahn, for a jump-start.

A plan was written; new production methods, people were trained in modern techniques, local delivery got underway and the Belarus tractor was born. They built 550,000 a year, many for export… the US and Canada became big customers.

Why is NHS workforce planning in tatters;

• From 2006, for a decade, there was a push for all Trusts to become FTs. To achieve this, their biz-plan bottom-line had to balance and most deliberately understated 70% of their costs… their staffing establishment. The unintended consequence; it skewed all subsequent workforce planning forecasts.

• In 2012 HEE was established with no legacy, little expertise, a fragmented infrastructure, dodgy workforce numbers and almost immediately, a budget cut of 9%. They’ve never recovered.

• The Bursary stopped.

• Brexit uncertainties and EU supply dried up.

• A global shortage of care-staff we ignored.

• Ten years of cuts to social-care… eligibility denied 900,000 vulnerable people the care they once got and care package availability crashed. Unintended consequence; NHS systems chocked up and created a demand for more nurses.

• Training-nurses and apprentices are supernumerary on wards, create costs but little contribution to care.

• 23,000 MH staff left last year and 90+ nurses a day quit the NHS.

• Inflexible staffing-rota leads to more staff electing to work agency.

• Safe-staffing is no longer possible… nursing becomes more pressured, risky… job satisfaction falls.

How many vacancies do we need to fill? Dunno…

• The vacancy-rate is the percentage of reported full-time equivalent staff in-post, against planned workforce levels. Trusts will not actively recruit to fill their entire gaps if they are under regulatory pressure to balance their books. Trust’s ‘establishment’ could be deliberately understated.

• A vacancy is defined as a post that is unfilled by permanent or fixed-term staff. Agency or temporary staff may fill some vacant posts and invite creative interpretation of ‘fixed-term’.

• NHS Digital tried calculating vacancies; using the number of job ad’s on the NHS Jobs website.

• It didn’t include vacancies advertised in the local press, Trust’s websites, Yachting Monthly, introduce-a-friend, or job ad’s on FaceBook, Linkedin and the rest if SoMe.

• And, one advert might be placed for several identical nurse vacancies at the same Band.

It’s probably time to admit… we don’t really know how many vacancies there are.

Solutions, think tractors;

• There won’t be enough people, ever. Get over it. Think, ‘new production methods’ and that means a national curriculum (not the 17 we have now), digital-first, AI, machine-learning, decision-support, new training methods and get a grip on interoperable, IT procurement.

• Trusts have to wake-up and become better employers. Share best practice, urgently and benchmark for results. What are they doing today to make their sons and daughters want to work there?

• Overseas recruitment must be reconciled with immigration policy.

• Create a national workforce development template that is bottom up, make sure every one understands the urgency. Implement it step-by-step. Don’t try and do everything at once.

• Realign regularity markers to focus on funding the front-line, supporting it and making it fun to work there.

The Belarus Tractor Factory has started making tractors with compression ignition diesel engines, matching the current emissions standards, including Tier 3/4i/4 (United States/Canada) and Euro 3a, 3b, 4 for emission standards in Europe.

Last year it exported $81.2m worth. Every 10th tractor in the world is from Belarus.

I don’t think the NHS workforce will get back on its feet until everyone thinks tractors.

Contact Roy – please use this e-address – roy.lilley
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Reproduced at by kind permission of Roy Lilley.