Building the right workforce

Building the right workforce

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  © Nuffield Trust Buildingthe workforce as we transform the delivery system Candace Imison The Commonwealth Fund and the Nuffield Trust 15th International Meeting on Improving the Quality and Efficiency of Health Care Pennyhill Park 17 July 2015
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  © Nuffield Trust Overview •The challenges we face • Workforce – the English context • The opportunities offered by changes in skill mix • The challenges of skill mix change • Lessons for the future
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  © Nuffield Trust Thechallenges we face – the need for transformation • Ageing population + rising burden of chronic disease and co-morbidity • Changing expectations of, and relationships with patients • 24/7 working • Impact of new medical and information technologies • Financial context – unprecedented productivity challenge – £22bn by 2020
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  © Nuffield Trust NHSWorkforce profile in England 0% 5% 10% 15% 20% 25% 30% 35% NHS Infrastructure support Support to clinical staff Additional professional, scientific and technical (including healthcare scientists) Allied Health Professionals (including qualified ambulance staff) Nursing and Midwifery Registered Medical and dental % Total earnings % FTE FTE data: NHS Hospital & Community Health Service (HCHS) and General Practice workforce as at 30 September 2014. Total earnings calculated through using estimated average earnings per staff group (taken from 12 month period ending February 2015) and FTE data. Data sources: NHS Workforce Statistics in England, 2011-2014, HSCIC; NHS staff earnings estimates to February 2015 - provisional statistics, HSCIC. Staff employed by NHS organisations – hospitals, mental health and community providers General Practice staff contracted to the NHS 0 25000 50000 75000 GPs Practice Nurses Advanced & Specialist Nurses Direct Patient Care (HCAs) Other Admin & Clerical General Practice Staff FTE FTE
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  © Nuffield Trust UKhas seen significant expansion of medical workforce (but not evenly distributed) -15% -10% -5% 0% 5% 10% 2009 2010 2011 2012 2013 2014 AxisTitle Medical and dental Nursing and Midwifery Registered Allied Health Professionals (including qualified ambulance staff) Additional professional, scientific and technical (including healthcare scientists) Support to clinical staff NHS Infrastructure support - including hotel, estates and managers Data source: NHS Workforce Statistics – February 2015, provisional statistics, HSCIC. Data taken from December of each year shown.
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  © Nuffield Trust England– workforce supply issues  Recruitment difficulties & forecast shortages  Nursing – hospital, primary care and community  Doctors – A&E, acute medicine, psychiatry, general practice  Social and informal care  Changing workforce expectations  More flexibility  Less organisational allegiance  How sustainable is continued restraint on pay?  Geographical variation – recruitment black spots
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  © Nuffield Trust RoyalCollege Physicians survey highlights some of issues
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  © Nuffield Trust Skillmix change could offer some solutions 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Delivers more patient focused care Addresses gaps in medical workforce Addresses gaps in skilled nursing workforce Delivers savings in service costs Improves health outcomes Improves overall recruitment and retention Addresses gaps in allied health professionals workforce Other Delivers savings in training costs What would be the benefits of skill mix change for the area with the greatest potential to benefit? (n=17)
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  © Nuffield Trust Allservice areas have potential to benefit from skill mix change – but particularly primary and community care 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Community services Hospital inpatient services (secondary) Hospital inpatient services (tertiary) Hospital outpatient services (secondary) Hospital outpatient services (tertiary) Mental health services Pharmacy services Primary care Social care Support for self-care How much potential do the following health and social care service areas have for skill mix change (recognising the opportunities offered by new technologies)? (n=18) Great potential Moderate potential Little potential No potential
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  © Nuffield Trust New(alternative) worker New work Old worker Old work increasing the numbers of nurses, doctors, and other health professionals expanding the job descriptions of existing workers, such as community matrons, to include work previously not done by anyone handing off existing tasks to other workers, such as nurse practitioners and general practitioners with specialist interests creating new jobs for work previously not done by anyone, such as genetic counselors, and lay providers to support self- care Redistribution Creation Capacity expansion Retraining Source: Bohmer, Imison. Health Affairs 2013, 32(11), 2025-2031 Framing the options for skill mix change
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  © Nuffield Trust Summary:considerations in workforce redesign 1. Complements vs. substitutes; previously new roles have been added w/out decommissioning old roles with a net increase in costs 2. Importance of role definition; new classes of worker often have poorly defined roles, especially in relation to the roles of others 3. Benefits of seniority; senior clinicians, although more expensive by the hour tend to order fewer tests and utilize fewer bed days, admissions and procedures 4. Risks of fragmentation; dividing the work among more (cheaper) workers increases team coordination costs 5. Importance of a career; new roles benefit from a formal career structure, national recognition and portability
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  © Nuffield Trust Messagesfrom Time to Think Differently • The staff we will have are the staff we already have – don’t rely on the pipeline • Align the workforce to the work – not the other way round • Develop teams not just individual professional groups • Support and “activate” patients • Support the informal workforce • Reverse the inverse training and investment law • National facilitation but local action
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  © Nuffield Trust Conclusion “Newtechnologies will force changes in delivery models that we have not yet thought of. Without building capacities and capabilities in our workforce for a world of continuous change and emergence of new roles and possibilities, we risk being perpetually out of step and continually rebuilding our workforce to do yesterday’s not tomorrows health work” Professor Richard Bohmer
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  © Nuffield Trust17July 2015 www.nuffieldtrust.org.uk Sign-up for our newsletter www.nuffieldtrust.org.uk/newsletter Follow us on Twitter: Twitter.com/NuffieldTrust © Nuffield Trust [email protected]