Have we got the time to wait?
With the Government announcement last week that a ‘revised workforce plan’ will be revealed next Summer, I was prompted to get on and write another blog.
So, in the original plan the government promised 170,000 more nurses, 64,000 nursing associates and 10,000 extra nursing students in England each year by 2037.
These were certainly ambitious figures but there’s nothing wrong with ambition if backed up with a good plan of execution. However, there were criticisms at the time about a lack of detail and the plan was also heavily criticised for not addressing the financial investment needed to attract a new workforce and retain the existing workforce.
The revised workforce plan is said to be likely to include details of how to increase the community health workforce, which will no doubt be crucial for 2 of the 3 shifts the government have broadly agreed to be necessary to improve health and care services in England.
Shift 1: moving more care from hospitals to communities
Shift 3: focussing on preventing sickness, not just treating it
Wes Streeting said “We will refresh the NHS workforce plan to fit the transformed health service we will build over the next decade.”
So, again, a focus on numbers will clearly be important, to address the community nursing workforce which is in decline and for which there has been a fall in the number of people studying for these positions. And with that significant financial investment too.
However, numbers and money alone will not provide what is necessary to give these two shifts any chance of success and it leads me to think that although it makes great headline news, we’re starting in the wrong place.
I fear that in setting out to ‘transform’ the NHS, the Government will opt for solutions that are overly complicated, too expensive or not the even best solutions (anyone remember Nightingale hospitals?) and what’s more, they’ll take a significant amount of time, and in the meantime, the risk of services deteriorating further, more of the workforce leaving and patients suffering increases.
I also can’t help thinking that the ‘Change NHS: Help build a health service fit for the future’ campaign is an example of this. I completed the main survey the day after it was live, and there were already 1000s of responses. I then went back to ‘submit an idea’ later that week and was completely overwhelmed with the ideas already submitted, many of which are repeated numerous times, as you would expect. The day of writing this blog there are more than 70,000 responses and 10,066 ideas! I’m presuming AI will be used to sift through all of the responses to some extent, but it strikes me that there will be so many ideas it will be impossible to know where to start.
So, where should we start?
With the people, of course! In the very same way that a holistic approach to health and social care provides the best outcomes for the patients/people being supported, we need to look at what the people in our workforce need to be happy, healthy and remain in their jobs. We need to look at the relationships, the culture and the immediate and wider environments within which they work. We need to consider not only their earning needs but also their learning needs, equipment needs, their motivators. And beyond their needs we need to look at the way their work is organised, and the obstacles that prevent healthcare professionals doing what they need to do and want to do.
We need to address what’s wrong with the whole system of course but in the meantime, I believe we need to look at what’s strong, namely a largely brilliant workforce. Although there are many stories of people leaving to work in supermarket chains where the pay is higher and the work less challenging, there are many staff I spoke to whilst my mum was in hospital last year that stay because ultimately, they love what they do.
So, in the interests of the committed, hard-working workforce we do have, we need to improve their working lives now, and not when the findings of these surveys are concluded and with a plan that has the risk of being so broad and wide that it misses the different needs of individuals, of teams, of departments, of geographical locations.
We can, and should, start now, locally, with teams and departments addressing simple changes that aren’t restricted by legislation and don’t need big system changes first. We need to look for common sense, simple solutions, that I have no doubt the people working closest to the patients have.
I know from personal experience caring for my mum and dad and using A&E, in-patient services, the GP surgery, community nursing teams and local authority social care services, I am often frustrated by the system. What’s more, I can very often see solutions that appear so common sense that I feel I’m missing something and yet when I chat to the professionals, I’m often told I’m not, ‘it’s just the way things have to be done’ and ‘yes, it is frustrating’ and ‘yes, there’s no sense to it’.
Imagine if every team, team leader, department, service or senior team member, started with changing just one thing – whether it’s changing authorisation levels, meetings, sign off procedures, budget processes, paperwork requirements and so on.
What difference would it make?
A little, is the answer. Well at least to begin with. However, across departments and organisation-wide, these small actions would soon become the force for powerful transformation.
Over time there would be more space for creative thinking and more time available to spend with the patients. Staff would hopefully feel more trusted, more supported and less controlled and there’s plenty of evidence to show that this will result in a higher quality service and higher satisfaction levels for both the workforce and the people they serve.
I was planning on sharing some first-hand examples here to back up my words, but I’ll save those for another blog and share just this one recent experience.
In October I spent a full night in A&E with my mum and during our time there, we were moved between 5 different cubicles/bays. There was a clock in each of those places but only 1 out of 5 was displaying the right time, day, date, month. Now I know as much as anyone that has been with a relative who is seriously ill in A&E that this is such a trivial detail; however, as I sat there throughout the night, I couldn’t help thinking that it sends out the wrong message.
It seems to reinforce the phrase we’ve become so used to hearing – that ‘the NHS is broken’. It unsettled me for a reason I find hard to explain but it’s bound in my earlier point that we need to look beyond numbers and money, we need to look at the environment, the culture and so much more, to create a place in which teams, patients and families can trust – a place that says we care, it matters and we’ve got you!
And to do that we need to change what we can now, there is no time to wait for the Government or local authorities, we need to start small and start now! So, whilst the much bigger issues, such as record sharing (so essential, but so very difficult and expensive) are being dealt with, we encourage and empower senior leaders, who in turn encourage and empower their teams to change what they can.
We start with the people, we let them re-design and build a system that has them at the centre rather than starting with numbers or funding and maybe, by doing this, we’ll find we don’t need such huge numbers or such huge budgets or at least that budgets can be re-directed. We’ll see that changing the way the work is done produces better outcomes – happier people (workforce and patients) and a higher quality, sustainable service. At which point, the recruitment will take care of itself through the staff that have been retained and instead of saying ‘I love my job but . . .’, they’ll simply say ‘I love my job’.
Let’s get started – the clock is ticking!
* If any of the above has resonated with you and if you think you or someone you know can help by starting to make small changes, then you might be interested in Public World’s ‘Challenge yourself to make a change‘. Look out for it on Public World’s social accounts: LinkedIn, X, Bluesky, Facebook.
Sources used for this blog:
‘You can’t recruit your way out of a retention crisis’ | News | Royal College of Nursing
https://www.rcn.org.uk/magazines/Advice/2023/July/NHS-workforce-plan
‘Refreshed’ NHS Long Term Workforce Plan confirmed for 2025 | Nursing Times
Was building the NHS Nightingale hospitals worth the money? | The King’s Fund