Shifting demand in both the nature and location of care – moving from hospital-based and acute provision to more community-based or bridged services, the challenges of treating an ageing population, the rising demands from long-term conditions and a focus on preventing ill health – all have an impact on the kind of workforce that the NHS needs.
These challenges are not unique to the NHS. Calls for better utilisation of specialist skills exist across all sectors and industries, and cross the boundaries of private and public divide in the UK and across the world. Dewhurst, Hancock and Ellsworth, in their January 2013 article for the Harvard Business Review, remind us that 'experts with prized skills are too rare to squander on jobs others can do'. Creating high-quality care will need NHS leaders to be bold about utilising highly paid specialists in high-value activity. This requires challenging the thinking about how health professionals spend their time now, and considering whether new roles, such as the hospitalist – a hospital doctor charged with the general medical care of patients while in hospital – need to be developed in the UK to improve the experience and efficiency of care.
Technological innovation will also undoubtedly have a major impact on how the workforce is shaped and how it operates. The use of mobile technologies is already challenging the traditional lag in communication, making geography a much less relevant factor in care and potentially speeding up diagnosis and in some instances (depending on your access to the web) communication with and between multi-professional teams and the patient. These advances will change the dynamic between professionals and patients and require a new set of skills. In her blog, Viv Bennett urged us to take advantage of technological advances but to ensure their use was driven by patients' needs not professionals’ desires, for example, to promote independent living.
Robert Francis has prompted further debate about the core skills and competencies of health professionals. A number of professional and academic bodies here and in the USA have done significant work developing competency frameworks for nurses and doctors including the Medical Leadership competency framework produced by the UK’s Academy of Medical Royal Colleges and the NHS Institute for Innovation and Improvement. These frameworks demonstrate a growing recognition that the role of professionals with specialist skills (and this includes all the allied health professions and the scientific staff involved in health care) requires a rethink if the NHS and its patient population are to extract the maximum benefit from those skills. It also prompts important discussion about team competencies and how we understand and develop the mix and utilisation of skills across a whole team.
Leadership plays a vital part. The blog by Partha Kar discussed the role of the consultant (and generated much debate about the role of specialists versus generalists on our website). It explored the need for senior doctors to go beyond leading only within their service and promoted a vision of a much more outward-facing consultant engaged in public health, community services and education as well as what was happening within the walls of their own hospital.
All our bloggers pointed to the theme of leadership in some way: the tensions that clinical leaders face, the nature of NHS management and how it has to change, and leadership across professional and organisational boundaries. Recent discussions about the appropriateness of a 'pace-setting', target-driven style for NHS leaders versus a more collaborative team- and values-based leadership position should not be confused with the need to move with pace to improve the utilisation and management of its workforce, the most costly and valuable element of our NHS.
Mark Newbold ended his blog with the question 'shall we get started?' If we are to aspire to being 'gold medal performers' then it is time for both political and organisational leaders at all levels in the NHS to have the difficult conversations and to begin to support and initiate action as opposed to waiting for change to be imposed.