Delivering the workforce of the future

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Part of Time to Think Differently

The leaders of today's NHS are facing the question of how best to develop a workforce that can take patient care into the future. This is perhaps one of the most challenging aspects of our Time to Think Differently programme as it requires leaders to visualise a future in which our current skills and roles may be redundant or need significant change. Writing over the past few weeks, guest bloggers Viv Bennett, Partha Kar and Mark Newbold have given us a call to action to initiate change.

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.

Read the related blogs

Comments

Marc Farr

Organisation
EKHUFT
Comment date
15 March 2013
Very interesting Vijaya,

The points about a hospitalist and the impact of IT mirror the key tenets from a lot of the discussion of healthcare disruption from Clayton Christenson and chime for us locally as long as people realise that teleheath and telemedicine are completely different things. For a jobbing NHS manager, one of the key considerations is whether we site lots of different providers in the same geographical location [so that minor injuries and children can stream easily out of A&Es], the health village or campus or whether we organise care closer to home, by sending someone already on the Community's caseload home from A&E where they should get seen quicker by a mobile rapid response team than waiting >4 hours in an increasingly busy A&E.

You talk about envisaging the future and getting started. For me personally, we need more of the type of statute that banned smoking in public. Very disappointing to see us stalling on minimum cost of alcohol, still no drive to get junk food out of hospitals and schools, still very little evidence of recurring health education for patients that are stabilised and simply bounce back because they fell off the low-salt wagon that that their brief discharge plan recommended.

Where's the big change?

Vijaya Nath

Position
Assistant Director,
Organisation
The King' s Fund
Comment date
18 March 2013
The distinction between Tele-health and Telemedicine is an important one.I agree the radical changes needed requires our political leaders and our leaders from health and social care to show commitment to these changes.
Thank you for entering the debate and reinforcing the need for a call to action.

Mark Newbold

Position
CEO,
Organisation
Heart of England NHS FT
Comment date
20 March 2013
Great summary Vijaya, and you are right to pick workforce as your theme as it is key. I think there are three key workforce challenges - we will need new skills in the future as you describe, we will need existing roles to evolve as we change our models of care, and we will need to dramatically improve the engagement of our existing people in the change process.

The latter is a real and pressing challenge for all leaders today, but I truly believe that progress on this will quickly pay back in terms of patient benefit. Our staff, at all levels, are hugely committed to patients but we need a more involving, inclusive, and collaborative leadership approach if we are to harness the same energy in designing and implementing change.

Partha Kar

Position
Clinical Director, Diabetes,
Organisation
Portsmouth Hospitals NHS Trust
Comment date
20 March 2013
Excellent summary of where we are heading, or trying to. The vast majority want to do the "right" thing and strong leadership is needed to harness that energy and drive. To reinstate the faith, we also need a strong sense of accountability. Perhaps we overcomplicate it and simply look at accountability from 3 viewpoints:
1. Are we doing the job we are paid for i.e.being present to do clinics etc?
2. Are we delivering good care- measured on outcomes- and agreed a tricky area as things stand
3. What do the patients think of what we are doing?

All said and done, my own experience has been that its not all doom and gloom- things can be changed and improved but it takes time and patience with relationships being the key- based on the bedrock of mutual respect. We are too caught up perhaps in the theory and need to start looking at models which are working or even learn from areas which hasn't worked.

As the saying goes..." Knowledge is knowing a tomato is a fruit; Wisdom is not putting it in a fruit salad". Fingers crossed..the collective goodwill will add up to improve patient care.

Chris Roseveare

Position
Consultant in Acute Medicine,
Organisation
President, Society for Acute Medicine
Comment date
21 March 2013
This is a good summary of the current workforce challenges which we are faced with. The need for more Generalists in hospitals has been reiterated, but as we look for solutions to provide this it is important that we do not attempt to reinvent the wheel. The specialty of Acute Internal Medicine was established to ensure safe effective care of medical patients admitted as emergencies; trainees in AIM undertake blocks of training in a variety of specialties and most will attain dual accreditation in general internal medicine (GIM). Working alongside geriatricians, Dually accredited consultants in GIM / AIM will be ideally placed to provide holistic ongoing care for those in-patients without specific speciality needs. However numbers of trainees in this area is currently insufficient to meet the demand for consultants in this field. It is vital that this issue, and the current challenges around recruitment into medical SpR posts are urgently addressed to ensure that we have a workforce which meets the future needs of our population.

Kelechi Nnoaham

Position
Deputy DPH,
Organisation
NHS Bristol
Comment date
25 March 2013
Thanks for this thought-provoking and timely blog Vijaya. As the need to deliver value in health systems gains increasing importance, more attention than has been the case needs to be paid to understanding the dynamics that would create true value in future health systems. In this respect, I am thinking of the factors that determine propensity to benefit from or be harmed by healthcare interventions since the relationship of these variables and their interaction with healthcare resource is what creates value. Understanding these dynamics will no doubt highlight the imperative of re-aligning the healthcare workforce both as a means of optimising resource input and health gain. In addition, the pressure of long term conditions and an ageing population puts into sharp perspective the need to emphasize prevention across the life-course and indeed, of making every clinical encounter count in respect of disease prevention and health promotion. Without giving this agenda its rightful place in health policy and medical education curriculum, we stand little chance as a nation of holding up under the pressures we face on healthcare resources. Our opportunity must lie in making prevention and the principles of public health core to the medical and wider clinical curriculum. Enshrining public health in core and wider clinical training has to be part of the answer if our health systems must create real value that matters to the public.

löparskor herr

Position
löparskor herr,
Organisation
löparskor herr
Comment date
07 October 2014
Im trying to figure out how to subscribe to the RSS feeds, but dont seem to figure it out. Some help would be great Thank you

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