WORKFORCE ISSUES
The report goes on to consider the following aspects of workforce supply and outlines its conclusions:
What will be the impact of the change in student nurse bursary arrangements on the future supply of student nurses? UCAS data showing that demand for student nurse places exceeds the supply of funded places, local NHS precedents of self-funded degrees and relevant policy experience from Australia are explored. The report concludes that removing the current cap could lead to an increase in the number of student nurses,
but much will depend on the attraction of nursing as a career, and the availability of high-quality training placements.
Is international recruitment a viable long-term solution for the NHS? International recruitment has been used as a quick, relatively cheap, fix for employers faced with the immediate pressure to fill vacancies. About one in eight nurses in the UK was trained in another country. The rate of international trained nurses has risen since 2009, with migration from EU countries accounting for most of the increase. The
The need for a national people strategy
SJ Leatherdale, partner at Odgers Interim, discusses the absence of a national people strategy during a time of turbulent transformational change.
Putting a spotlight on senior roles within Trusts across the country, we have seen chief executives vacating positions at pace in recent months, and this is having detrimental effects on the workforce. Increasingly viewed as a highly challenging task with little support and high pressure, leadership positions are becoming undesirable and no longer something to aspire to. Ultimately, when working closely with the NHS and looking who its future leaders will be, it is becoming increasingly difficult, because those with the right level of experience, who in years gone by would have done all they could to move up the ladder, are being dissuaded.
There is no doubt there are exceptions to the unusually high turnover of staff, but the trend is undeniable, and stems from the lack of a national people strategy coupled with imminent pension reform. The NHS’ workforce at all levels is no longer nurtured with training and development opportunities as it once was. It needs to harness and galvanise talent at management level to identify who the senior managers of the future will be; where this was once the role of the CEO. Developing a national people strategy would enable the NHS to identify where there are gaps in the system and nurture talent to grow into them. Additionally, analysis needs to be focused on factors that may make the NHS an unattractive place to work; it may be around culture, values or pay, but this needs to be explored. This may help prevent the need to look abroad for talent which is unfortunately becoming more common.
Driving change
The work of the NHS is globally renowned and continues to be of high quality, despite the challenges facing it. Yet the lack of a national people strategy is affecting staff at every level and the Lord Carter review is
already increasing the collective downward pressure on senior leaders, who have played, and will continue to play, an integral role in helping the health service respond to the austerity agenda, plug specific skills gaps and drive system-wide, as well as local health economy, transformation.
Senior leaders have played, and will continue to play, an integral role in helping the health service respond to the austerity agenda, plug specific skills gaps, and drive transformation. With this backdrop, it seems that their skills are needed more than ever to help implement major restructuring and allow permanent management teams to keep their focus on the day-to-day operations, quality and above all, safe staffing. Increasingly directors of nursing and other leaders in clinical governance are sought after to ensure that there are no shortfalls in the quality of and provision of care. HR support is in demand to assess what the Carter report means for the workforce, and to help everyone adapt and cope with any periods of unsettlement. They are also being called upon to help plug skills gaps that can emerge from the organisational changes, and managers that have worked outside the NHS and the public sector are increasingly sought after. Effective HR is essential to make the Carter project work and drive the cost savings it is supposed to, as well as to decipher how we can retain really experienced people. Cultural transformation on this scale can sometimes be met with resistance. For the NHS to continue to deliver a world class health service, those working on Carter need to avoid taking a transactional approach to its implementation, instead putting people at the forefront of ongoing development and ultimately, improvements.
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implications of Brexit on these flows are as yet unclear, but will increase concerns about this source of workforce supply. The report concludes in the short term, policymakers need to look at how international recruitment can be used alongside policies focused on staff retention and effective use of temporary staff to address current and looming workforce shortages. This requires more effective coordination of different central government departments, including Health, Home Office and Treasury, as well as professional regulation. In the long term, there is a role for Government in monitoring and moderating international recruitment, so it becomes a more integral part of a more sustainable, long-term approach to the effective supply of health professionals for the NHS.
Can the recruitment, retention and distribution of GPs be improved? Recruitment, retention and distribution of GPs are critical issues for the English NHS, and workload is rising faster than workforce and funding available. The report concludes that policy needs to give greater consideration to achieving a more equitable distribution of current GP services. International experience suggests this requires looking at skill mix changes, service redesign and better use of technology, as well as trying to increase the number of GP hours available.
Can the physician associate become a significant part of the workforce? Similar roles have been introduced in the US, but with only around 200 physician associates currently employed in the NHS, and a suggested training intake of 650 per
OCTOBER 2016
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