HEALTHCARE ESTATES 2022 KEYNOTES
new roles. Take physician associates, for example, and in 2014 there were just 52 across England, but in 2022, there were 1250, with more set to graduate over the coming years.”
A ‘much more strategic’ approach Looking ahead, he believed that the service plans, the NHS Long Term Plan, and Dr Claire Fuller’s review (on the ‘Next steps for integrating primary care’), plus the ‘refreshed’ cancer and mental health plans, all presented opportunities ‘to develop a much more strategic approach to the workforce’. Equally, the merger of Health Education England into NHS England, and the creation of Integrated Care Boards, afforded ‘a real opportunity to integrate workforce planning into service and financial planning’. Sir David had also been interested to learn – from IHEEM and HEFMA’s joint Workforce Strategy, Future Leaders, published in March 2021 – that there are almost 100,000 staff working in healthcare estates and facilities nationally in England – representing about 8% of the total NHS workforce across England, in over 300 different roles. He said: “Having read the Strategy, my challenge to you – given what I said about my three priorities for this presentation – is: ‘Is it strategic? Do you take a long-term perspective alongside the immediate challenges you face? What will your workforce look like in 15 years’ time? – not only what will the hospital look like, and what will the workforce required to work in it be, but what will your workforce look like?’”
An ‘inspired’ Faraday Challenge Sir David felt the IET’s Faraday Challenge for schoolchildren had been ‘inspired’, and had begun to ‘hint at the answer to that question’. He said: “But let me explore some of the more general issues across the workforce.” He explained that, having undertaken workforce planning
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over the past 3-4 years, in 2019 Health Education England worked on the People Plan with Baroness Dido Harding, which was still awaiting publication. He said: “Then, in 2021, we were asked by the then Health Minister to produce a strategic framework on the future, and in 2022, by Health Secretary, Sajid Javid, to create a Workforce Plan, projected for completion by November this year.” He continued: “You’ll all know – since those commissions were introduced – the uncertainty that has arisen as a result of the political changes, so I thought it interesting that in her plan for patients, the new Health Secretary, Therese Coffey, committed to publishing a Workforce Plan. Yesterday, speaking at the Conservative Party Conference, Robert Jenrick committed to produce a Workforce Plan. I regard it as significant that two senior government ministers have committed to such a plan.”
NHS workforce has grown Here, turning to focus on ‘the current shape’ of the workforce, Sir David noted that while the NHS workforce had grown by over 20% between 2010 and 2020, demand had risen faster than supply, driven by demography – largely older people presenting with complex, comorbid conditions. While the pandemic had driven delays in treatment times, increasing waiting times, the speaker said he believed the sector was ‘overly focused on acute care in England’; the percentage of nurses and midwives working in acute Trusts was 80% – exactly the same as in 2001. He said: “So, we’re concentrating on responding to care, and not on prevention and early intervention. We have, however, created
Sir David Behan: “We must regard workforce as our human capital, and invest in it over the long term”
22 Health Estate Journal January 2023
Increasing reliance on international recruitment These new roles were, however, ‘only a small percentage of our current workforce’, with an increasing reliance on international recruitment – a factor he believes is ‘unsustainable long term.’ He said: “Taking a long-term perspective on workforce is incredibly difficult. It’s quite easy to predict the number of nurses and doctors we’ll have over the next 3-5 years – because they started at university this week. We can make the subtractions for attrition rates of students, and when people graduate, but anticipating how many obstetricians we’ll need in 15 years’ time is much more challenging, and when you get on to those services which will depend on technology, it becomes even harder.” Thus, rather than planning, Sir David said the sector needed to use ‘foresight’ techniques to look at different scenarios of how the future will develop. He said: “Just walking through the exhibition here, it is absolutely clear the impact technology is going to have on the tools and techniques that will be available for healthcare delivery.” One of the most interesting visits he had undertaken in 2022 had been to the elective surgery wards in Exeter, designed through the conversion of a former Nightingale hospital, where hip and a knee transplant patients were now being discharged on the day of operation – really ‘pushing way beyond’ what the ‘Getting it right first time’ initiative had said about a three-day stay length, but with no diminution in outcomes. It was, he said, ‘really interesting how technology will drive changes in the way clinicians can respond to speeding treatment’. “But how,” he asked, “do we anticipate how many anaesthetists we’ll need in two years’ time with elective surgical hubs, where an anaesthetist, working with anaesthetic assistants, can operate in theatres simultaneously? How do those kinds of calculations work their way into future workforce projections?”
Drivers of change Sir David next addressed some of the drivers of change. He said: “The first is demography; by 2037 there are projected to be 1.42 million more households headed by someone aged 85+. In Cornwall, Somerset, and Devon, people this age will account for over a third of the population, while two-thirds of them will have complex, comorbid conditions likely to drive demand for services.” It was also known that spending on a person aged 85+ was five times greater than for a 30-year-old. The relationship between
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