The NHS employs about 1.6 million people, which puts it on to the list of the world’s top five biggest employers, rubbing shoulders with the US Department of Defence and China’s People’s Liberation Army. In England alone the NHS has 1.3 million staff working in 300 different roles on the payroll of 1,000 different employers. That 1.3 million includes 111,000 hospital doctors, 356,000 nurses, midwives and health visitors, 37,000 managers, 40,000 GPs and a clinical support workforce of 359,000, according to the Health and Social Care Information Centre.
The figures illustrate the challenges the NHS faces in keeping the right number of people with the right skills in the right place to deliver today’s services. But they also highlight the scale of those challenges to ensure that the workforce keeps pace with the future patient demographic, such as an increasing older population, and developments in clinical practice and science, like genomics, which have the potential to revolutionise the way healthcare is delivered.
But workforce is not just about numbers. Danny Mortimer, chief executive of NHS Employers, which represents trusts, says: “I don’t think it’s as straightforward as employing more doctors and nurses, it’s about making use of the professions that are available and growing new roles.”
Mortimer says it is crucial to bring the social care workforce into the equation in future as health and care and support becomes more integrated. “Workforce doesn’t sit in a vacuum – it’s to support the service you need to deliver in the long term. If you start with the patient and who cares for that patient it includes services by social care.”
Health Education England (HEE) is responsible for commissioning the education and training for the NHS in England. Its £5bn 2015-16 workforce plan includes boosting the number of nurses by 4.2% and promises 14% more GP training places by 2020. The number of training places for physician associates – a new role in primary, emergency and adult medicine developed in the US where the clinician takes on some of the duties currently delivered by junior doctors – is increasing to 205; a 754% rise in one year.
Skills for Health, the sector skills council for the NHS, acknowledges that new roles need to emerge to meet current and future NHS needs. But according to chief executive John Rogers, “there is definitely a need to develop assistant practitioner roles and physician assistant or associate is at the top end of that, but there are a lot more roles we are developing which have a huge impact and are less sexy”.
The creation of nail care assistants, for example, has helped reduce the waiting times for podiatry appointments from two years to six weeks. “Nobody sees nail cutting as a big thing but 30% of the over-65s can’t cut their own toenails – that’s 2.7 million people.”
The creation of this new care assistant role reflects Skills for Health’s desire to develop its existing support workforce, those who according to national Agenda for Change classification are in the lowest bands one to four. This support workforce accounts for 37% of the total health service workforce and includes roles such as porters, cleaners and administrators. Healthcare assistants are also in that number and are responsible for about 60% of direct patient contact.
“They are a critical part of the workforce but historically we spend very little on their education, training and development; we have left if it up to them,” says Ian Cumming, HEE’s chief executive.
Investment in this workforce also makes economic sense, according to Skills for Health, which calculates that changing the skill mix and increasing and developing the support workforce by 1% has the potential to save £100m a year. Ian Wheeler, Skills for Health’s head of research and evaluation, says investment in non-clinical support staff such as administrators can also make an impact. “They account for 13% of the workforce and a good administrator is worth their weight in gold.”
Prompted by the conclusions of the Francis report into the failings at Mid Staffordshire NHS foundation trust and the recommendations of the Cavendish review which scrutinised the role and training of health and social care assistants, steps are being taken to boost the quality of the support and wider NHS workforce. Mortimer says trusts are investing in support staff to meet the core competencies required by the new care certificate, which all care workers will have to achieve before they can work unsupervised.
Post-Francis, trusts now regularly report on ward and trust-wide safe staffing levels. HEE is developing a higher care certificate, creating new career pathways for ambitious care assistants and has trained 300,000 NHS staff in dementia awareness: a patient group predicted to increase by 40% by 2015.
It wants to see more undergraduate training placements occurring in the community in future and new undergraduate programmes offering dual professional nursing and social worker qualification are emerging.
“It’s fair to say that discussions are still continuing about this as some feel that you lose something if you don’t retain that professional expertise,” says Cumming.
