The future NHS workforce will have to change significantly if it is to meet the challenges facing the health service.
It will also have to adapt to cater for the demands that the next generation will bring, in terms of how they want to access and use health services via technology.
“Three things need to happen for the workforce of the future: change, change, change,” said Prof Jane Dacre, president of the Royal College of Physicians.
She told delegates at the NHS Confederation annual conference in Liverpool: “Visions for the future are clouded by the crisis going on today with a workforce that was created yesterday. The answer is around the word ‘change’.”
Change is so necessary because two-thirds of patients coming into acute hospitals are over 65 and they present with various chronic health conditions. Hospital admissions are up by 47% and mortality at weekends has increased by 10%. A third of babies born this year will see their 100th birthday in contrast to 1948, when 50% died before the age of 45. Prof Ian Cumming, chief executive of Health Education England, also on the panel for the discussion, added that genomics will have “a revolutionary impact on how we deliver healthcare”. The workforce of today is not equipped to meet this increasing future demand, the panel agreed.
Cumming said that some of the issues with quality of care might be explained by an almost 50% increase in NHS consultants from 2003-13 and only an 11% increase in nurses and midwives during the same period. He questioned whether the shortage of nurses in the NHS and social care was because of a failure in workforce planning, or because the service had changed. He highlighted the “Mid-Staffs effect” which has seen an additional 21,000 nurses in the acute sector.
The panel agreed that more staff are needed and Dr Ruth May, incoming nurse director at the regulator, Monitor, said: “In the post-Francis era, we have needed and will continue to need more nurses.” She added that 13% more registered nurses were due in 2017 but questioned how the workforce would cope in the interim. She also highlighted the gap in skills and training between those with a care certificate and a graduate nurse.
Dr Amanda Doyle, chief clinical officer at NHS Blackpool clinical commissioning group, acknowledged that the government had promised 5,000 extra GPs to deal with demand. She questioned, however, where these GPs were going to come from. She said: “Last year, 261 GPs joined the NHS. Where are we going to get 5,000 from inside 20 years? We’re not. We’re not retaining the ones we’ve got. In Lancashire, where I’m based, 38% are due to leave or retire in the next 10 years.”
She added that there are issues around finding and training more GPs, especially in areas which are “not as attractive as central London and Manchester ... The situation is fairly dire. We need to stop talking about what a big problem it is and start coming up with solutions.”
She suggested training a surplus of people so that there are more qualified GPs. She outlined the need to accept that the workforce is made up of more women now and that working patterns should adapt to allow them to work part-time. “For 500 years the medical profession has been dominated by men. In the last few years that has changed. In 2017, it will be dominated by women. Some people see it as a crisis. Some see it as a welcome change.”
She pointed out that there could be an opportunity to convert biomedical sciences students into medicine. She suggested that pharmacists, with developed clinical skills, could help reduce the burden on the health service. She added that there was an immense need for great managers and she suspected that not many graduates were considering that as a career.
Dr Jennifer Dixon, chief executive of the Health Foundation, agreed and added that managers are needed to look at operational management, how people are supported and how to create order out of disorder. She said: “Clinicians don’t know how to make change ... They make brilliant changes at the frontline, but after a while they get stuck against other parts of the hospital. They don’t have the skills to negotiate bigger changes.”
Dacre continued by saying that some things would need to change to create a workforce of the future. One top priority is to improve the morale of doctors; 80% are happy with their work, but most are unhappy with the system in which they work. She added that doctors need to learn to innovate in daily roles, and that the generalist doctor should be valued as well as specialists. She emphasised that flexibility was all important.
“We need to get out into the community and deliver care where patients are. We need flexibility for the demographics of the workforce and to make sure the health service makes the most of all its staff. Every doctor must feel empowered in a social movement. We need to empower, educate, engage, and focus on equality and diversity.”
