Negotiations at an impasse as further industrial action looms

By Gabriel Blaazer

Almost 9,000 ambulance workers were on strike yesterday (Monday 6th February), with the GMB and Unite also striking across 9 regions in England – the most NHS settings ever affected by a single day of industrial action.

Following Monday’s unprecedented strike action, nurses with the RCN are striking today (7th February), with the Chartered Society of Physiotherapy striking on 9th February and the ambulance union, Unison, striking on 10th February. This means that Wednesday (8th February) will be the only day this week on which no strike action is taking place.

Official figures show that more than 88,000 appointments have been postponed already this winter due to industrial action, yet unions have accused the government of intransigence over the disputes, which centre largely around pay and conditions and a perceived lack of investment in recruitment and retention.

Despite claims that comparatively low pay and high levels of in-work stress are contributing to the difficulty in recruiting and retaining health and care professionals, unions say that the government is in effect refusing to discuss improvements to pay and conditions. There are more than 130,000 vacancies across the NHS in England alone, and a worrying number of health and care professionals plan to leave their jobs in the coming years, citing burnout, anxiety and working in a system that has reached its breaking point.

Further, a recent analysis of official figures has shown that burnout and stress among health staff has led to more NHS staff absence than the Covid-19 pandemic. NHS sickness figures show that more than 15 million working days have been lost since March 2020, more than double were list to Covid infections and self-isolation.

A government spokesperson has claimed that Health Secretary, Steve Barclay, is ready to resume talks with unions, and said that “the Health and Social Care Secretary has held constructive talks with unions on pay and affordability.” This was disputed by the General Secretary of Unite, Sharon Graham, who said that no such discussions were taking place. On the negotiations, she added: “In 30 years of negotiating, I’ve never seen such an abdication of responsibility. Categorically…there have been no conversations on pay whatsoever with Rishi Sunak or Steven Barclay about this dispute in any way, shape, or form.”

Pat Cullen, General Secretary of the RCN, today accused the government of ‘punishing’ nurses for their stance, after Maria Caulfield, (the minister for mental health and women’s health strategy, herself a nurse and RCN member), said that nurses’ pay would be discussed, “but only [for] next year’s deal.” However, all 14 health unions have declined to continue talks on this basis, saying that they would only negotiate a settlement that covers the 2022-23 pay deal.

Hope remains for a breakthrough, however, with the new Chief Executive of NHS Providers, Sir Julian Hartley pointing out that industrial action in Wales and Scotland have been suspended following fresh pay offers.

Saffron Cordery, who until 1st February was interim Chief Executive of NHS Providers, said: “For many trusts, Monday [6 February] will be the toughest challenge they’ve ever had as nurses and ambulance staff strike together for the first time, and in more places than before. Leaders are doing everything they can to prepare by putting plans in place to minimise effects on patients and making sure they can provide high-quality, timely care where possible. But without a resolution, disruption is inevitable.

“We need to do everything we can to ensure industrial action doesn’t become the new normal. The government has the power to end this disruption right now by talking to the unions about working conditions and, crucially, pay for this financial year. Their reluctance to do so is getting in the way of efforts to tackle elective recovery for patients.”

Rachel Harrison, National Secretary of the GMB said: “It’s been almost a month since the Government engaged in any meaningful dialogue – instead, they’ve wasted time attempting to smear ambulance workers. The NHS is crumbling; people are dying and this Government is dithering.”

Finding the right support to provide the NHS with the capacity needed

By David Duffy

Dr Jean Challiner, Medical Director for Medinet, outlines how the NHS must harness spare capacity from all corners of the health and care sector to meet this period of unprecedented service demand.

As has been made abundantly clear by the Prime Minister earlier this month, the NHS is suffering from a severe capacity crisis. In addition to emergency departments tackling the toughest winter on record, 7.21 million people are currently on an elective care waiting list and staff shortages are crippling service delivery.

The Prime Minister himself acknowledged that these trends existed prior to Covid-19 but the pandemic has escalated the problem beyond what the NHS is able to tackle without added support. “With so many people waiting longer and longer for elective care, patients’ conditions are worsening and becoming urgent for some,” reflects Dr Jean Challiner, Medical Director for independent healthcare provider, Medinet.

Dr Challiner stresses that for Medinet, who have a two decade history of providing dedicated ‘insourcing’ for NHS trusts to boost capacity, the time patients are spending waiting for treatment is having a drastic impact on their work. “We used to almost exclusively offer capacity in the NHS for low complexity day cases, but now the priorities within the NHS are very different, and there is a growing need for us to address more urgent and more complex cases.”

Medinet holds the country’s largest pool of expert clinicians across 20 different specialties, and supplies teams to provide additional clinical capacity to enable hospitals to meet waiting times targets and then work with them to ensure these are not breached. In the last 12 months, 170,000 patients have been seen and treated by Medinet’s clinical teams.

The fact that Medinet teams work in close conjunction with NHS clinical teams and within existing estates means that they can adapt their service offering to include more complex surgery when needed. This includes cancer surgery and other procedures that fall under the realm of specialised commissioning. Medinet’s large pool of consultants, often made up of part-time NHS doctors or recent retirees, can perform most procedures, although they rarely tackle acute emergency procedures.

Reforming the referral process

Beyond directly boosting capacity with additional staff, Medinet have looked to enhance NHS efficiency and bring down backlog figures by reducing time to referral for patients. With cataract surgery, (accounting for one of the largest elements of the elective waiting list with 600,000 patients waiting for a procedure) patients are now having to wait up to two years to have their cataracts assessed.

“We are seeing some trusts getting twice as many referrals in certain areas as before and you can’t instantly train the necessary staff to meet this demand in the short term,” says Dr Challiner. “Part of our process is to not only bring in additional direct expert capacity where required but also help enhance overall efficiency or perhaps deploy existing resource differently.”

Based on a study conducted with a customer in Scotland, Medinet consultants have recently put forward recommendations to bring down cataract wait times across England, particularly for low risk patients. The study set out to determine the suitability of community cataract referrals for a one-stop cataract surgery service and the target areas for referral refinement. The results of the study showed that waiting time was significantly reduced – an average of 30 weeks for one-stop patients. Approximately one quarter of referrals were considered suitable for the one-stop service and many more may have been suitable if there had been more information in their referrals.

Capitalising on system reform

While Medinet services are still primarily commissioned by individual NHS trusts, the development of integrated care and closer collaboration between individual providers could potentially create opportunities for Medinet to expand its service offering elsewhere. “There is a huge opportunity within ICSs to change the model of harnessing spare capacity and applying [it] to other parts of the system. ICSs must provide the framework for providers to break out of regional, professional and organisational silos and boundaries to alleviate the capacity crisis currently being faced by the NHS.

“As providers evolve their service offerings to meet new challenges, they must be able to highlight where new capacity where is required without fear of reprimand.”

Encouraging active dialogue

Under no illusions, Dr Challiner acknowledges that the Medinet model is not a magic bullet to NHS capacity pressures as there are fundamental obstacles that can restrict impact. “Operating within existing NHS estate allows us to work much closer with NHS teams,” she says, “but we face regular challenges with bed availability, as we cannot conduct day case surgery unless there are beds available for recovery if needed. We also often have difficulty in simply finding the space within a trust for Medinet to operate in work or having a trust staff lead on hand to provide trouble shooting assistance or can locate replacement equipment if required.

“We encourage trusts to highlight new ways in which we can boost capacity. We are seeing an NHS that is working tremendously hard, and we want to help them. Nothing is off bounds for us, to help tackle what is most important, so we need the NHS to talk to us, and engage in discussions to look for possible solutions that are risk assessed and will work.”

Medinet’s position as a capacity booster has placed it in a unique position to reflect on the various challenges that lie within the NHS backlog. Last year, the organisation released its Manifesto for Better, outlining how they plan on supporting hospitals across the country to support commitments to improve access to treatment, empower patient choice, and provide the capacity required in response to the growing backlog of elective services.

Support through the menopause is a necessity, not a luxury

By Professor Dame Jane Dacre

‘The only matter where a woman can take time off for her reproductive health that is widely accepted is pregnancy – that’s the reality’.

These are not my words but those of one of the doctors in the UK that responded to a recent survey by the Medical Protection Society (MPS).

It is a sentiment that many women will recognise. But the medical community surely can, and must, do better than this in 2022.

Every day initiatives are announced to support healthcare professionals’ wellbeing and to enable those of us further along in our careers to continue working. I would argue that support for healthcare professionals experiencing menopause has to be a top consideration as part of this work.

NHS Digital data tells us that women make up more than 75 per cent of the NHS workforce, and that there are more women in medicine than ever before. However, looking at the split of doctors on the GMC register, there is quite a dramatic reduction in the number of women over 45. Under the age of 45, female doctors form the majority of the profession. There will be many reasons for this, including the extent to which women entering medical schools have outnumbered men in recent years.

However, the lack of support for those going through the menopause could be a factor in the reduction of female doctors over the age of 45 on the register. Better recognition of the impact of the menopause on some women’s medical careers could help to keep them in practice for longer.

Some of the most common physical menopause symptoms include hot flushes, night sweats, menorrhagia or a change to the menstrual cycle. Migraines and other headaches are also frequently reported, as well as joint and muscle pain, heart palpitations, urinary incontinence, vaginal dryness, genitourinary infections, and an adverse effect on an individual’s sex life, which can affect relationships and overall wellbeing.

Mental health symptoms reported include anxiety, mood swings, panic attacks and depression. Other reported symptoms include fatigue, poor concentration, brain fog, dizziness and insomnia.

These symptoms can of course have a negative effect on a person’s work performance. The UK’s Faculty of Occupational Medicine and the Chartered Institute for Personnel and Development state that 25 per cent of women say they have considered leaving their job and 1 in 10 do end up quitting as a result of menopause and a lack of available support.

Healthcare professionals will know more about the menopause than others, but this does not mean we are immune from these pressures or that we get the support we need.

A recent survey of 261 doctors in the UK conducted by MPS found that just 14 per cent of female doctors who have experienced the menopause report feeling supported by their employer/workplace and only 7 per cent feel supported by their line manager, with most (76 per cent) feeling supported by their family and friends. 28 per cent feel supported by colleagues, yet 17 per cent say colleagues have been dismissive of their menopause symptoms. 19 per cent said they have considered early retirement due to the menopause.

While the sample size is small, these findings suggest more needs to be done to help doctors experiencing menopause continue to perform at their best and stay in the workforce for longer. A work culture that destigmatises menopause and other factors that impact on a doctor’s wellbeing is much needed to reduce the continued exodus of doctors. Creating an environment that promotes wellbeing is a necessity, rather than a luxury, as the impact of engaged and content clinical staff on patient safety should not be underestimated.

There is a crisis in the medical workforce, due to understaffing, which needs to be addressed urgently, so that we can continue to provide the highest quality of care to our patients. Recognising the potential difficulties faced specifically by women doctors, and addressing them compassionately will help reduce attrition, and will benefit the medical workforce overall, and ultimately, patients too.

MPS, of which I am President, offers support to members including making our 24/7 confidential counselling service available for those struggling with the menopause and other wellbeing concerns.

A much broader approach is needed by the wider system however to ensure better mental wellbeing support and greater awareness from leaders. This is why MPS, in its paper Supporting doctors through menopause, is calling for better training and education around the menopause and its symptoms for managers and senior leaders, and asking healthcare organisations to consider flexible working arrangements to support female doctors to stay in the workforce for longer.

GMC urges removal of barriers to help tackle NHS workforce crisis

By Gabriel Blaazer

The rules preventing thousands of doctors from being deploying deployed to areas of high patient demand must be removed to help tackle NHS challenges, the General Medical Council has said.

The regulator of doctors in the UK is urging the government to relax rules which dictate the roles that specialty and associate specialist (SAS) and locally employed (LE) doctors can undertake.

Published yesterday, the GMC’s The state of medical education and practice in the UK: workforce report 2022, identifies SAS and LE doctors – who are skilled doctors in non-training roles – as the fastest growing part of the medical workforce and a cohort which may become the largest group in the medical workforce by 2030.

The report argues for a relaxation of current rules to allow these doctors to be deployed to areas of high patient demand, including primary care. Rules such as the Performers List, which details those practitioners approved to work in primary care, can restrict the roles that doctors fulfil.

The number of licensed SAS and LE doctors rose from 45,587 to 63,740 between 2017-2021 – a 40 per cent rise. During the same period, the number of licensed GPs rose from 60,6090 to 65,160 – a 7 per cent rise. It is hoped that allowing more flexibility in the roles that doctors are permitted to undertake will help plug staffing gaps where demand is higher than workforce constraints can accommodate.

According to the Chief Executive of the GMC, Charlie Massey, a change to the rules would also help in the recruitment and retention of doctors, as it would allow for greater flexibility over when and where doctors can work. “Lots of these doctors tell us they want better career development and progression, and to have more flexibility in the positions open to them. But there are barriers that hinder their development, and rules that prevent them fulfilling some important roles,” he said.

The report also shows that many SAS and LE doctors come to the UK after qualifying abroad and are more likely to work for in the NHS for relatively short spells. It is hoped that offering more flexibility and career opportunities to these doctors will persuade more to stay in the UK “make the most of these talented and able doctors”.

Mr Massey added: “These are skilled doctors who do hands on work but are not in training to become a consultant or a GP. Many have made a positive choice to work in non-training and non-specialist roles in secondary care, where they do hugely valuable work.”

“But we know there are significant numbers who want wider opportunities. Systems must adapt to make the most of their talents. We need fresh thinking about how these doctors are deployed, and how they can be best used to benefit patients.”

“Now is the time to discard dated ideas and tap into the skills and experience these doctors provide.”

Building sustainable ICS staffing to weather the workforce crisis

By Dr Anas Nader

The advent of integrated care systems (ICSs) across the NHS marks an invaluable opportunity to facilitate greater collaboration, efficiency and more joined-up care for patients.

To be successful, this period of transformation needs to be underpinned by a strong, comprehensive workforce strategy that enables staff to be flexibly and safely deployed in line with fluctuating demand.

Amid present staff shortages and rising waiting lists, and with pressures set to grow over winter, this is, unsurprisingly, no easy task for organisations. As managers rightly address these immediate challenges, it’s understandable that little time or capacity is left to support broader workforce transformation. Yet the benefits of a transition to more collaborative ICS-wide staffing have the power to tackle these same challenges in the long-term.

While it may seem like another hurdle for teams who are already facing extreme pressure, there are a number of ways that ICSs can reap these benefits, without compounding workloads or piling additional pressure on staff. Throughout my time working closely with NHS organisations to tackle various workforce challenges, I have found the following steps essential to successfully enabling truly collaborative staffing. I believe they are also the key to unlocking a more sustainable, long-term workforce strategy.

Harnessing the power of collaborative temporary staffing

Temporary staff are crucial to the successful running of an ICS, helping to plug any gaps in rotas across the region. However, currently, when organisations are unable to source clinicians from their own internal staff bank, they must often turn to more costly external agencies to fill vacant shifts. Instead, by building a collaborative network of approved temporary clinicians, organisations can seamlessly tap into a much larger and more flexible contingent workforce from which to reliably fill shifts.

The key to effectively leveraging a collaborative staff bank is enabling compliant digital passporting for all participating clinicians. This means approved workers can passport their credentials across different participating organisations, without having to repeat compliance or background checks. As a result, they can more easily work across a number of different sites and locations and be deployed effectively in line with demand throughout the ICS.

Increasing data oversight

In order to reliably plan ahead, identify staffing gaps and deploy staff where most needed, access to comprehensive data insights is crucial. This means not only enabling managers to view data from within their own organisation, but granting access to pan-regional workforce data from across the entire ICS.

Dynamic data reporting, which provides timely, granular insights into organisational performance, can help measure the success of workforce planning, enable targets to be reliably met and pinpoint areas where improvements can be made. Individual organisations should be able to assess their own performance data and compare this with others in their region. With clear visibility over regional shift fill rates, workforce spend and staffing trends, it becomes easier to identify areas for improvement, while harmonising pay rates and maintaining safe staffing levels in a truly collaborative manner.

Introducing more flexible rostering

When it comes to rostering, the current systems at managers’ disposal are often slow, outdated and require large amounts of manual input. Introducing more streamlined, digital systems which can safely provide staff with greater flexibility and predictability, while reducing the admin burden on managers, can help open the door to more effective ICS-wide rostering in the future.

Rostering clinicians based on skillset rather than title or grade will allow managers to deploy staff more effectively, in line with patient need. This will also give staff the flexibility to safely work in a wider range of roles, in different locations across the ICS, and to access wider professional development opportunities. These are all essential to helping boost retention.

Meanwhile, multi-organisational rostering could begin to allow more efficient deployment of staff to areas of highest need across the ICS. This makes it easier for managers to reliably plan ahead and gives staff greater control over where they work, in line with their personal and other professional commitments.

Prioritising system integration

System integration is a fundamental prerequisite to the success of every single one of these steps. If the systems being used to organise staffing within different organisations are unable to communicate or share data with each other, genuine collaboration will remain out of reach.

When introducing new workforce management systems, organisations should prioritise those which are fully integrated or interoperable, enabling managers to directly share workforce data, rota planning and temporary staffing networks with other organisations throughout the ICS. This reduces the need for manual data input, minimising admin for managers and speeding up the transfer of vital data and information.

As a result, organisations will be able to collaborate in real-time and deploy staff to the most appropriate services in line with evolving ICS-wide demand.

To reap the full rewards of ICS working, facilitating a collaborative, flexible workforce is vital. This transition does not have to be costly, nor add additional burden to managers or organisations. By working together and implementing these four key areas of change, we can lay the foundations for strong, collaborative ICS-wide working, built to weather the challenges which lie ahead.

Health worker sexual abuse reporting site launched

By Integrated Care Journal

Women in Global Health launch #HealthToo Project today, a platform to compile reporting of sexual abuse of health workers.

Sexual Exploitation, Abuse and Harrasment (SEAH) is a considerably under-reported form of violence healthcare workers face, according to Women in Global Health, an organization that campaigns for the protection of women workers in healthcare settings.

“There is a huge gap in data and research related SEAH in the health and care sector from all regions, with the most serious absence of data is in low- and middle-income countries, where women are reportedly the most affected, ” said Dr Magda Robalo, Global Managing Director, Women in Global Health.

A majority 62 percent of 330,000 health workers across a range of countries reported exposure to work related violence and harassment (WRVH) in a single year, according to the Journal for Occupational and Environmental Medicine. But this data is not disaggregated to separate the SEAH component.

In response, Women in Global Health launch today a new platform and research project entitled “#HealthToo”, to seek, compile and document stories from women health workers who have experienced work-related SEAH. The platform is open for individual story contributions from September 5 to November 30, 2022. By submitting their stories anonymously, women will be able to share their experiences freely without risking job security or personal repercussions in their place of work.

Rarely discussed, under-reported

Currently, a large percentage of women in the global health workforce face discrimination, bias and sexual harassment in their work. In some countries, women also experience WRVH either on the way to work or when engaged in community outreach.

The causes vary: many women face unprotected exposure to sexual and violent acts because perpetrators remain unaccountable in work settings owing to a lack of legal and policy frameworks, poor or no follow up, under reporting due to fear of retribution or issues around standard of proof. Other factors have also contributed to the abuse, including women’s segregation into lower status roles, systemic bias and discrimination in the health care sector.

In several contexts, particularly low- and middle-income countries, there is no legislative framework in place to support gender equality at work and no laws to prohibit and punish sexual discrimination and sexual harassment at work.

“Work-related SEAH in the health workforce is an extension of the gender-based violence against women and girls that we witness every day, and in the vast majority of cases, it is perpetrated by male colleagues, male patients/clients and male members of the community,” said Dr. Robalo.

“The presence of women at all levels…makes an immediate difference.”

Dr Magda Robalo, Global Managing Director, Women in Global Health

If not acted upon urgently and consistently, such acts create unsafe and toxic work environments that affect retention of women staff, reduce their physical and mental health leading to increased healthcare costs and a reduction in the quality of care provided.

By addressing the root causes of gender inequity in the health and care workforce and challenging the power and privilege afforded to men, Women in Global Health aims to contribute to the overall reduction of workplace SEAH in global health and therefore strengthen health systems.

This should be backed with concrete action by decision makers to put appropriate laws and policies in place, including ratification and implementation of the International Labour Organization Convention 190 (cILO 190).

“There is no single pathway to solve sexual exploitation and abuse but the presence of women at all levels from leadership down, coupled with adequate laws and policies makes an immediate difference by creating a conducive, motivating and empowering work environment free of such abuse and discrimination,“ said Dr Robalo.

Social care: a sector now in perpetual crisis

By Rusheen Bansal

Association of Directors of Adult Social Services reports dramatic rise in numbers of those seeking review or start of social care provision.

The number of people awaiting review of current provisions, start of a service or direct payment for social care, has increased by 37 per cent from November 2021 to April 2022, according to a count carried out by The Association of Directors of Adult Social Services (ADASS) in 83 councils.

Almost 300,000 people are waiting for an assessment of their needs by social workers, an increase of 90,000 (44 per cent) in five months. One in four has been waiting longer than six months. At this rate, the number waiting can hit 400,000 by November 2022, a two-fold increase from last year.

While demand for care is expected to increase in line with winter pressures, peaking around January and dropping in the spring, the findings from ADASS suggest that the typical ‘cycle’ of system pressure is changing, being replaced by a state of perpetual crisis.

To the outside observer, those stating that social care is in crisis may sound like a broken record. For years now, however, stakeholder groups and think tanks have been warning that crippling staff shortages, precarious pay, working conditions and insufficient funding had left a system on its knees, even before the Covid-19 pandemic hit.

A shrinking (paid) workforce

The crux of the issue is relatively simple, if not profound in scale – as Cathie Williams, ADASS Chief Executive put it: “the big reason why almost 40,000 people are waiting for the care and support they need to actually start is that care providers simply do not have the pairs of hands they need to sustain services.”

A recent PPP report, The Social Care Workforce: Averting a Crisis, quotes a 2021 survey of 2,000 social care services undertaken by the National Care Forum (NCF) that reveals how 74 per cent of providers have experienced an increase in the number of staff leaving since April 2021. Indeed, the vacancy rate for care home providers has nearly doubled in the last year, from 5.9 per cent (in March 2021) to 10.3 per cent (in May 2022).

The NCF survey also states that 50 per cent of those leaving highlighted stress as the main reason for their departure, with 44 per cent citing poor pay. Due to poor retention of the social care workforce, existing employees are experiencing an increase in workload that has not been accompanied by an increase in pay thus far.

Care workers are paid a median hourly rate of £9.50, in line with the National Living Wage. However, a high proportion of these workers are employed on zero hours contracts – 41 per cent of social care workers in London are on such contracts. To that end, social care professionals often leave the sector for less demanding and/or better paid jobs such as retail roles or jobs in the NHS, where similar skills are often more appreciated and rewarded.

ADASS has discovered a similar pattern – almost seven in ten ADASS members surveyed said that care providers in their area had closed or handed back contracts. Many more said they could not meet all needs for care and support because of providers’ inability to recruit and retain staff. The implications of this are significant. When people’s needs are unmet (or unknown), this can place a sizeable burden on their lives and on the lives of unpaid carers who may feel obliged to step in. Indeed, over the last ten years, the number of young people aged 16-25 in England and Wales providing unpaid care to family and loved ones has risen to approximately 350,000.

“The picture is deteriorating rapidly”

Councils are simply overwhelmed. The ADASS Spring Survey found that most councils were facing an increase in numbers of people seeking support: 87 per cent said more were coming forward for help with mental health issues, 67 per cent reported more approaches because of domestic abuse or safeguarding, and 73 per cent reported seeing more cases of breakdowns of unpaid carer arrangements. In addition, 82 per cent of councils were dealing with increased numbers of referrals of people from hospitals and 74 per cent were reporting more referrals or requests for support from the community. To that end, the Health Foundation has estimated that an additional £7.6 billion will be needed to meet demand in 2022/2023.

Sarah McClinton, ADASS President, commented: “These new findings confirm our worst fears for adult social care. The picture is deteriorating rapidly and people in need of care and support to enable them to live full and independent lives are being left in uncertainty, dependency and pain.”

In September 2021, the government announced a new ‘Health and Social Care Levy’, effective April 2023 onwards – a 1.25 per cent increase in National Insurance contributions from employed people as well as pensioners. Yet, now more than ever, policy experts recommend that financial planning and smart allocation, elements that have been lacking in the past, are required to reap the maximum benefits from this additional funding. The Levy, which will aggregate to £5.4 billion over three years, has been reported to fund necessary reforms in the social care sector such as improving staff training and recruitment practices, initiatives for mental health well-being and new avenues for career progression. Yet, many regard this amount as insufficient – according to The Health Foundation, a further £7 billion will be required every year to tackle demographic and inflationary pressures and to increase staff pay.

While it is true that the COVID-19 pandemic significantly worsened the social care crisis, it is only one of the many crises that have exposed and underscored the foundational instability of this system. Since the 2016 Brexit vote, for instance, the vacancy rate of social care workers has increased year-on-year. Prior to this, 1 in 20 social care workers were EEA migrants, and since more than 90 per cent did not have British citizenship, many had to leave England. To mitigate concurrent widespread resignations, the government announced a Health and Care Visa that would help fast-track visa applications for those in the healthcare sector. However, care workers are not categorised in the list of eligible jobs.

More than 600 people are joining waiting lists to be assessed for care and support in England each day. Resolving issues other than funding are key for the successful integration of social care into effective healthcare. Greater efforts should be made for recruiting and retaining social care staff, especially younger people, by improving the pay, workload and working conditions in the sector. Otherwise, broken record or not, the system is in danger of collapse.

New research finds recruitment crisis threatens to undermine virtual ward revolution

By Integrated Care Journal

Nearly half of NHS Trusts need to recruit new roles amid sector-wide staffing crisis to enable the effective operation of Virtual Wards.

Freedom of Information Act data obtained by digital health technology provider, Spirit Health, has revealed the scale of the recruitment crisis that threatens to undermine the delivery of NHS England’s virtual ward ambition.

Spirit Health collected data from 107 NHS Trusts across England and found that 40 per cent need to recruit additional staff to support the delivery of virtual wards. The NHS is increasingly pivoting to virtual wards, which are intended to allow people to receive care outside of hospital settings, whether at home or in domiciliary care facilities. The Covid-19 pandemic saw the NHS establish COVID Virtual Wards, and their success has prompted a renewed ambition for their widespread use outside of treating Covid-19.

The acceleration of digital expansion plans is in response to NHS England’s recent mandate for all NHS Trusts to offer 40 to 50 virtual beds per 100,000 population. This ‘comprehensive development of virtual wards’ comes at a time when hospital waiting lists are exceeding 6.6 million, with the Health and Social Care secretary demanding radical action to avoid a winter crisis.

Of Trusts needing to recruit, a third (32.6 per cent) anticipate making appointments across up to three roles, while some Trusts have stated that they expect to recruit new staff in as many as seven different roles before launching a virtual ward.

Of the 31 Trusts that subsequently provided a breakdown of the roles they intend to hire, 84 per cent anticipate hiring Secondary Care Practitioners (such as consultants, therapists, advanced clinical practitioners, and nurses), with a further 29 per cent seeking primary care practitioners (such as GPs and pharmacists). The projected influx of specialised staff underscores the scale of this initiative – and the recruitment challenge that threatens to undermine the successful rollout of virtual wards.

The impact of workforce challenges on the expansion of virtual wards has been felt directly by Spirit Health’s clinical monitoring team. In recent months, its in-house team has experienced an uplift in the number of requests for flexible clinical support to Trusts to deliver digital programmes and help them onboard staff. This latest research comes after a recent report by the Health and Social Care Select Committee which suggested more than 475,000 NHS staff will be needed by early 2030 to deliver vital care, throwing into question how NHS Trusts plan to recruit and retain key staff.¹

Healthcare authorities hope that the deployment of virtual wards will significantly reduce these pressures by combatting staff shortages and minimising lengthy discharge times. Initial pilots of the programme have offered promising results already: virtual wards have been proven to deliver a 40.3 per cent reduction in the average length of hospital stay and a 50 per cent reduction in re-admission rates.²³ Likewise, Spirit Health’s CliniTouch Vie platform has seen a 67.5 per cent reduction in unscheduled emergency admissions.⁴

The NHS’s adoption of digital healthcare services is also likely to be motivated by the economic benefits of these proven efficiencies. Virtual wards are expected to save the NHS up to £4,000 per patient stay, whilst CliniTouch Vie alone is predicted to save the health service more than £500,000, by building on the successful virtual ward pilot operation it ran to support Leicestershire Partnership NHS Trust.⁵

These significant savings will go a long way in supporting the NHS workforce of the future – with funding being freed up to be reinvested in both the upskilling of the current workforce and enlistment of new staff to further ease the current strains on the health system.

Speaking about the recruitment crisis that is threatening the implementation of virtual wards, Dr Noel O’Kelly, Clinical Director at Spirit Health, said: “Virtual Wards offer a lifeline to enable the continued delivery of first-rate care and be a strong addition to face-to-face services, which have struggled to keep pace with the current workforce challenges and lengthy patient waiting lists across the health sector.

NHS staffing shortages threaten to undermine the exciting opportunity that virtual wards bring: digital healthcare technology cannot support patients without the necessary specialists to operate it. These findings echo the frustrations that we hear from our partner trusts, who are reporting that workforce challenges are hindering efforts to scale this technology achieve its full potential. We must urgently demonstrate the capacity of this technology to ease pressures for the stretched workforce, and thus attract fresh talent to support its delivery.”

^{1 https://committees.parliament.uk/publications/23246/documents/169640/default/}

^{2 Swift, J. et al, 2022. An evaluation of a virtual COVID-19 ward to accelerate the supported discharge of patients from an acute hospital setting. British Journal of Healthcare Management, 28(1), pp.7-15.}

^{3 NHSX. 2022. Remote monitoring for patients with chronic conditions in the Midlands [online] Available at: <https://www.nhsx.nhs.uk/covid-19-response/technology-nhs/remote-monitoring-for-patients-with-chronic-conditions-in-the-midlands/> [Accessed 25 January 2022]}

^{4 Ghosh S, O’Kelly N, Roberts EJ et al. Combined interventions for COPD admissions within an urban setting. BJHCM: 2016;3:122–131.}

^{5 A successful pilot of virtual wards for COPD, Heart Failure, and Covid-19 across LPT produced savings of £529,719 for the health system.}

Why is technology underrepresented in the training of health, housing and care professionals?

By Tunstall Healthcare

Andy Hart, Head of Delivery and Technical Support at Tunstall Healthcare, discusses why educating health, housing and social care professionals is vital to meet the needs of our growing and ageing population.

People today are living much longer. It’s recently been reported that the UK’s population hit a record with over-65s overtaking under-15s, and by 2030 it is estimated that 1 in 6 people globally will be aged 60 years or over.

But living longer does not necessarily mean living more healthily. Long-term health conditions are more prevalent in older people, with approximately 15 million people in the UK requiring health and social care services for chronic illnesses.

Andy Hart, Head of Delivery and Technical Support at Tunstall Healthcare, discusses why educating health, housing and social care professionals in the benefits and appropriate use of technology is crucial if we are to improve service provision, and why technology continues to be underrepresented in training.

Why technology is underrepresented

The urgent need to invest in preventative services and early interventions to reduce pressures on our services is being increasingly recognised. In fact, almost two thirds (63 per cent) of directors of adult social care recently indicated that their local authorities were taking positive investment strategies in digital and technology.

However, large-scale change involving health and care technology is complex and presents many challenges for the stakeholders involved. Key barriers to successful digital evolution include the budget constraints and the cost of implementing new systems, organisational attitudes towards risk, and the relationships that exist between health, housing and social care services.

Most of these barriers can be mitigated through greater training and the education of professionals. Greater education will help to build partnerships, maximise the use of data, drive cultural change and bring staff on the digital journey, whilst supporting them in their roles.

Investing in education

People are the greatest asset of any organisation and, like any other asset, they need investment and maintenance. The next generation of health, housing and care leaders require support if they are to continue to develop themselves, and therefore their teams and services.

The education of professionals within these sectors is crucial in enabling a cultural shift so that staff understand the value and use of technology, and how it can support them in effective caregiving, as well as improving the quality of life of the people being cared for.

With the right education staff should reap a number of benefits, including becoming more aware of the features of telecare devices, developing confidence in assessing and referring end users to the right solutions, and understanding the positive impact of telecare on working practices.

As the Occupational Therapy programme lead at the University of Lincoln, Carol Duff is significantly involved in the education of Occupational Therapists. She commented: “It’s very important that we give our students the opportunity to gain practical confidence in the use of digital solutions in a safe setting that are essential to support their practice in health and social care.

“Technological solutions may mean our patients are able to remain safely at home for longer and avoid or delay moving into hospital or into care. It is essential that our occupational therapists of the future can confidently and creatively explore digital solutions that may also reduce pressure on the system and release time to care.”

A digital future

With the impending changes to our telecoms network, digital is fast becoming the industry standard to ensure the safety of health and social care services, staff and end users.

New kinds of leadership will be needed to deliver change and evolve governance, while at the same time improving the working lives and motivation of employees. Cementing a cultural shift towards technology driven, outcomes-led approaches is required to achieve this, and in turn, this needs early engagement from professionals and an understanding that technology is designed to provide support, rather than to replace.

By harnessing the benefits of training and education, we can raise awareness of the value and potential of technology across the healthcare landscape, and provide enhanced support to users, carers, professionals and providers.

For more information on educating the future generation of health, housing and social care professionals, please visit www.tunstall.co.uk/training-services.

News, Social Care, Thought Leadership, Workforce August 1, 2022

The Health and Social Care Committee’s report on the care workforce; what is missing?

By Mary Brown

On 25th July, the Health and Social Care Committee (HSCC) published their report, Workforce: recruitment, training and retention in health and social care.

The report calls for the government to provide its workforce plan for the NHS and social care (promised in spring 2022 but still not yet published), and provides several practical recommendations for the plan. Refreshingly, large sections of the report focus specifically on the social care workforce; a workforce often ignored in conversations around health and care.

The report appropriately recognises the gravity of the situation facing the social care sector, stating that, in comparison to the NHS, “the situation is regrettably worse in social care”, referencing incredibly high staff vacancy and turnover rates and poor working conditions.

Key recommendations in the HSSC report regarding the social care workforce include:

Higher baseline pay for care workers, reflecting the true value to society of the services they provide
Sustainable strategies in terms of pay progression, professional development, and career pathways
Contract choices offered to care workers on zero-hours contracts
A call for the government to produce an externally validated care certificate, provided at no cost to care providers, and is transferable between care providers and the NHS

While the report makes some promising recommendations, it falls short in several areas. On 26th July, Public Policy Projects (PPP) launched its report, The Social Care Workforce: averting a crisis.

This report was based on two roundtables with PPP’s Social Care Policy Network, held in May 2022, made up of key stakeholders in the adult social care sector and a lived experience panel (comprising five individuals with first-hand experience of the social care system). While many of the conclusions and recommendations of the HSCC’s report have parallels in PPP’s report, PPP highlights further areas that the workforce plan should address.

A fairer deal for the social care workforce

The reports from HSCC and PPP are broadly aligned regarding their sentiments and recommendations around pay for care workers. It is evident that care workers must be paid more, and equivalent to, their NHS counterparts.

Both reports therefore include recommendations advocating increases to the baseline pay for care workers, to reflect the true value that care workers bring to society and reduce the number of care workers leaving for better paid jobs in retail, hospitality, or elsewhere. Both reports also agree that there must be pay progression in the care sector in line with that of the NHS Agenda for Change pay scale, providing opportunities for care workers to be paid fairly and to advance their careers.

The two reports agree that terms and conditions, as well as pay, must be improved for social care workers. They acknowledge that zero-hours contracts can provide instability for many adult social care workers, and that care workers do not tend to enjoy the same pension options, sick pay or overtime renumeration as equivalent NHS workers, nor do they receive the public admiration or ‘sweeteners’ (including NHS staff discounts offered by many businesses).

It is no secret that the social care sector is severely underfunded. In order to appropriately pay care workers, both reports agree that local authorities must be appropriately funded to provide the fair cost of care to providers, to ensure that self-funders are not subsidising the cost of workers’ wages. This will require substantial investment from government.

However, PPP’s report provides several additional recommendations for the elevation of the social care workforce. Crucially, PPP’s report focuses on the need for an elevation in the status of care work, to raise the profile of those working in care. The report notes the boost in public sentiment towards nursing that followed Florence Nightingale’s work during the Crimean war, and stresses the need for a similar shift to take place for care work. Not only would this ‘Nightingale shift’ boost staff morale, PPP’s report argues that it would help to address recruitment and retention issues, provided it is accompanied by improvements to pay and conditions.

To kickstart this ‘Nightingale shift’, PPP’s report recommends that the government should provide investment for positive advertising campaigns for social care careers, with clear messaging of the immense value of a career in care and its potential to transform lives. In conjunction with this, it recommends that care providers should be working with careers advisors in schools to promote care work to young people as an attractive and fulfilling career.

Another recommendation in PPP’s report, which was not addressed by the HSCC report, is the potential creation of cross-sector roles between health and care, as well as placements and secondments of NHS staff into social care. This would help raise the status of social care by actualising a parity of esteem between the NHS and social care workforces. It would also serve to increase the awareness and visibility of the social care system within the NHS, and aide in the integration of the workforces.

More training is not a panacea

Training was highlighted as a key area in the HSCC report. However, PPP’s Social Care Policy Network argues in the report that extra workforce training should not be conflated with the wider issues around attracting and retaining staff. PPP’s Lived Experience Panel were at pains to express that constant training and annual training renewal is often a poor use of time and resources and cannot be a substitute for meaningful sector reform.

Where PPP’s report addresses training is in their recommendation around the proposed Social Care Leaders Scheme, dubbed the ‘Teach First’ of social care. The care sector is in need of strong leadership, as registered managers are not always sufficiently prepared or trained for a job that carries substantial responsibility.

The Social Care Leaders Scheme, proposed by a steering group of leaders from the social care sector convened by the CareTech foundation, aims to attract high calibre talent to the sector by training bright university graduates for leadership roles in social care, emulating the successful Teach First model. The report calls for the government to reconsider its position on the partial funding of the scheme, which promises to elevate the sector, provide attractive careers, and improve leadership structures.

The HSCC report also focuses on mandatory Care Certificates, which should be offered, at no cost, to care providers, and are transferrable between care providers and the NHS. This is undoubtedly a sensible recommendation, and PPP’s report further recommends the establishment of a Royal College of Care Professionals. The institution of a Royal College would serve the dual purpose of professionalising the workforce and secure an elevation in its status, as well as providing a central body which can represent, support, and oversee the development of, the care workforce.

Finally, the report by the HSCC makes no mention of a vital section of the care workforce: volunteers. PPP finds that volunteers can greatly alleviate the burden on social care professionals and improve the experience of recipients of care. It is essential that volunteers are included in the workforce equation.

PPP recommends that the volunteer sector should be integrated into the workforce strategy and planning for social care, given the substantial value it provides. Further, it warns that the government must act soon to seize upon the enthusiasm for volunteering that built up during the COVID-19 pandemic.

For a truly comprehensive workforce plan which will truly elevate social care and reduce the immense pressure on the sector, these recommendations must, too, be incorporated. For more information on the report, please contact PPP’s Social Care Policy Analyst, Mary Brown, at mary.brown@publicpolicyprojects.com

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