New endoscopy staff bank to boost NHS capacity in Cheshire and Merseyside

By Gabriel Blaazer

NHS Cheshire and Merseyside Integrated Care System (ICS) has established a new endoscopy staff bank to help boost local capacity and give endoscopy staff greater flexibility over when and where they work.

Developed in partnership with Mersey and West Lancashire Teaching Hospitals NHS Trust as lead employer, a new collaborative staffing bank for endoscopy staff will enable local trusts to pool their individual networks of temporary workers and adjust staffing levels according to demand. A total of seven trusts, which provide endoscopy services at 10 hospital sites and are part of the Cheshire and Merseyside Endoscopy Network, are participating.

The new bank is available to all NHS staff who specialise in endoscopy across the seven trusts taking part, including clinical, administrative, nursing and medical staff, and it is hoped that greater flexibility for staff will help boost staff retention. The bank will enable staff to pick up additional shifts as and where they wish, allowing them to view and select shifts at any of the 10 hospital sites via a mobile app, connected to a new digital platform built in partnership with workforce solutions provider Patchwork Health.

Participating trusts will be able to manage and approve payments through the platform, as well as gain access to a data reporting tool providing key staffing insights from across the collaborative bank, including staffing levels, pay rates and shift fill rates at the 10 hospitals. Workers joining the staff bank will be engaged through Mersey and West Lancashire Teaching Hospitals’ (MWL’s) Lead Employer team and added to their workforce and payroll systems.

Much of the information required on staff will be imported automatically from their existing NHS employment, reducing ‘time to hire’ and avoiding the duplication of checks including pre-employment screening and mandatory training. The new bank will also mean staff do not need honorarium contracts, which were previously required when staff worked for trusts other than their primary employer.

It is hoped that this will benefit staff by introducing greater flexibility to respond to personal circumstances, thereby boosting staff retention.

The ability to allocate workforce and resources within a region according to real-time need has long been touted as a potential strength of ICSs. Cheshire and Merseyside ICS hope that the establishment of the staffing bank will help to reduce reliance on agency staff, cutting costs and leading to shorter waiting times for patients. Visibility of staffing data will help teams across Cheshire and Merseyside Acute and Specialist Trusts (CMAST) – the provider collaborative which covers the ten hospital sites – to monitor staffing trends and identify areas for improvement, supporting them to meet rising patient demand.

The Cheshire and Merseyside endoscopy staff bank is the second major collaborative staffing initiative launched by lead employer, MWL Teaching Hospitals NHS Trust. In 2020, it launched the North West Doctors in Training Collaborative Staff Bank, the largest initiative of its kind in the UK, which brings together 24 trusts across the North West and has helped retain an estimated £6 million within the NHS to date.

The seven trusts, which provide endoscopy at 10 hospital sites and are all part of Cheshire and Merseyside Endoscopy Network, are:

Countess of Chester Hospital NHS Foundation Trust;
Mid Cheshire Hospitals NHS Foundation Trust – Leighton hospital;
East Cheshire NHS Trust – Macclesfield hospital;
Mersey and West Lancashire Teaching Hospitals NHS Trust – including Whiston, St Helens and Ormskirk hospital sites;
Warrington and Halton Teaching Hospitals NHS Foundation Trust – Warrington hospital;
Liverpool University Hospitals NHS Foundation Trust – including Liverpool Royal and Aintree hospital sites; and
Wirral University Teaching Hospital NHS Foundation Trust – Arrowe Park hospital.

Tracey Cole, Diagnostics Programme Director, Cheshire and Merseyside, said: “We are delighted to be able to offer this new way of flexible working so that staff can select where and when they want to work to ensure that all our patients are seen with the shortest possible waiting time.

“Each trust across Cheshire and Merseyside can access this secondary bank in addition to their own internal bank, which means that there will be less reliance on agencies when additional capacity is required.

“Staff are able to work and earn in addition to their substantive employment and share learning and best practice with their peers.”

Dr Anas Nader, CEO and Co-Founder at Patchwork Health, said: “It’s a privilege to be working with Cheshire and Merseyside and lead employer Mersey and West Lancashire Teaching Hospitals NHS Trust to expand access to collaborative staffing in the region through the new ‘Diagnostics Collaborative Bank’.

“By connecting workforces from across the region, it is helping to increase flexibility for staff and workforce teams alike. This is especially important as services face unprecedented demand; more flexible, collaborative workforce planning is making it easier for staff to be deployed in line with patient need.

“We’re excited to continue growing this initiative as we onboard more staff and support them to work flexibly through the collaborative staff bank. By doing so, we hope to help support retention, boost collaboration and ease staffing pressures across the region, empowering services to work together to facilitate more sustainable staffing.”

Anyone interested in joining can apply via the following link:

Number of nurses experiencing suicidal thoughts up 98%, RCN finds

By Gabriel Blaazer

The findings have been described as a “frightening wake-up call”, with mental health support for nursing staff declining amid increased pressures.

The number of nurses experiencing suicidal thoughts has risen by 98 per cent compared to the same period last year, according to new data released by the Royal College of Nursing (RCN).

Calls to the RCN’s Advice Line in October found that an equivalent of one person each working day was reporting suffering from suicidal ideation in their initial call, compared to just one per week in October 2021. In response to its findings, the college has commissioned research to understand in greater detail the reasons behind poor wellbeing among members, and to discern whether or not marginalised groups are being impacted disproportionately.

The RCN has previously highlighted the “failure of [the] UK government’s promise to recruit 50,000 nurses”, and points to a 12 per cent fall in the number of people expected to take up nursing courses in England this year as evidence that the nursing workforce is facing “dangerous staff shortages”, which are proving harmful to staff morale and patient care.

The RCN is renewing its call on the government to invest in dedicated mental health support for nurses who are suffering from “persistent understaffing, intolerable pressures at work and financial insecurity at home”. Despite these pressures, one third of the 41 mental health hubs established by NHS England have closed, including seven specialist hubs established during the Covid-19 pandemic. A further seven reported in May 2023 that they had less than a year’s funding to stay open.

The RCN’s Interim Head of Nursing Practice, Stephen Jones, has described the findings as a “frightening wake-up call”, adding: “Nursing staff contribute so much to our society, but working in an inherently stressful job can come at an enormous personal cost. Yet we see support services cut when we should be seeing greater investment in looking after those who care for us.

“The increasing burden on nursing staff, as they try to help clear the excessive backlog in care, has created intolerable working conditions on every shift. Coupled with nursing pay not keeping up with the cost-of-living, we’re alarmed by this growing mental health crisis among nursing staff.
“The UK government must understand that cuts to mental health support for nursing staff can’t continue – when you invest in the health of nursing staff you also invest in the health of patients.”

Saffron Cordery, Deputy Chief Executive at NHS Providers, said that: “The RCN is right to highlight the impact of escalating pressure on nurses’ mental health due to increased demand and staff shortages. We need urgent action to tackle this situation, which has led to an alarming rise in suicidal thoughts among nursing staff.

“Nurses play a vital role in our society but cannot be expected to meet such high demand without proper national support for, and investment in, frontline services.”

Recognising the value and impact of AHP support workers within healthcare

By Integrated Care Journal

This week the Chartered Society of Physiotherapy, along with a coalition of 13 other allied health professional (AHP) bodies, is celebrating Support Worker Awareness Week.

AHP support workers are an integral part of multidisciplinary teams. They are relied upon for the transformative role they have to play across many different services, including physiotherapy. They work within their scope of practice to carry out a wide range of tasks and are supervised by a registered healthcare professional who retains responsibility for patient care.

The value of support workers cannot be underestimated. The contribution to services by support workers, both in the NHS and the independent sector, enhances patient outcomes, improves patient experience and increases service efficiency. They also provide immeasurable guidance and support to the wider health and care team.

Currently, we see increasing numbers of support workers playing a vital role in facilitating education by supporting physiotherapy students with their learning. By supporting physiotherapy students with practice-based learning during their placements, support workers offer a safe and supportive space, and contribute to the growth of the profession.

During the pandemic, support workers demonstrated great flexibility and brought new skills to the role. Their responsibilities increased and elements of their practice developed to meet the extraordinary pressures on the system.

Need for more support workers

More physiotherapy support workers are needed within the NHS, but this demand can’t be met by increasing the registered workforce alone. With ever-increasing physiotherapy waiting lists, an ageing population and more patients living with multiple conditions, more support workers are needed to fulfil population, patient and service delivery needs in safe, effective ways.

The CSP has recently conducted a physiotherapy workforce review in England and is calling for 6,500 additional non-registered physio posts in the NHS over the next five years. Additionally, the recent NHSE intermediate care framework recommends maximising the use of skilled support workers. If utilised at the right points in intermediate care pathways, their skills and expertise will improve access to high quality rehab that is timely, safe and person-centred.

In Northern Ireland, we want to see the implementation of the recommendations outlined in the Physiotherapy Workforce Review Report published in 2020, including the establishment of apprenticeships for physiotherapy support workers. In Scotland, we are calling for funded ‘earn and learn’ routes to be established and in Wales, the expansion of the level 4 apprenticeship scheme for support workers.

The support worker role is evolving, with increased opportunity to carry out additional responsibilities in practice. Higher-level support workers have additional responsibilities across the four pillars of practice. These roles are important to provide a positive impact on patient flow, quality of patient care and to meet new national policy developments.

What support workers need

Support workers need clear opportunities and pathways to develop capabilities and pursue career development. Each UK country should have a programme of work to develop support worker roles including those at higher level. This should both develop CPD opportunities, a greater consistency in levels of practice, capabilities and governance arrangements.

Higher-level support worker roles are one example of career development and provide opportunity for managers to think creatively about the skills mix within their teams.

With the right systems and support in place, support workers can do so much more.

Looking to the future

With the opening of the National Rehabilitation Centre (NRC) in East Midlands planned in early 2025, there is a new pioneering role.

The centre will offer a foundation degree apprenticeship for a rehab assistant practitioner role (band 4 equivalent). The rehab assistant practitioner will work across OT, physio and nursing with an evidence and training base behind them.

The NRC plans to offer around three to four hours a day of rehab as opposed to the 30-40 mins per day rehab normally offered in the NHS. Rehab Assistant Practitioners will be key in meeting these ambitious targets.

It is clearly time to recognise and shine a spotlight on the vital role of support workers but also most crucially to invest in their pathway and career opportunities.

Addressing whistleblower concerns in the NHS

By Chancelle Blakey

Building a culture of transparency and accountability will be essential steps to encourage and protect whistleblowers in the speak-up system.

The NHS has been grappling with concerns surrounding its whistleblowing systems and cultural health. This has been highlighted repeatedly in the press over the last week with coverage of the Lucy Letby trial, within which there were shown to be multiple failures in internal reporting processes.

This demonstrates the need for an independent reporting line for employees across the organisation. NHS employees must have the opportunity to speak with an entirely impartial party who can process their concern and pass on the information to the appropriate team for further investigation.

Whistleblowers within the NHS have often faced challenges, making them hesitant to report wrongdoing due to fears of retaliation and detrimental treatment. Despite these obstacles, 2023-23 saw a significant increase in NHS whistleblowers coming forward compared to the previous year, highlighting the urgent need for reform in the whistleblowing process.

In fact, a record 25,000 plus NHS whistleblowers came forward last year. Of these cases, as has been reported by Freedom to Speak Up Guardians office, the most common reports were of inappropriate behaviours and attitudes (30 per cent), followed by worker safety and wellbeing (27 per cent) and bullying and harassment (22 per cent).

Reports indicate that NHS employees are lacking confidence in the current speak -up system, with many feeling labelled as troublemakers when they raise concerns. This detrimental culture not only deters individuals from speaking up but also hinders the NHS’s ability to identify and address wrongdoing, potentially endangering both patients and employees. And that’s before the damage to the NHS’s reputation is considered.

Improving the speak-up system

For optimal trust and confidence in a speak-up system, employees must feel that their concerns will be taken seriously and investigated appropriately.

Unfortunately, this most recent case is the most extreme example of that not happening, with Dr Stephen Brearey stating that if hospital executives had acted on concerns about nurse Lucy Letby earlier, lives may have been saved.

To address these pressing issues, steps need to be taken to: improve employee confidence; identify and combat wrongdoing; and protect those who come forward to report concerns.

One crucial measure is to review and audit the NHS’s whistleblowing policy, processes, and operations to understand the reasons for the breakdown of trust. Identifying and holding accountable those responsible for retaliating against whistleblowers is essential to foster a culture of transparency and accountability.

Providing whistleblowing training to both employees and managers is another critical step to improve the speak-up culture. When employees are aware of how to raise concerns, and the legal protections they have under the Public Interest Disclosure Act (PIDA), they are more likely to come forward without fear of retribution. Additionally, providing training to managers on how to receive and handle disclosures appropriately can help deter misconduct.

The current Freedom to Speak Up (FTSU) Guardian scheme, while a positive step towards improving whistleblowing culture, appears to lack confidence among NHS employees, with many remaining hesitant to report serious concerns through an internal system due to doubts about confidentiality and impartiality. One worker told the FTSU Guardians that “the Guardian was excellent, but nothing has been resolved”. The Guardians themselves have said that managers need to be trained about their obligations once they receive a report.

Taking affirmative action to instil trust

To build trust, the NHS can consider offering an alternative means of disclosure, such as a dedicated, outsourced whistleblowing hotline provider, ensuring true anonymity and independence in the reporting process. Safecall already works alongside several NHS Trusts helping make their processes more robust and transparent. Employees are much more confident speaking to, and reporting through, a third party.

It is vital that the investigation procedure is handled in a fair and balanced fashion, and not conducted in a way that undermines the whistleblowers’ concerns. To instil confidence in the reporting process, investigations should be conducted in an independent and confidential manner. Outsourcing the investigation process or ensuring that internal investigators undergo proper training and possess the necessary experience can help safeguard employees’ wellbeing and protect the NHS’s reputation.

It is paramount for the NHS to take affirmative action in protecting whistleblowers and fostering a culture of transparency and accountability. No healthcare professional should face detrimental treatment for raising concerns that may impact patient safety. To achieve this, the NHS must review its systems, provide comprehensive training, and offer reliable and independent reporting avenues.

The NHS must strive to offer confidentiality, impartiality, and independence when receiving and investigating concerns. These efforts should be continuous and consistent to create effective and sustainable change within the organisation.

In conclusion, addressing whistleblowing concerns in the NHS is crucial for promoting a culture of transparency and accountability. By taking proactive steps, such as reviewing policies, providing comprehensive training, and ensuring independent investigations, the NHS can create an environment where employees feel confident and protected when speaking up against wrongdoing.

Fostering a culture that values whistleblowers and their contributions will not only strengthen the NHS internally but also enhance its reputation and commitment to patient care.

*Chancelle Blakey, Business Development Manager, Safecall*

NHS Workforce Plan will need a change in mindset from clinicians, patients and systems

By Amanda Grantham

Enacting reforms through a clinically-led, multi-disciplinary lens will be critical to achieving the ambitions of the NHS Long Term Workforce Plan.

The NHS Long Term Workforce Plan centres on the need to train, reform and retain its employees to meet future demand, leading to an increase of up to 360,000 new staff across integrated care systems (ICSs). Increasing the number of formal training places available through more diverse points of entry and improving retention through rewarding career and development are at the heart of what needs to be done to deliver this plan.

The introduction of new roles, reforming the way care is delivered and by whom, will be critical to meeting anticipated demand in 2036/37. But these roles will need to be designed, clinically-led, and committed to driving productivity to create the capacity needed.

Determining which roles will be needed to meet demand

It is important to recognise that more staff will not increase capacity unless clinical pathways can be redesigned to be more efficient and effective. During COVID-19, there was about a 10 per cent increase in headcount within NHS acute trusts. However, at the beginning of 2023/24, providers were at 97 per cent of pre-pandemic productivity levels. Delivery of the NHS Workforce Plan means broadening the skill mix of multidisciplinary teams, creating new and diverse roles across systems. In designing the new workforce, the roles need to create new capacity to meet demand, either through new services to meet future need or by increasing provision in existing services.

Creating a new role requires the redesign of the way that multidisciplinary teams work together. The starting point for this workforce design should be the optimal clinical pathways, rather than what is being done today. That means setting out the clinical red lines (what can only be done by a registered healthcare professional), looking at the skills and roles needed, and the most efficient use of capacity.

The design of the COVID-19 vaccination workforce demonstrated how new roles could be created to meet increased demand. The drive to create this workforce led over 145,000 people to join the NHS working as unregistered vaccinators who came from diverse backgrounds, including retired medical staff, airline workers, volunteers and students.

Systems will also need to be more focused on the competency of the workforce, training employees in the skills needed to deliver their role safely and efficiently. The aim from the offset should be designing broad and rewarding recruitment, training and career pathways that will attract and retain the right talent. This could include consideration of how these roles can be steppingstones into future training or careers, as well as how apprenticeships could open doors for eligible people to take on these new roles.

To meet growing demand in the national breast screening programme, two unregistered roles have been created in collaboration with the College of Radiographers, along with redefined roles and clinical career frameworks. Approximately 30 percent of the breast screening workforce is now in these new roles. – mammography associates and assistant practitioners – with defined scopes of practice and accreditation to undertake mammography.

Clinical leadership is required

Creating new roles in healthcare is about shifting care, or elements of decision making, to another trained and competent healthcare professional. This requires a change in approach from the provision of clinically delivered care to a position where healthcare is clinically-led but can be provided by a diverse multidisciplinary team. Clinicians should be at the centre of the redesign of the workforce, but their input will need to be coupled with that from those with the skills and expertise in increasing capacity.

The NHS has had mixed success in integrating new roles into healthcare teams. The COVID-19 vaccination programme was a nationally designed workforce model which used simulation to provide an evidence base and was clinically-led.

Another approach, the Additional Roles Reimbursement Scheme (ARRS), was established in 2019 and produced more variable results. The scheme provided an automatic funding stream to Primary Care Networks to recruit 26,000 alternative roles to expand service provision and reduce patient waits.

This was part of the government commitment to improve access to general practice and included roles such as clinical pharmacists and technicians. Not all practices have seen the anticipated benefits of these roles, with the Kings Fund highlighting that the roles were not being implemented or integrated into primary care teams effectively.

It will also be important to manage the expectations of patients, in particular that they will always see a medical professional. The government and NHS leaders need to consider how to secure public acceptance of self-management for those with long term conditions, more care being provided in the home and community rather than hospital, and from trained staff who are not medically qualified. However, there will need to be a visible improvement in access to healthcare services if the public are to support these changes.

The NHS is aiming to have 10,000 virtual ward beds in place to support growing demand this winter. A clinically-led redesign of the workforce means that care will continue to be overseen by a medical team, but the delivery of healthcare will predominantly be through a multidisciplinary team of healthcare support workers and allied healthcare professionals.

New capacity will be needed to meet training demands

The Workforce Plan contains a commitment to grow the number of training places across all professions. Capacity to provide this training will need to be created from existing workforces and services. This creates a risk that waiting times may increase.

The plan commits to growing the number of medical school training places from 10,000 in 2028/29 to 15,000 by 2031/32. Each of these training place will require support from existing clinicians. The British Medical Association (BMA) recommends additional non-patient facing time to support trainees, of only an hour a week, per trainee, for each consultant.

To meet this standard will require more than 125 full time consultants/GPs to be released each year from NHS services. By 2036/37 this will see more than 625 full time consultants/GPs supporting additional trainees, rather than delivering care. That makes it critical that productivity and efficiency are at the heart of service redesign to minimise the impact on waiting times.

This underlines that the plan’s ambitions on training and retaining staff will not be achieved without fundamental reform. That will require a careful analysis of the right size and shape of the workforce that will be needed to meet future demand for local populations. Now more than ever, diverse, multidisciplinary, efficient, and clinically-led approaches will be the key principles that systems should be adopting when driving the reform of their workforce.

Written by Amanda Grantham, healthcare expert and Partner at PA Consulting.

How industry can help deliver the ambitions of the NHS Workforce Plan

By Stephen Jowett

The long-awaited NHS Long Term Workforce Plan (NHS LTWP) was published at the end of June and has been broadly welcomed across the healthcare system.

The NHS in England is under increasing pressure. By 2037, the number of people aged over-85 is estimated to grow by 55 per cent, which means there will be an ageing population who will require more healthcare interventions and more care for long-term conditions and co-morbidities. The NHS currently has the longest waiting times and lowest satisfaction rates ever recorded which has been demotivating for employees and frustrating for patients.

The current NHS workforce challenges have impacted the whole of the healthcare system and can delay people receiving the best treatments available. Once a treatment is approved by the National Institute for Health and Care Excellence (NICE) there needs to be the capacity for it to be rolled out, including any additional training requirements and this will have an impact on industry partners if new treatments are not utilised.

There are examples of fast-paced innovation within cancer treatments, but the adoption is slowed by a stretched and understaffed system – following the long-term impacts of the pandemic – that does not have protected time to embed new approaches. Collaboration between sectors is also crucial to support adoption at scale. If these workforce challenges are not addressed, patients will not be able to access the right healthcare when they need it.

There are three big ambitions laid out in the NHS LTWP:

Recruitment – there is a focus on a big recruitment drive into roles in the NHS and into training places. As there are currently shortfalls in almost every area of the NHS, particularly in frontline care, this needs to be a priority.
Retention – a large number of professionals leave the NHS every year, so focusing on how the NHS keeps the people who are already employed is essential if they are going to meet the increasing demand on the system.
Retraining – there is more to training than getting new people into the workforce – it is also recognising that to make the NHS future proof, more needs to be done to support the current and future workforce to embrace new technology. This needs to address how the whole health system embraces new ways of working and developments in technology. There can’t be fast adoption of new technologies if the training and skills aren’t quickly put into place for the workforce and patients.

Although the NHS LTWP has been broadly welcomed by the healthcare system, there are some very clear omissions that will make it hard to deliver. There is no mention of infrastructure, meaning that capital investment isn’t aligned to the planned workforce investment. Many of the current hospital buildings in use are not fit for purpose and it was recently announced that the target to build 40 new hospitals by 2030 is likely to be missed.

“There is an opportunity for industry to think about how new technologies can address some of these pressures in the system.”

This NHS LTWP does not include social care and is not aligned to a similar reform of our social care system, which is currently suffering from many of the same challenges as the NHS in terms of increased demand on services with a reduced workforce. If the healthcare and social care systems do not receive investment simultaneously, then one will take on the burden of the other, as they are intrinsically linked.

The NHS LTWP talks about innovation in robotics which has dramatically reduced how long patients need to stay in hospital; for example, heart surgery often now requires a shorter stay in hospital due to technological advances. However, these technologies often need to be accommodated in modern facilities, which means new capital investment. Furthermore, without appropriately resourcing the social care system, many patients are not able to move out of hospital when they are ready to.

Many of the ambitions laid out in the NHS LTWP will take time to deliver, so there is an opportunity for industry to think about how new technologies can address some of these pressures in the system. Those in industry can position themselves to make relevant value propositions and be part of the discussions over the coming years.

The education piece in the NHS LTWP is also interesting for industry, as there are plans to accelerate how people are trained, meaning that there could potentially be a role for life sciences to support with this. IQVIA’s work in population health management and service redesign will also continue to help address workforce challenges, especially when aligned and augmented with IQVIA’s clinical services.

This NHS LTWP is highly innovative, but there is no mention about how it is going to be funded, which raises questions around whether it will actually deliver what is needed for the NHS. This is especially true given the current issues within social care, but by working collaboratively with industry, there is an opportunity to bring in experts to look into niche, innovative solutions.

Stephen Jowett is Senior Director and Head of Healthcare Consulting at IQVIA.

Digital innovation will be key to realising ambitions of the Workforce Plan – Richard Stubbs

By Richard Stubbs

Responding to the NHS Workforce Plan, CEO of the Yorkshire & Humber AHSN, Richard Stubbs, argues that plan’s success will depend on the adoption of digital innovation and the creation of a digitally-capable workforce.

Workforce pressures remain one of the greatest challenges facing the health and care system, with ever-increasing and diversifying demands of the population driving the need for greater system capacity. It is implausible to imagine that we will continue to expand our workforce to meet future demand in a sustainable way. As well as supporting and championing our workforce, we need to also explore new ways of working by unlocking the power of digital, introducing new models for delivering services which will enable our staff to spend more time on activities that directly benefit patient care.

These ambitions are reinforced by the recently published NHS Long Term Workforce Plan, majoring on training and retaining our healthcare workforce, alongside the need to reform our ways of working and workforce training offer.

Digital technology, data, AI, and robotics offer numerous opportunities to address system capacity challenges and enable patients to receive timely, high-quality care. For example, the PinPoint blood test optimises NHS urgent cancer referral pathways so patients in greatest need are seen first, whereas the Digibete online platform supports better management of young people with diabetes and helps prevent unplanned hospital admissions.

These innovations will never replace care delivered by people and the specialist skills of our health and care workforce, nor is it an alternative to safe levels of staffing. Instead, it should be an integral part of a modern health and care system’s approach to coping with increasing demand. However, as around 22 per cent of the UK population lack basic digital skills, digital technology needs to be introduced in a way which doesn’t exacerbate existing inequalities. As the Digital Divide report I supported in conjunction with Public Policy Projects recommended, we need to avoid a ‘digital-by-default’ approach, and instead, ensure that adoption of digital technology is sensitive to the needs and challenges of different population groups.

As the Long Term Workforce Plan acknowledges, adoption of digital technology needs to take place alongside digital skills training for the workforce, enabling them to continue providing high quality care aided by digital technology. The linkages between digital technology and health inequalities should also be further highlighted within the workforce, helping mitigate inequalities caused by future introduction of ‘digital by default’ services.

“ICSs’ intrinsic knowledge of the populations they serve will also help to ensure that digitally enabled services don’t exacerbate existing health inequalities.”

ICSs have a critical role in delivering the Long Term Workforce Plan and mitigating current workforce challenges by bringing together workforce, clinical, and service planning and implementing digital solutions which unlock system capacity and deliver patient and system benefits. ICSs’ intrinsic knowledge of the populations they serve will also help to ensure that digitally enabled services don’t exacerbate existing health inequalities. The fifteen Academic Health Science Networks also have a role to play in supporting ICSs to match local need with evidence-backed innovations and supporting equitable adoption and spread of innovation across services.

We can only fundamentally address our current workforce challenges by reimagining the way we deliver health and care. Digital and tech transformation has been the journey for almost all non-health sectors over the last few decades. ICSs and AHSNs will be fundamental in driving this transformation, ensuring digital technology is adopted in a way which supports our workforce, meets local demand and reduces inequalities in access to services.

Richard Stubbs is CEO of the Yorkshire & Humber AHSN, an organisation that connects NHS and academic organisations, local authorities, the third sector and industry to facilitate change across health and social care economies. Prior to becoming CEO, Richard was AHSN’s Commercial Director.

Damaging NHS disputes hindering progress on productivity, finds survey

By Integrated Care Journal

Trusts making progress on NHS targets and taking steps to boost productivity but concern mounting about staff morale and burnout as operational pressures take their toll.

Ongoing industrial action presents a major operational and financial challenge for NHS trusts, and is hindering all trusts’ ability to recover productivity, according to a new survey carried out NHS Providers. It highlights the scale of the task ahead for the NHS, as it simultaneously grapples with increasing numbers of patients with complex conditions staying in hospital for longer, emergency care pressures and limited bed capacity, exacerbated by the crisis-hit social care sector.

Trusts across hospital, community, mental health and ambulance services have made significant early progress towards meeting care backlogs for urgent and emergency care, cancer tests, long waits and diagnostic services as they strive to deliver better outcomes for patients, say NHS Providers.

They have introduced a range of measures to boost productivity in the NHS – delivering more care with existing resources – including targeted initiatives to improve staff health, wellbeing and retention alongside efforts to help discharge patients faster and adapting their buildings to treat more patients.

But trusts are now warning that eight consecutive months of industrial action across the NHS are taking their toll on efforts to cut waiting lists, with more than 651,000 routine procedures and appointments rescheduled so far and many tens of thousands more likely to be delayed as the health service faces back-to-back walkouts by junior doctors, consultants and radiographers in the coming days.

“Increasingly hard to improve productivity”

The new survey by NHS Providers, Stretched to the limit: tackling the NHS productivity challenge, outlines the scale and complexity of the challenge ahead, particularly as trust leaders count the cost of industrial action given the disruption to planned care, and increasing costs due to agency spend and the impact of consultant rate cards.

The Chief Executive of NHS Providers, Sir Julian Hartley, said: “Leaders and staff are working flat-out to cut waiting lists and to see patients as quickly as possible in the face of major obstacles.

“With waiting lists at a record high, trusts are keenly aware of the need to carry out more operations, treatments and scans. They are doing everything they can to see more patients more quickly and to deliver better quality care, including introducing virtual wards and new initiatives to speed up hospital discharge and offer more care at home.

“However, it is increasingly hard to improve productivity because of staff burnout, high turnover, vacancies, a rising number of patients with more complex conditions, stretched community and social care capacity, and fewer hospital beds per person than comparable countries.

Trusts are also warning that it will be very difficult to deliver the government’s overall demands in terms of performance while delivering unprecedented efficiencies, seeking to protect quality of care for patients.

The survey finds that:

Almost nine in ten (89 per cent) trust leaders said the scale of the efficiency task is more challenging than it was last year.
Almost three in four (73 per cent) did not think they had access to sufficient capital funding over 2023/24 to cover the costs of vital repairs to buildings and equipment.
Nearly two thirds (61 per cent) were not confident that they and their system partners would hit targets to reduce long waits for mental health care.
Fewer than half (43 per cent) expect to meet an interim recovery target of 76 per cent of A&E attendances to be seen within four hours during 2023/24.

The findings reveal widespread worry among trusts about having to deliver more for less as budgets, staff and resources are stretched to the limit, leaving trust leaders facing increasingly difficult dilemmas about how to sustain services in the future.

Despite an overall increase in workforce numbers and the welcome promise of more staff in the future through the new long-term workforce plan, rising concerns about staff morale and burnout also continue to play heavily on trust leaders’ minds. They are contending with 112,000 vacancies across the health service in England with staffing numbers and skill mix failing to keep pace with growing and changing demand.

This is piling on the pressure, with trust leaders identifying discharge delays, relentless demand on emergency care, a lack of investment in social care and a dependency on agency staff as the biggest barriers to returning to pre-pandemic levels of productivity.

They are clear that capital investment in the NHS estate is also key to boosting productivity. This would allow trusts to expand bed capacity and community provision, deliver digital transformation, bear down on care backlogs and eliminate the persistent inefficiencies created by creaking buildings and equipment.

But with the NHS capital maintenance backlog now exceeding £10bn, and only a handful of trusts benefitting from much-needed investment through the New Hospital Programme, a great many more need urgent major capital investment to overhaul their ageing estates to achieve better – and safer – outcomes for patients.

Sir Julian Harley added: “Industrial action also poses a significant financial risk to trusts, given the disruption to planned care, and increasing costs due to agency spend and the impact of consultant rate cards.

“The new long-term workforce plan with its focus on recruitment, training and retention could finally put the NHS workforce on a sustainable footing if commitments are made to keep it updated and funded. But the benefits of that plan can only be reaped with a wider focus on productivity and its enablers, many of which we explore in this report, such as investment in management capacity and capital.

“If we are to ramp up productivity across the NHS, we need a step change in capital investment to provide more beds, more community care, a digital revolution, a safe and comfortable therapeutic environment, and appropriate support for social care.”

Poor work/life balance driving NHS exodus

By Integrated Care Journal

As vacancies hit record levels, doctors and nurses want more flexible work arrangements to carry on working in healthcare, study from Deloitte finds.

Poor work-life balance is a key driver of job dissatisfaction for healthcare workers, and improvements are within the power of employers, according to new research from Deloitte’s Centre for Health Solutions.

The findings come from the report, Time to Change: Sustaining the UK’s clinical workforce, which looked at the experience and resilience of front-line clinicians, based on a survey of 1,286 UK public healthcare workers. The study examines how attitudes within the profession have changed since 2017, when a similar piece of research was conducted, and includes input from doctors, nurses and other clinical staff working in primary, community and secondary care.

Having a ‘sense of fulfilment/making a difference’ (42 per cent) and a good ‘work-life balance’ (41 per cent) are the top two drivers of job satisfaction for healthcare workers, the study found. By contrast, pay (60 per cent) and having a poor work-life balance (42 per cent) were found be the two main drivers of job dissatisfaction within the professions.

The high ranking of work-life balance for job satisfaction and dissatisfaction is in stark contrast to five years ago, when work-life balance was the fifth-biggest driver of job satisfaction, according to Deloitte’s 2017 study.

When asked how their feelings on job satisfaction and dissatisfaction has affected career intentions, the most common response, among 53 per cent of all respondents and 59 per cent of doctors, was to reduce hours and move to part-time working in healthcare. In addition, 40 per cent of clinicians overall, including 35 per cent of doctors and half of nurses and midwives had considered leaving the profession and changing career.

The study follows a slew of unwelcome news in recent days, including (now-confirmed) speculation that the government’s long-awaited NHS workforce plan (due to be published Tuesday 30th May) is to be delayed as it is considered too costly and the admission from the Health Secretary, Steve Barclay, that the 40 new hospitals will now not be built by 2030 – in contravention of the Conservative government’s flagship pledge.

Additionally, NHS vacancies remain at record levels as the health service continues to struggle to attract and retain staff. One-fifth of all nursing posts in England are estimated as vacant, and NHS trusts fear that the situation will not change until the government sets out a fully-costed workforce plan.

Karen Taylor, Director and Head of Research at Deloitte Centre for Health Solutions, said: “The problem has worsened over the past few years and our findings mirror recent staff surveys from the industry. There is a clear need to address the physical and mental health needs of staff if employers are to build a resilient workforce.

“Many solutions are in the hands of local health organisations to address and several have implemented effective solutions, just not at the scale needed.”

Sara Siegel, Partner and UK and Global Head of Health at Deloitte, said: “The most vital asset in healthcare is its workforce. Our study shows that the availability, accessibility and quality of care available to patients depend on having the right professionals, with the right skills, in the right place, at the right time.

“Healthcare leaders have a real opportunity to make a long-lasting impact in this crucial area. Those that have adopted new ways of working and technologies, have already realised the benefits to empower their workers. Not only will this help patients, but it will have a positive impact on job satisfaction that supports individuals to build rewarding, long-term careers in healthcare.”

Implications for physical and mental health

The study also revealed that 87 per cent of clinicians had experienced an increase in their workloads since March 2020, including 90 per cent of nurses and midwives and 84 per cent of doctors, with serious mental health and wellbeing implications for those staff affected; 46 per cent of clinical staff reported experiencing a negative impact on their physical health, including 50 per cent of hospital doctors and 45 per cent of hospital nurses. The study also found 57 per cent disclose a negative impact on their mental health, including 58 per cent of hospital doctors and 59 per cent of hospital nurses.

This contrasts with the 2017 study, in which 30 per cent of hospital doctors and 32 per cent of hospital nurses said that their workload had a negative effect on their physical health; and 23 per cent of hospital doctors and 33 per cent of hospital nurses said that it affected their mental health.

Digitisation will help – eventually

Numerous policy documents and reports, including the NHS Long Term plan, have identified the importance of adopting technology across healthcare. Deloitte’s study therefore asked healthcare workers which technologies they think are helping to improve the quality of patient care. The top five technologies included Electronic Health Records (EHR) (87 per cent), e-prescribing (78 per cent), patient apps (73 per cent), at-home diagnostics (70 per cent) and remote consultations (70 per cent).

Adoption remains low, however, and only 64 per cent of clinicians said they are using EHRs, while fewer than half of respondents have adopted e-prescribing (46 per cent), patient apps (33 per cent), at-home diagnostics (22 per cent) and remote consultations (39 per cent). Likewise, automation of human resource and occupational development services is lagging behind other industries and the study points out the crucial need to modernise these areas.

Dr Karen Kirkham, partner and Chief Medical Officer at Deloitte added: “While healthcare workers know that technology-enabled care models, systems and processes can improve outcomes and safety for patients, simplify tasks and reduce the significant administrative burden for clinicians, adoption remains fragmented.

“Healthcare leaders need to modernise and unlock better ways of working that improve the employee – and employer – experience. More efficient HR and people policies that focus on equality, diversity and inclusion, investing in leadership and professional development, and accelerating the digitalisation of healthcare infrastructure, will go a long way towards developing new ways of working that release time to care.”

News, Workforce May 23, 2023

NHS must seize upon growth in physiotherapist numbers

By The Chartered Society of Physiotherapy

Growth in the physiotherapy workforce should be the solution to the workforce crises in the NHS community rehabilitation services.

The physiotherapy workforce is ripe for expansion, which is good news for the public, policy makers and service providers. But this good news is not resulting in a high-quality rehabilitation service for all with a well-resourced physiotherapy workforce.

Many people do not know what good quality rehabilitation should look like, and there exists a growing unmet population need, combined with historic understaffing of community services, particularly of rehabilitation services.

At present, nearly a third of people in England has a long-term health condition. People with long-term conditions are being pushed into the most expensive and overburdened parts of health and care because they are not being supported in the community to manage their conditions effectively.

The needs of people with long-term physical conditions account for half of all GP consultations, 70 per cent of bed days in hospital and 70 per cent of total health and social care spending, while more than 60 per cent of patients admitted to hospital as an emergency have one or more long-term conditions.

Lack of access to high quality rehabilitation services

Narrowing the gap in healthy life expectancy will only happen with better access to quality community and primary care services for people with long-term conditions and for these services to be integrated around their needs.

NHS community rehabilitation services have been developed in a piecemeal way, often siloed by medical condition, with varying criteria for access. Furthermore, poor access to rehabilitation is particularly concentrated in areas of deprivation and among marginalised groups, resulting in more demand for GP appointments, increased A&E attendance and admissions.

Delivery plans for NHS policies have been also undermined by the lack of calculations on the additional staff capacity needed. For example, policies on urgent community response and discharge to assess have been implemented at the expense of rehabilitation, because they are delivered by the same group of staff. This has meant the policies have failed to reduce emergency admissions or the harm from delayed discharge.

However, for the last five years, additional roles in primary care have improved access to expert advice and diagnosis within primary care.

The value of Musculoskeletal first contact physiotherapist roles

An example of this is the establishment of the role of the Musculoskeletal first contact physiotherapist (MSK FCPs). MSK FCPs are improving patient outcomes, reducing demands on GPs, cutting medicine prescribing and reducing unnecessary onward referrals and tests.

The initial target provided in the Interim People Plan 2019 was stated as 5000 MSK FCPs, but currently there are only 1376 posts covering many GP surgeries and population sizes several times more than originally modelled. Due to these issues, GPs report that they don’t feel the impact of MSK FCPs, and issues of MSK FCPs retention are emerging.

This dynamic undermines implementation and has slowed down the evolution of the MSK FCP role which would support integration with community services.

How can we expand the physiotherapy workforce?

Community rehabilitation services are experiencing difficulties with recruitment and retention, but even greater issues are a lack of established posts and gaps in provision. 15 per cent of physiotherapy staff are leaving the NHS each year and almost half of them are leaving within the first five years of qualifying.

Many are moving to the private sector, but some newly qualified physiotherapists are seeking positions in low-skilled roles in the commercial sector citing less stress, flexible working hours and better pay. There is also the worrying issue of support workers retiring; a 2019 CSP survey of support workers shows that approximately 24 per cent of the current physiotherapy support worker workforce are over 55 years of age.

To compound this, a recent CSP staffing survey, showed that 93 per cent of physiotherapy managers reported that there were insufficient staffing numbers to meet patient needs and 39 per cent of physiotherapy staff reported that this was something they were very concerned about. CSP members also reported having less time to spend with patients, longer waiting times and a lack of available time to improve services, while issues around staff retention and an inability to fill vacant posts were also highlighted by members as contributing factors to insufficient staffing levels.

In the UK, there are currently nine registered physiotherapists for every 10,000 people compared to Denmark, where there are 26.8 physiotherapists for every 10,000 people and Norway, where there are 25.3 physiotherapists for every 10,000 people.

What are the solutions?

Over the years, the NHS has not grasped that, if done well, an increase in physiotherapy provision can help to meet patient needs and reduce pressures on the most overstretched parts of the system.

Insufficient staffing levels are contributing to recruitment and retention problems, which has led to a vicious cycle of high workloads and too few staff.

Change can happen but this requires increased staffing as well as doing more to attract and retain the physiotherapy workforce. The growth in the numbers of registered physiotherapists is increasing, but a sustainable and long-term workforce solution is urgently needed.

The NHSE Long Term Plan must support integrated workforce planning, with targets across primary and community sectors based not on the status quo but on Government and system policy objectives to improve provision to meet population need.

Support workers also have a vital role to play – they need expanding in number and should be upskilled through Rehab Assistant Practitioner apprenticeships to take on greater responsibility, making it possible to safely expand the support worker workforce as a proportion of the workforce overall.

As well as addressing under-staffing, community services also need more strategic leadership, consistency of provision and visibility within the NHS. The lack of leadership in community services is worrying; where Trusts have Chief AHPs at a senior level, community service leadership is strengthened, improving visibility. As well as ensuring this is the case within all Trusts, there need to be more clinical therapy roles within the community working at an advanced practice or consultant level to drive up consistency in standards, lead integration across pathways and partnership working with primary care.

The good news is that the number of registered physiotherapists is growing, alongside a supply of students. Now is the time for the NHS to utilise this rise in numbers. Doing so will go a great way towards tackling the current workforce crisis in NHS community rehabilitation services.

The Chartered Society of Physiotherapy will be joining ICJ and Public Policy Projects at the Integrated Care Delivery Forum in Manchester, this Thursday 25th May. The event is free to attend for relevant healthcare professionals, so come and say hello!

All news