Solutions for the NHS Workforce Crisis

This week, the Kingsfund, one of the most respected think-tanks on health and social care in the UK declared that the current NHS staffing levels are becoming a ‘national emergency’.

 

The latest figures have been published by the regulator, NHS Improvement, for the April to June period.

 

They showed:

  11.8% of nurse posts were not filled – a shortage of nearly 42,000

  9.3% of doctor posts were vacant – a shortage of 11,500

  Overall, 9.2% of all posts were not filled – a shortage of nearly 108,000

 

NHS vacancies a ‘national emergency’

 

This is having a profound impact on staff who are working in the NHS now, with low morale, high stress levels, increasing mental health problems and people leaving the profession (either to go over seas, where pay and work-life balance is considerably better) or retire early. 

 

Increasing the number of doctors, nurses and midwives (all with considerable debt, mind you!), by 25% over the next 5 years is welcome, but it doesn’t solve the problem now, and it is unlikely to be enough, even then!

 

But, let’s take a solutions focussed approach. What can we do now? I think there are a few things we need to consider:

 

  1. I can understand how frustrating it is for the public to find that waits are longer to receive much needed care. When we’re anxious or worried about our own heath or that of a loved one, we are understandably at a position of higher stress. However, this staffing crisis is not of the making of the nurses, doctors and other health professionals who work long hours every day to provide the best health care they can. So, it’s really important that as a country, we treat our NHS staff with kindness, gratitude and respect. The current abuse of NHS staff is making the job even harder and really making people not want to come to work. And that means we also need to make complaints in a way that is perhaps a bit more compassionate or understanding towards people who are working under high stress situations. It is important that we learn from mistakes, but complaints have a huge impact on staff and can hugely affect their confidence, even when they are dealt with in a very compassionate way by those in leadership. 
  2. We need to ensure that we use our appointments appropriately. Yes – sometimes, we have to wait a while to see our GP, but if we get better in the mean time, we really don’t need to be keeping the appointment! And missing appointments costs us all so much time and energy and makes those waiting lists ever longer. If we value our health system, we need to either keep appointments, or take responsibility to cancel them.
  3. We need to take an urgent look at the working day of our NHS staff and work out how we build more health and wellbeing breaks into their days. We need staff to have space to connect, keep learning, be active, be mindful and take appropriate breaks. This means senior leadership teams getting the culture right, when the pressure is on and the stakes are high. 
  4. We need to get smarter with digital and enable patients to make better and more informed choices about their own care and treatment, with better access to their notes. In this way, we waste less time and empower people to become greater experts in the conditions with which they live everyday. There are great examples of where this is happening already. It isn’t rocket science and can be rolled out quite easily. It’s good to see some announcements about this from the new health secretary Matt Hancock MP, but we need to make sure the deals and the products are the right ones. It’s also vital, when it comes to digital solutions that Matt Hancock listens to his colleague and chair of the health select committee, Dr Sarah Wollaston MP, in being careful what he promotes and prioritises.
  5. We need to be thinking NOW about the kind of workforce we are going to need in the next 2-3, and 5-10 years and we need to get the training and expectations right now! There is no point designing our future workforce based on our current needs. Rather, we need expert predictive analysis of the kind of future workforce we will need, in line with the ‘10 year plan’ and begin to grow that workforce now. If it’s healthcoaches we need to work alongside GP practices, then let’s get them ready, if it’s community focussed nursing teams, then let’s adjust the training programmes. This kind is vital and must influence what happens next.
  6. We need to stop putting pressure on NHS staff to deliver that which is currently undeliverable without causing significant stress to an already overstretched workforce. By this I mean centrally driven schemes, such as the intended roll out of GPs working 8-8, 7 days a week. Maybe it’s an aspiration for the future if we can sufficiently reimagine the workforce, but it’s not a priority now and isn’t the answer to the problems we’re facing.
  7. We need to stop the cutting of social care in local governments, and ensure that central funding flows to where it needs to be, to ensure the allied support services are present in local communities to work alongside NHS colleagues in getting the right care in the right place at the right time. This is the single biggest cause of our long ED waits and our problems with delayed discharges from hospital. It isn’t rocket science. It’s the reality of cuts to our social care provision, which have been too deep and this needs to be reversed.

 

Personally, although it is an option, I feel uncomfortable about a ‘recruitment drive’ from overseas, as it is very de-stabilising to health care systems in more deprived parts of the world when we do that. I think there are some win-win initiative we could develop pretty quickly that could also form part of our international development strategy.

 

In summary, we need to treat our NHS staff with kindness, look after their wellbeing, use our services appropriately, use digital technology with wisdom and not for political gain, redesign and start building the workforce of the future now, stop undeliverable initiatives and ensure the right funding and provision of services through social care which means central government funding back into local government. It won’t solve everything, but it will go along way towards giving us a more sustainable future to the NHS.

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Better Care Together – We Have to Fix the IT

iu-4In all the places I have seen an ability to try something radical and new in the sphere of health and social care (Valencia and Arkansas being two prime examples), I have witnessed one key component. They have fixed the IT! It is really not beyond the wit of man, though I accept it is not altogether straightforward. However without it, change is painfully slow and it is extremely difficult to make the kind of changes we need to see. I do not understand why the Government will not invest in this area appropriately. Here in Morecambe Bay we need to crack this nut if we’re going to be able to let go of our past and embrace a truly collaborative and integrated way of working.

 

The benefits to everybody would be huge. Patients would have safer, more streamlined and ultimately more affordable care. This would cut the complaint and litigation culture to an absolute minimum. Clinicians would be able to work far more collaboratively, effectively, safely and efficiently. If we allow ourselves to imagine just what a difference it could make then we will act to make this a reality.

 

There have been some great strides forward made here by the excellent work of GPs like Tim Reynard and George Dingle, who are developing some fantastic new ways of working and building relationships between primary and secondary care. But their efforts are being hampered by a lack of a truly integrated system.

 

As just one example, take the referral process. If a patient comes to me asking for a referral, which may also require some complex tests to help reach a diagnosis, currently there is so much wasted time and effort plus duplication of work that it is an absolute farce. Say someone comes to see me with a suspected rheumatological condition. Currently, I can see them, assess them, order some (but not all tests) and then refer them. My notes will be on my computer system, but my letter to the consultant may not fully convey all the intricacies of the history I have taken over weeks. My letter has to be written and sent off (on occasion they get lost in the system, causing huge frustration to the patient). Then the consultant sees them……..she will probably order further tests, which she will then write to me to organise, or have them done at the hospital, then she will see the patient again. She will then start some treatment, but will write to me to prescribe it and then the patient will then come to collect it from my surgery. She also asks me to refer onto our community physio teams (a letter I read at 7pm after 11 hours of non-stop work, when I want to get home for my kids’ bedtime stories). There are several points of frustration for everybody involved in the process, not least the patient with wasted time and resources along the way (plus extra letters to answer complaints for missed referrals or whatever else might go wrong).

 

In an integrated system, the patient sees me. I write good and detailed notes, which I link to the consultant rheumatologist, assigned to work alongside my practice, Unknown-5with a short note attached. She then liaises with me in a straightforward way about the case, decides what extra tests are required and these are organised (within appropriate resource allocation) ahead of the consultation. The consultant sees the patient, with a full history and set of investigations. She agrees a treatment course with the patient, prescribes the necessary drugs, which automatically appear in the electronic record, so my team can print out the prescription and the patient can pick it up. She also simultaneously links her consultation to the community physio with a short note and her therapy can be arranged in a slick and easy fashion. This has saved loads of steps, time, energy, complexity and errors. It is a basic example. There are many more areas, like maternity care, patients with complex medical problems involving the care of multiple departments etc where this is simply a no brainer.

 

So what is stopping us? Actually it’s pretty straight forward. 1) A lack of sensible and adequate resourcing from the government within the Vanguard system, which would allow us to make significant changes in a small amount of time. Instead of concentrating on a few Vanguard sites and allowing us to really flourish, things have become far too watered down across way too many experimental initiatives and the funding promised has not been made available. This really needs to be rectified. I’m sure there are things we could also streamline within our Accountable Care System. 2) Stupid competition laws and sweeteners offered to some of our partner providers to use certain IT systems which are clunky and unfriendly when it comes to creating platforms that can talk to each other, have slowed us down. We need a focused and joined-up approach. 3) Priorities. My argument is that without integrating the IT fully and investing in front end smart IT that promotes self care and more appropriate use of resources, we will not achieve together what we could in a way that will benefit everybody.

 

In short, we need to fix the IT. It is the solution to a vast majority of our problems and will allow us to really have Better Care Together.

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