Engaging our workforce

Jenny Briggs, Associate Director and Julie Frampton, Senior Manager talk about their experiences of workforce redesign and the challenges facing health and social care providers.

Context: “I wouldn’t start from here!”

There is an age old joke about a tourist that asks a “local” for directions and gets the response “well if I were you, I wouldn’t start from here.” The NHS and social care workforce have been under significant challenges for the last decade and the current backdrop of staff shortages, low morale, change fatigue, junior doctors’ disputes and Brexit uncertainty does not make fertile ground for a radical transformation of the way staff work. With few exceptions staff at every level in every sector feel that they are near “rock bottom,” running on empty and tied up with bureaucracy. It is true to say that ideally – we wouldn’t start radical workforce redesign programmes from here!

The NHS Constitution outlines the principles and values of the NHS in England including pledges that set out what staff should expect from NHS employers. The fourth pledge states that we will:

“Engage staff in decisions that affect them and the services they provide, individually, through representative organisations and through local partnership working arrangements. All staff will be empowered to put forward ways to deliver better and safer services for patients and their families.”

Every year the NHS staff survey results show that we don’t get this quite right, however the overall measures around staff engagement are improving year on year. Opportunities presented by the development of new models of care as outlined within the Five Year Forward View give us the opportunity to refocus our workforce planning agenda to simplify systems and processes, improve cross-boundary working and build a workforce that is resilient, skilled and empowered to “do the right thing.” As change agents and system leaders we owe it to the 2.75 million people currently working within the health and social care system to make system reform work for staff as well as patients.

How do we do this?

STPs and Accountable Care Organisations provide unique opportunities to tear up red tape and do something different, bold, and adventurous – and we are mandated to engage staff in the design of their “new world.”

Some organisations have started sharing board level roles across STP footprints to help break down walls between organisations. Others have started taking huge steps forward in trusting each other with co-location and management “hosting” of large numbers of staff to offer the best terms and conditions, or make roles more attractive. Many systems have highlighted ageing workforce in their STPs and are designing new roles that move away from traditional professions – this offers entry level trainee roles and career development for established staff.

Before we start planning our future workforce we need to start with the population and patients that need care. Once we understand the current and emerging care needs we can start to work through the interventions required, and the corresponding skills required. All of this comes before we even map the current workforce. It may sound counterintuitive, but it’s critical that we are not constrained by our “mental valleys” about how care might be delivered and which care professional does what. This opens people’s thinking to explore new roles and completely different ways of working that span across organisations and even sectors. We know our current workforce is not sustainable, so we cannot focus on doing more of the same thing!

Workforce planning model

Conclusion

There is no quick fix, but we must act quickly and take advantage of the opportunities presented by new models of care and STP collaborations. Take some time to listen to staff about what change they feel is needed – and be encouraged by their passion to “do the right thing.” Give them autonomy and permission to “do the right thing” and work with them to understand the needs required by your population and the interventions and skills needed to care for them.

Attain adopt an inclusive and evidence based whole systems approach to delivering change that places patients, carers, and clinicians at the heart of the process. Our work is tailored to the needs of individual customers, and grounded in an appreciation and understanding of local issues or circumstances. We provide a clear sense of purpose, robust accountability, quality assurance, and knowledge transfer to ensure effective transformational change that is sustainable into the future.

Attain has a wealth of skills and experience within its teams that combines extensive clinical experience with robust project management. Attain has a reputation for rigorous and effective delivery of tangible transformational change programmes.

Case study

We have supported a West London CCG in developing the workforce model for a new model of care for over 65s. As part of this process we helped:

  • identify a new role for GPs in care of the over 65s – including risk stratification, multi-disciplinary working and providing care outside their practice environment;
  • develop case management capability across the multi-disciplinary team environment – based on the needs of individual service users; and
  • design a new role for health and social care assistants – who work across health and social care to support the individual needs of service users – providing basic health care, social care, mental health, OT and physio for the over 65s. These roles are designed to ensure personalised care for service users, but also to ensure that scarce NHS and social care resources and workforce are focused on those most in need.

We designed these roles with clinicians, operational staff and managers, developed the job descriptions, secured funding for their rollout and subsequently supported the recruitment to these roles. They are now in full operation across West London CCG’s population.