building the right workforce
TRANSCRIPT
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Building the workforce as we
transform the delivery system
Candace Imison
The Commonwealth Fund and the Nuffield Trust
15th International Meeting on Improving the Quality and Efficiency of Health Care
Pennyhill Park
17 July 2015
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Overview
• The challenges we face
• Workforce – the English context
• The opportunities offered by changes in skill mix
• The challenges of skill mix change
• Lessons for the future
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The challenges we face – the need for
transformation
• Ageing population + rising burden of chronic disease and
co-morbidity
• Changing expectations of, and relationships with patients
• 24/7 working
• Impact of new medical and information technologies
• Financial context – unprecedented productivity challenge
– £22bn by 2020
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NHS Workforce profile in England
0% 5% 10% 15% 20% 25% 30% 35%
NHS Infrastructure support
Support to clinical staff
Additional professional, scientific andtechnical (including healthcare scientists)
Allied Health Professionals (includingqualified ambulance staff)
Nursing and Midwifery Registered
Medical and dental
% Total earnings % FTE
FTE data: NHS Hospital & Community Health Service (HCHS) and General Practice workforce as at 30 September 2014. Total earnings
calculated through using estimated average earnings per staff group (taken from 12 month period ending February 2015) and FTE data.
Data sources: NHS Workforce Statistics in England, 2011-2014, HSCIC; NHS staff earnings estimates to February 2015 - provisional
statistics, HSCIC.
Staff employed by NHS organisations – hospitals, mental health and
community providers General Practice staff contracted to the NHS
0 25000 50000 75000
GPs
Practice Nurses
Advanced & SpecialistNurses
Direct Patient Care(HCAs)
Other
Admin & Clerical
General Practice Staff FTE
FTE
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UK has seen significant expansion of medical
workforce (but not evenly distributed)
-15%
-10%
-5%
0%
5%
10%
2009 2010 2011 2012 2013 2014
Axis
Tit
le
Medical and dental
Nursing and Midwifery Registered
Allied Health Professionals (includingqualified ambulance staff)
Additional professional, scientific andtechnical (including healthcarescientists)
Support to clinical staff
NHS Infrastructure support - includinghotel, estates and managers
Data source: NHS Workforce Statistics – February 2015, provisional statistics, HSCIC. Data taken from December of
each year shown.
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England – workforce supply issues
Recruitment difficulties & forecast shortages
Nursing – hospital, primary care and community
Doctors – A&E, acute medicine, psychiatry, general practice
Social and informal care
Changing workforce expectations
More flexibility
Less organisational allegiance
How sustainable is continued restraint on pay?
Geographical variation – recruitment black spots
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Skill mix change could offer some solutions
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Deliversmore patientfocused care
Addressesgaps inmedical
workforce
Addressesgaps inskillednursing
workforce
Deliverssavings in
service costs
Improveshealth
outcomes
Improvesoverall
recruitmentand retention
Addressesgaps in allied
healthprofessionals
workforce
Other Deliverssavings in
training costs
What would be the benefits of skill mix change for the area with the greatest potential to benefit? (n=17)
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All service areas have potential to benefit from skill mix
change – but particularly primary and community care
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Communityservices
Hospitalinpatientservices
(secondary)
Hospitalinpatientservices(tertiary)
Hospitaloutpatientservices
(secondary)
Hospitaloutpatientservices(tertiary)
Mentalhealth
services
Pharmacyservices
Primarycare
Social care Support forself-care
How much potential do the following health and social care service areas have for skill mix change (recognising the opportunities offered by new technologies)? (n=18)
Great potential
Moderate potential
Little potential
No potential
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New (alternative) worker
New work
Old worker
Old work
increasing the numbers of
nurses, doctors, and other
health professionals
expanding the job
descriptions of existing
workers, such as
community matrons, to
include work previously
not done by anyone
handing off existing tasks
to other workers, such as
nurse practitioners and
general practitioners with
specialist interests
creating new jobs for work
previously not done by
anyone, such as genetic
counselors, and lay
providers to support self-
care
Redistribution Creation
Capacity expansion Retraining
Source: Bohmer, Imison. Health Affairs 2013, 32(11), 2025-2031
Framing the options for skill mix change
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Summary: considerations in workforce redesign
1. Complements vs. substitutes; previously new roles have been
added w/out decommissioning old roles with a net increase in costs
2. Importance of role definition; new classes of worker often have
poorly defined roles, especially in relation to the roles of others
3. Benefits of seniority; senior clinicians, although more expensive by
the hour tend to order fewer tests and utilize fewer bed days,
admissions and procedures
4. Risks of fragmentation; dividing the work among more (cheaper)
workers increases team coordination costs
5. Importance of a career; new roles benefit from a formal career
structure, national recognition and portability
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Messages from Time to Think Differently
• The staff we will have are the staff we already have
– don’t rely on the pipeline
• Align the workforce to the work – not the other way
round
• Develop teams not just individual professional
groups
• Support and “activate” patients
• Support the informal workforce
• Reverse the inverse training and investment law
• National facilitation but local action
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Conclusion
“New technologies will force changes in delivery models that we have not yet thought of. Without building capacities and capabilities in our workforce for a world of continuous change and emergence of new roles and possibilities, we risk being perpetually out of step and continually rebuilding our workforce to do yesterday’s not tomorrows health work” Professor Richard Bohmer
© Nuffield Trust 17 July 2015
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