From current spend on agency staff to concerns about the long-term problem accessing required skills, NHS staffing remains a top priority. With the additional pressures created by the Brexit vote in 2016, organisations throughout the health service are struggling to determine the best way forward.
While there is a general focus on minimising the cost of staff by driving down the use of agency staff, in line with the government’s demand to find £20 billion in savings, more critical is the quality of patient care and the ability to meet care standards, most notably ensuring 95 per cent of emergency patients are seen, admitted or discharged within four hours.
Accessing skills, recruiting talent and maximising existing resources to both minimise spend and meet standards of care is a hugely complex issue and one that demands in-depth understanding of trends in patient needs and skills availability in both the short and long term, insists, Orlando Agrippa, CEO, Draper & Dash.
In a complex, multi-tiered environment, effective management of resources is an incredibly challenging task. And with the well-documented pressures facing the NHS, it is perhaps not a surprise that the Health Foundation has warned the NHS workforce will not be fit for purpose in the near future because the service is not attracting or retaining enough skilled workers, especially with a sharp decline in the number of trainee nurses.
Gaining access to skills is a challenge – and while the number of people in the NHS workforce increased by 2 per cent in the year to April, growth was uneven and largely in managerial or consultant roles. In the past three years, the number of senior managers rose by 13 per cent while the number of nurses grew by 1.1 per cent.
The use of agency staff to plug the gaps continues to be a concern, with spend on stand-in midwives hitting £100 million last year, with the figure for England 20 per cent higher than in the year before. At the same time, recruitment is a serious concern post Brexit - there has been a 96 per cent drop in EU nurses registering to work in Britain since the Brexit vote. The result is there were 469 fewer nurses and health visitors in April compared with the year before, despite rising patient numbers.
However, some improvements have been made to address the apparently inexorable increase in staffing costs – for example, while the NHS spent £2.9 billion on private agency workers in 2016-17, that was down from £3.6 billion the year before after pay caps were imposed on nurses, doctors and midwives. Much of the fall was due to the NHS switching from external agencies to in-house “staff banks”, where workers are called in as required.
Even more effective is to leverage data and analytics to accurately forecast demand levels. By modelling multiple scenarios to determine the most optimal way to arrange staffing, a hospital has a far better chance of delivering the required standard of patient care – without over-reliance on agency staff.
This is particularly valuable within emergency departments, where demand patterns fluctuate significantly. Rather than adopting a flat staffing model across every 24 hours, which can leave departments massively under-resourced at peak times, leveraging historic trends to match staff levels to actual demand profile is far more effective. Within emergency departments, demand rises sharply after 3 p.m. – understanding and planning resources in line with these demand patterns will increase the chances of providing patient access to the best treatment and being seen, admitted or discharged within four hours. Indeed, understanding actual demand patterns not only improves patient treatment but could also translate into potential savings in agency spend or unnecessary investment.
Deepening the Skills Pool
Of course, with rising patient demand comes the need for ever greater staff numbers. And with well-documented staff retirement, especially within the GP community, there is a need to consider ever more innovative approaches to boosting NHS recruitment. But this is far from straightforward – while the government is aiming to recruit 2,000 GPs from overseas over the next three years, only 38 were recruited in the first six months of this year, a report from the Health Foundation found.
In addition, numbers of EU doctors and nurses registering in the UK has plummeted since the Brexit vote, leading hospitals to refocus recruitment activity to Asia and the Far East. But this is a potentially expensive exercise and it is, therefore, essential to make this recruitment activity successful – and that means understanding specific roles that must be filled, not just in individual hospitals, but across a wider area.
Deep analysis of historical data is essential to understand the evolving demand for specific skills – from the need to respond to the challenges of an older and heavier population to the innovations in areas such as gene therapy and targeted treatment programmes. Scenario modelling can play a vital role in optimising the balance of skills. What would be the impact on patient care of prioritising the recruitment of GPs? Or consultants in specific specialisms? Should a Trust concentrate on recruiting experienced nursing staff, or is there an opportunity to employ less experienced individuals to support existing teams of highly skilled nurses?
Combining accurate insight into the evolving skills requirements across the NHS with information about the potential skills available globally will help to inform the recruitment drive and enable administrators to prioritise specific areas of shortage. By undertaking this exercise both at a local level and more broadly, administrators will be better placed to efficiently plan the running of both individual hospitals and the collective healthcare system.
Of course, given the budgetary constraints, the staffing demands of the NHS cannot be filled by recruitment alone. It is also essential to understand existing skills levels and ensure they are used and deployed as effectively as possible. NHS Improvement and the Care Quality Commission (CQC) believe there is significant potential for more productive use of resources across the NHS, which would improve quality of care for patients – with ‘people’ one of the essential Key Lines of Enquiry (KLOE) being assessed.
The focus is to highlight opportunities to improve the way existing staff skills are utilised whilst also cutting costs where possible, for example by reducing reliance on temporary staff, in particular, agency nurses and medical locums; flagging any significant gaps in current staff rotas; encouraging the use of e-rostering or similar job management software systems; and ascertaining the balance of skill mix at any one time.
But it is also essential to take a longer-term view. The use of analytics to understand demand patterns over the past three to five years, factoring in rises in population and new trends in a reduction in EU staff, will help administrators to understand how best to both realign the resources currently in place and plan for the future.
The NHS has the most fantastic depth and breadth of skills and expertise. Staff are under huge pressure, and it is effective management of staffing levels that will be key to not only addressing the valid concerns about agency spend and a lack of skills but also reducing staff stress and ensuring patient care standards are met consistently.
Orlando Agrippa, CEO of Draper & Dash
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