Evidence submitted by NHS Partners Network
(WP 43)
KEY POINTS
— The NHS Partners Network is an alliance
of independent healthcare organisations—commercial and not-for-profit—which
provide diagnosis, treatment and care for NHS patients through
the Department of Health's procurement programmes.
— Our centres have performed almost
200,000 elective and diagnostic procedures for the NHS since the
Government launched its programme in 2003.
— The main function of ISTCs is to
provide high quality diagnostic and elective surgery procedures
for NHS patients and, by increasing available capacity, provide
greater choice for NHS patients.
— Workforce planning would be better
done if the total need of NHS patients was considered not just
traditional NHS providers.
— Workforce planning should be based
on the business expectations ofcommissioners and not on the views
of the Royal Colleges and providers.
— We would also like to see a level
playing field for ISTCs regarding the use offoreign registered
specialists who are able to work in the NHS but not in ISTCs.
— For the NHS reforms to work, there
is a need to remove additionality requirementsand introduce a
free labour market.
— The recruitment and training of local
NHS staff for ISTCs workforce needs will have a positive impact
on staffing knowledge and skills and benefit traditional NHS providers
when they return to work.
— ISTCs can help meet the demand for
workforce through the training they can offer their staff thereby
improving skill levels.
INTRODUCTION
1. The NHS Partners Network is an alliance
of independent healthcare organisations—commercial and not-for-profit—which
provide diagnosis, treatment and care for NHS patients through
the Department of Health's procurement programmes.
2. Our members are: Alliance Medical, BMI
Healthcare, BUPA, Capio, Clinicenta, Mercury Health, Nations Healthcare,
Netcare UK, Nuffield Hospitals, Partnership Health Group and UK
Specialist Hospitals (UKSH). We are leading national and international
independent sector healthcare companies, with extensive experience
of managing elective surgical centres and diagnostic facilities.
3. Our centres have performed almost 200,000
elective and diagnostic procedures for the NHS since the Government
launched its procurement programme in 2003.
4. Our aim is to ensure that patients, doctors
and the public have a better understanding of how new and traditional
healthcare providers are working together in partnership for the
benefit of NHS patients.
5. We support the NHS, in principle and
in practice, and believe that the principles behind the government's
reform programme—extending patient choice, encouraging innovation
and stimulating competition—are integral to the development
of higher quality NHS provision into the future.
How effectively has workforce planning, including
clinical and managerial staff, been undertaken, and how it should
be done in the future?
6. We do not think that workforce planning
has been done very effectively to date. We would like to see it
done in the context of the total need of NHS patients not just
traditional NHS providers.
7. It should be based on the business expectations
of commissioners and not on the views of the Royal Colleges.
8. We would also like to see a level playing
field for ISTCs regarding the use of foreign registered specialists
who are able to work in the NHS but not in ISTCs. This is particularly
important in the case of Commonwealth Registered doctors whose
training and experience follows the UK clinical tradition, model
and culture and whom in many cases have worked in the NHS at some
point and either speak English as a first language or as an excellent
second language.
9. The use of specialists registered and
qualified in Europe is working well, but efficiencies can be improved
if the Commonwealth Doctors are used in the independent sector
too.
10. In the case of nursing, we are concerned
at the over-regulation of their activities. A large number of
nurses will reach retirement age in the next five years and the
impact will be exacerbated if early retirement happens (paragraph
21).
In considering future demand, how should the effects
of the following be taken into account?
The increasing use of private providers of services
11. Future workforce demand should be based
on commissioners' plans for purchasing care rather than on providers'
plans for delivering it.
12. If demand exceeds the capacity of the
independent sector workforce market and outstrips the pace at
which provision can be brought on stream, both price inflation
and pressures on quality control can occur. To offset this, there
should be careful planning and modelling for the existing supply
capacity and the speed at which it can be flexed without reducing
standards such as training and certification requirements.
13. However, if the pace of supply and demand
can be aligned then it may be possible to improve value for money
relative to workforce costs by creating a more robust and sustainable
competitive environment.
14. Wave 1 ISTC contracts imposed strict
additionality requirements on ISTC providers prohibiting providers
from employing staff currently working in the NHS or who had worked
in it within the last six months.
15. For wave 2 contracts, additionality
will only be justified where specific shortages of certain NHS
clinical and professional staff exist. NHS staff will also be
able to offer their non-contracted hours to ISTCs. For the NHS
reforms to work, a free labour market is needed.
16. We are very keen to be able to recruit
and train local staff currently employed with traditional NHS
providers and believe this will have a beneficial impact on staffing
knowledge levels when they return to traditional NHS providers.
Our staff develop and are trained in more innovative and efficient
working practices than in the traditional NHS and use more efficient
and productive techniques, all of which they will take back to
traditional NHS providers.
17. All staff employed by ISTCs are qualified
to work in the NHS—robust measures with regards staff competency
apply, including registration on the GMC specialists register.
How will the ability to meet demand be affected
by:
Financial constraints
18. There will always be a tendency to train
fewer staff than are actually needed because of concerns about
training too many staff. However, rarely have there been situations
where the NHS has had too many medical staff. Having too manyis
more cost-effective, exerting a downward pressure on labour costs
and ensuring sufficient supplies.
Increasing international competition for staff
19. This will put additional pressures on
the workforce supply chain leading to increased inflationary pressures
and will exacerbate any problems with a misalignment of supply
and demand. It may result in other Governments such as South Africa
reversing its present support for the UK proposals to rotate the
use of clinicians-from overseas.
20. There will also be less hostility to
training too many if they can get jobs abroad.
Early retirement
21. This is likely to have quite a big impact
on staffing levels and needs, particularly on nursing levels,
given the number due to retire in the next five years.
To what extent can and should the demand be met,
for both clinical and managerial staff, by:
Changing the role and improving the skills of existing
staff
22. This is likely to have a huge potential
as it will mean that staff knowledge and skills are transferable
within the NHS and should reduce some demand for staff.
23. Additionally, it will free up resources
in specialties where shortages exist—for example, the use
of Radiography Assistants to help Radiographers in the processing
of patients. Also Advance Practitioners are now undertaking roles
previously undertaken by Radiologists including reporting, ultrasound
scanning and barium enemas.
Better retention
24. This has historically been an issue
but initiatives such as Agenda for Change have begun to address
this through enhanced payscales and progression opportunities.
25. In some cases, a higher turnover of
staff would be beneficial.
The recruitment of new staff in England
26. This is vital and can be more effective
than the use of overseas staff in terms of avoiding concerns around
quality control and long term sustainability of the service. But
this can lead to higher costs and take longer to implement than
utilising pre-trained overseas staff.
International recruitment
27. This is of limited value in the short
term. It may be suitable where the services can be performed remotely
and can help sustain competitive tension within the UK to ensure
value for money.
How should planning be undertaken? To what extent
should it be centralised or decentralised?
28. There are arguments for both—centrally
works where there is a national programme of change that needs
to be imposed, sometimes in the face of objection arising from
local interest that is secondary to national interest. The upside
is that overall benefits can be prioritised, initiatives can be
implemented more rapidly and greater economies of scale can be
achieved. The downside is well understood and is primarily a problem
of lack of ownership and concerted resistance that can damage
the initiative during implementation.
29. This could also be a role for the Strategic
Health Authorities.
How is flexibility to be ensured?
30. By engaging with the market during the
planning of procurement and, based on their input, ensuring that
competition is structured in a manner that enables the bidders
to offer flexible solutions.
31. Additionally, by training slightly more
than estimates suggest are needed and moving towards a flexible
and open labour market.
Mark Smith
NHS Partners Network
10 March 2006
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