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Workforce planning for the health service is challenging and complex. The future workforce is difficult to predict: social and technological changes mean that some skills will become redundant while demand for others will suddenly increase. Basic staff numbers are hard to forecast and problems are exacerbated by the length of time required to train staff: at least three years for most health professions and up to twenty years for some senior doctors.
Nonetheless, workforce planning is a vitally important process. 70% of NHS funding is spent on staffing costs and so the effectiveness of its workforce in large part determines the effectiveness of the health service. Workforce planning is the key means for the health service to understand and anticipate the impact of demographic, technological and policy trends on future service requirements. It is also an important way of improving the efficiency of the health service. In short, changing and improving the NHS depends on effective workforce planning.
In light of its importance, the Health Committee recommended a thorough review of health service workforce planning in 1999. This recommendation was accepted and in 2000 the Government published an excellent blueprint for workforce planning entitled A Health Service of all the talents. In the same year, targets were set for a large increase in the number of staff employed by the NHS in the NHS Plan. There was also to be a significant expansion in the number of training places for clinicians.
However, the huge growth in funds provided by the Government, together with the demanding targets it set, ensured that the increase in staff far exceeded the NHS Plan. Many new staff were recruited from overseas. In 2005 there were signs that the NHS was spending too much. Boom turned to bust. Posts were frozen, there were some, albeit not many redundancies, but, most worryingly, many newly qualified staff were unable to find jobs and the training budget was cut.
Although the Government argued for improvements in productivity, in practice little happened. It was too easy to throw new staff into the task of meeting targets rather than consider the most cost-effective way of doing the job. Large pay increases were granted without adequate steps being taken to ensure increases in productivity in return. There were attempts to create a more flexible workforce and improve the skills of staff so they could take on more complex and responsible tasks. The results of these efforts have been mixed: in some cases, there have been few savings, in others the results have been very successful. Unfortunately, cuts in the training budget threaten what successes there have been.
There has been a disastrous failure of workforce planning. Little if any thought has been given to long term or strategic planning. There were, and are, too few people with the ability and skills to do the task. The situation has been exacerbated by constant re-organisation including the establishment and abolition of Workforce Development Confederations within 3 years. The planning system remains poorly integrated and there is an appalling lack of coordination between workforce and financial planning. The health service, including the Department of Health, Strategic Health Authorities (SHAs), acute trusts and Primary Care Trusts (PCTs), has not made workforce planning a priority.
We cannot know precisely what workforce the health service will require in future. This means we will need a more flexible workforce. Increasing productivity is another vital goal, particularly as the rate of funding growth is likely to slow down. Employers need to make better use of the new staff contracts, particularly the new consultant contract and Agenda for Change to improve workforce productivity. If a health service, rather than a sickness service, is to be created, then it is crucial that the primary care workforce is expanded and improved.
Managers are a crucial component of the health service workforce. The quality of managers remains highly variable and the absence of minimum standards or training requirements is a concern. The contribution of clinicians to managing health services must be improved. Clinical training should contain a larger management element and senior clinical staff should be better supported to take on general management roles.
To avoid the boom and bust of recent years and produce a workforce appropriate for the future, we make one major recommendation: workforce planning must be a priority for the health service. We do not support further restructuring. It matters less who does the job than it is done well and taken seriously. Therefore, despite their failings to date we recommend that workforce planning continue to be undertaken by SHAs.
The 10 SHAs should take the lead on creating a better workforce planning system. Most importantly, the integration of workforce, financial and service planning must be improved, as these processes have often been very badly synchronised. In addition, more integrated planning will mean increased involvement for education providers and the independent sector. The planning system also needs to take more of a long-term view of workforce requirements and think more strategically about how to achieve them.
More time, effort and resources need to be devoted to workforce planning. SHAs must recruit workforce planners of the highest calibre and ensure that they are supported by staff with appropriate skills. Most human resources staff do not have these skills. Other organisations, including trusts and the Department of Health, must improve the quality and accuracy of the information they produce on a range of matters, including workforce forecasts, productivity and the cost of new policies. Finally, the Department of Health must stop micromanaging. In addition to ensuring SHAs have information of a high quality, they should act in an oversight capacity ensuring that SHAs are giving workforce planning the priority its importance requires.
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