Health CommitteeWritten evidence from Work Futures Research Centre (ETWP 101)

The committee must contextualise changes in health care services and workforce within wider social and economic changes. Uncertainty about the demands of the NHS workforce are mirrored in wider uncertainties surrounding deindustrialisation, globalisation, scientific and technological developments and population change. Each of these play out in social and working lives and influence workforce and the economy. We note the following factors worth considering:

Shifting inter-professional boundaries: modern healthcare and services require different and new forms of work. What nurses, doctors and other health professionals is changing. The old specialty and professional boundaries are being eroded—for example by extended scope practice in physiotherapy where these allied health professionals now have the skills once only used by orthopaedic surgeons. Changes to skill mix and job roles cannot be understood outside the wider changes to nature of work—the shifting boundaries of what it means to be a Doctor or a Nurse. We are seeing increasing labour substitution—nurses for doctors, healthcare assistants for nurses, clerical for health-related staff and this may be in addition to artefact or technical substitution—the introduction of equipment or IT to augment or “replace” roles. (We have undertaken studies of the deployment of computer decision support to enable clerical staff to undertake triage—NIHR SDO projects: Turnbull et al 2011–13 and Pope et al 2008–10) The changes in turn change the kind of workforce we need—one important gap at present (given the increasing digitisation of healthcare) is in IT specialists necessary to build and sustain digitised services effectively.

Recruitment and retention: huge demographic changes—notably the ageing workforce in the developing world are having an impact. There is currently a serious lack of qualified healthcare workers, with prognosis indicating an increasing shortage in the context of rising demand from an ageing population. We need to understand how to attract and retain an ageing workforce into healthcare (some public services have traditionally had early retirement—the UK Police for example often sees retirement at 50–55).

Dealing with high sickness rates: sick leave rates are higher in healthcare sector than in most other industries or services. We have recently begun exploring the “long-term-healthy” approach (translated from Swedish “långtidsfrisk” developed by and described in Johansson et al (2003)) to shift the focus away from counting sickness rates to understanding potential solutions—how and why people thrive at work and stay healthy, and the circumstances, strategies and interventions, which build and sustain well-being at work.

The need for lifelong learning: healthcare work is changing so rapidly that in order to retain an optimum workforce we must constantly retrain and up skill our workers. This challenges some traditional models of healthcare education in which training and skills are front-loaded in the early part of adult lives and which can exclude mature entrants who acquired few qualifications at school but who with training and development have great potential to contribute to the quality of health care. Fuller et al have undertaken innovative work looking at work-based learning, apprenticeships and the characteristics of healthcare workplaces as learning environments which may provide solutions to this need for widening participation, continual development and career progression (Fuller et al 2010).

Migrant and Immigrant labour: Attention must be given to the recognition of non-UK qualifications—there is evidence that consigning or overseas trained healthcare workforce to career/non-progression grades is demotivating and negatively impacts on retention. (Halford and Leonard—BMA work). We must equally recognise the additional and continuing training needs of migrant workers.

Non-traditional career paths: with women now accounting for over 50% of doctors in training, on top of a predominantly female nursing and healthcare workforce, we must address the needs for flexible and part-time working. Many female doctors self select into specialties (General Practice) that offer work cultures and work-life balance to fit with domestic and familial arrangements. If we are to sustain the range of health care services and specialties we must find ways of making this kind of work pattern possible in other areas (this will also address the ageing workforce issue).

New organisational forms: we may need to look outside the UK to other contexts to explore different/new modes of service delivery and organisation. For example very specialised and centralised Indian hospitals which focus on a single specialty or procedure. We need to understand the impact of these models on an increasingly globalised and competitive workforce. We may also learn from best practice elsewhere.

Need for review of the relationship between the AfC pay banding structure, the NHS career framework and National Qualification Levels: to identify how the rigidities of the banding structure may be acting as a disincentive to individuals to pursue education and training and to employers to pursue progressive workforce development and progression strategies.

December 2011

Prepared 22nd May 2012