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Fit for the future? Rethinking the public services workforce Contents

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Chapter 2: A long-term approach

A strategic approach

22.Given the long-term demographic challenges and the likelihood of persistent difficulties in recruiting sufficient staff, long-term thinking and strategic approaches to workforce planning, are required. These approaches will necessarily consider public service design and delivery which set the requirements the workforce must meet.24

23.Contributors argued that long-term thinking must consider different ways to boost workforce numbers, such as UK training routes and immigration,25 but should also examine how to boost efficiency in public services, through improved development and use of data, more flexible and creative deployment of staff and technology, better engagement with people with lived experience, and investment in preventative services.

24.In some areas, the Government is already taking steps to develop workforce plans to meet changing demand. For example, the Department for Education uses the ‘Teacher Workforce Model’ as a projection tool for teacher and pupil demographics.26 Health Education England has also been commissioned to develop a ‘Long-Term Strategic Framework for Health and Social Care Workforce Planning’.27

25.These though, are usually limited to a single Government Department, and do not constitute a comprehensive look at future workforce needs nor, crucially, how to address them. Sarah McClinton though, stated that “what is missing is a long-term strategy for what we will need in10 years and how we get from where we are now”.28 The Royal College of Nursing has also criticised the Government for the “absence of a proper health and care workforce strategy”.29 We heard that the Government’s focus on workforce planning has been “on short term management, muddling through and firefighting, with longer-term planning and development not a priority.”30 Robin Wilkinson emphasised the need for a long-term view, telling us that “maintaining quality and supervision at pace brings some challenges, so long-term planning is vital.”31

26.Agency working is one example of such short-termism in workforce planning, and it was raised repeatedly.32 Without available staff, some teams are compelled to turn to consultant or agency staff, at a higher cost. Joanne Roney, President of Solace and Chief Executive at Manchester City Council summarised:

“We could do better with the money that we currently spend. We have 112,000 vacancies in the care sector and 5,800 agency workers. About 15% of the children’s service workforce is agency and 8% of the adult care service is agency. We pay more for agency than we would pay were we retaining, developing and growing our own.”33

Reasons for the use of agency staff may vary, but evidence indicated a lack of resource or timely recruitment was the driving issue in some areas. The Chartered Institute of Environmental Health reported that:

“Teams [delivering environmental health services] at 87% of local authorities told us that agency staff were used because of shortages in resources or delays in recruitment rather than due to unprecedented demand for services (30%) or due to specialist knowledge not being available in-house (23%).”34

27.Changes in the needs of the UK population will mean long-term growth in demand for public services which will outstrip the growth of the potential workforce. This presents a long-term challenge which requires long-term, strategic solutions. To ensure a truly sustainable workforce, these solutions will need to go beyond attempts to recruit and retain more staff: flexibility, creativity, and imagination will be key.

The role of data in developing strategies

28.Daniel Gerson, Head of Unit Public Employment and Management, in the Directorate for Public Governance at the Organisation for Economic Cooperation and Development stated that: “Improving workforce data is … huge in order to be able to map and understand where our workforce is, what skills they have, how we can address them and bring them together to address a pandemic or any kind of crisis”.35

29.However, such data is not always readily available to public services providers or Government departments. Prospect, the second largest trade union in the civil service, said that:

“Government and public service employers have too often failed to gather the workforce data or develop the planning tools necessary to identify and prepare for future workforce needs … [Prospect] often found employers unable to provide detailed or reliable information on their own workforce, and has sometimes found employers turning to the union for intelligence and insight into skills shortages or demographic risks.”36

30.Data will be needed on current and future needs, the make-up and deployment of the workforce and recruitment and exit data. More qualitative information is needed too, including on reasons for leaving. This last point is crucial to enable the public sector to address these problems and thereby improve retention.

31.The lack of information was apparent when looking at specific sectors, too. For example, Age UK argued:

“The absence of current, reliable data on our health and care workforce is a real impediment to effective planning, and the ability to identify service and skills gaps and take early action is limited by these data gaps.”37

Such concerns extended to data held around social enterprises and other third sector bodies.38

32.Alongside concerns around public services providers lacking accurate workforce data, witnesses raised concerns about a lack of coordination or understanding in how data was gathered, held, and deployed across Government.39

33.The Government does not yet have sufficient, reliable data on the public services workforce, nor projections for future demand. Developing this capability will be essential in developing effective workforce strategies for the future.

34.The Cabinet Office should work with all Government Departments, and particularly the Department for Levelling Up, Housing and Communities to promote best practice on developing and sharing workforce data at a local and national level.

Drawing out the untapped potential of the workforce

Deploying staff

35.We were told that, within the workforce, “the scale of the untapped potential capacity is evident”. Allowing staff, particularly staff in frontline roles and at more junior levels to deliver more services, and to identify needs would, we were told, improve service provision. This is particularly the case in enhancing access to early and preventative measures, and in many cases, delegation of services would free other staff to provide services only they are able to.40

36.A number of examples were provided to us.

(a)Staff working with children, such as teaching assistants, youth support workers, health visitors, personal advisors and welfare officers, all of whom have established training, “could be trained further to help meet the early mental health needs of … children and families”. This, we were told, could help in managing multiple and complex circumstances and better support children and families in early intervention.41

(b)During the pandemic, Wigan Council developed a “reservist model” which allowed council staff to be deployed to frontline roles to meet staffing shortages. They intend to retain this model, which they say provides an understanding of the “assets we have [within] our own workforce”.42

(c)As part of the Loneliness Strategy, the Home Office have trialled a “Safe and Connected” scheme where postal workers call in on lonely older people to check on their needs and share this with local authorities.43

(d)During the pandemic, hospice and palliative care staff took on additional tasks to support the wider health and care system, including in upskilling and educating other health and social care professionals.44

Delegating decision making

37.We heard that empowering staff through increasing decision making at junior levels would improve outcomes for staff and service users.45 Wigan Council thought that staff should have “permission to work more imaginatively and more creatively; to leave behind traditional ways of thinking”.46 Jade Hamnett, a representative of the care organisation Social Care Future, thought that: “There can be a lot more imagination” for how people are deployed, and how different groups can be engaged.47

38.Professor Catherine Mangan, Professor of Public Management and Leadership at the University of Birmingham, outlined the priorities she thought that change managers face, saying they should:

“… champion agility, open-mindedness, creativity and flexibility, recognising the potential of people who are perhaps slightly different from them, and designing roles where people feel they can make a difference and have autonomy”.48

39.Some examples of effective delegation of decision making and further opportunities included:

(a)In June 2022, a “community pharmacy cancer diagnosis pilot” was announced, which will enable pharmacists the power to refer patients directly to cancer specialists, without need to refer to a GP.49

(b)When we visited the Anglia Ruskin campus, we were told that in some paediatrics teams nursing staff have a “veto” over discharge. This enabled factors outside the strictly medical condition to be considered in discharge decisions.50

(c)The DHSC have committed to increase the number of “appropriate clinical interventions social care workers can safely carry out by developing a national delegation framework of healthcare interventions.”51

40.Delegating decision making to boost productivity and empower staff should not only be examined for frontline roles. Kate Caulkin, Director of the People and Operational Management Hub at the National Audit Office shared an example of self-organising teams at the independent police conduct authority. Teams handling complaints were allowed to manage their own workloads rather than having cases allocated to them by management. This resulted in productivity rising by 33%.52

41.This is sensible flexibility. But regulation can act as a barrier and be slow to change. Medical Associate Professionals such as physician associates are unable to take on some tasks such as prescribing, which are regulated powers. This is despite having extensive training and skills. This is changing, with some skills and responsibilities being taken on by professionals who had not previously done so. The General Medical Council described these changes as a “major step forward”. Further progress though, for example on prescribing powers was described as “long overdue”. The Director of the NHS Workforce, similarly, expressed frustration that it had not been rectified “at the pace we would all like.”53 We agree with our witnesses that when regulation and rules become constraining, “it is devastating for morale, and both pushes people out of the profession and builds a reputation that deters others from applying.”54

42.We also consider it likely that career protectionism plays a part in the difficulty in removing, or making more permeable, these barriers. Gavin Larner, Director of the NHS Workforce, shared his frustration that rules on the responsibilities and abilities of physician associates were difficult to change, but without going into detail as to why.55

43.The potential of many staff to deliver services is largely untapped. There is a need for far more imagination and flexibility in how public services staff are deployed, the tasks they can undertake, and the decisions they are empowered to make.

Involving service users in workforce and service planning

44.Our previous work has argued strongly for users to be involved in the design and delivery of public services at every level because a lack of consultation embeds fundamental weakness in the service.56 Evidence to this inquiry confirmed that improved engagement of service users, including in workforce planning, would enable providers to better meet user need. Consultation should, we were told, extend to people with protected characteristics, and those with knowledge of their local communities. Dr Bryan McIntosh, Senior Lecturer in Healthcare Management, asked: “Who knows their communities best but the people who live in them?”57 Debra Baxter, a service user with 22 years of experience in the public and charity sector, including 15 years as a trainer, stated that:

“Working together in partnership with ‘the experts’ is also cost-effective … because there will be less time/money spent of people returning with more issues and working together results in better outcomes for the public and services funding.”58

45.The danger of failing to grasp the needs of service users and how to address them was acknowledged by witnesses from the Government, with Rob Smith, the Director of Workforce Planning and Intelligence at Health Education England stating: “Trying to do workforce planning without that clear vision about the service users’ need and the service to meet it is, frankly, doomed to failure”.59

Barriers to co-designing services and plans

46.Challenges and barriers to effective co-production included:

(a)Fear of losing support: When representing Social Care Future, a network which campaigns to improve social care including through greater involvement of people with lived experience, Jade Hamnett stated that:

“Fear is a massive issue that just cannot be overstated … Every time I speak to any service that has power over me, there is that terror: ‘You could ruin my life if you wanted to. You could take away half my care plan in an email’”.60

(b)Accessibility: Local authorities do not always consider service users’ needs when creating opportunities for engagement. Jade Hamnett noted that before the pandemic she had not been allowed to participate virtually in meetings organised by the council, and that meetings had not been organised for times or in ways which were accessible to her.61

(c)Financial barriers: Jade Hamnett commented that a person with lived experience participating in a policy development meeting may receive minimal or no compensation for their time or expertise.62

(d)Structural barriers: Dr Bryan McIntosh argued that in some cases introducing or increasing elements of co-design face structural barriers, such as requiring employee contracts to be redesigned or renegotiated, including through trade unions or legal barriers.63

(e)Cultural barriers: Dr Bryan McIntosh argued that: “If you really recognise the value and worth of that user and what they can contribute, that multiplies their voice. We often have the exact opposite of that. That user voice is diminished or we do not recognise it.”64

47.Marie Curie, a provider of end of life care, argued that training needed to incorporate engagement with people with lived experience, stating that: “by integrated cultural awareness into training, the health and social care workforce will be more equipped to provide culturally appropriate care”.65 Alongside improving training for staff, the importance of engaging with service users in the design and delivery of programmes needs to be communicated from leaders in public services providers.

48.The Government should set the clear expectation that engagement with service users and people with lived experience must be embedded in the design and delivery of services, strategies, and workforce planning, and should strongly encourage regional and local bodies to do the same. The Government should outline best practise to ensure that such engagement is meaningful and rewarding for those service users consulted.

49.The Government should prioritise developing training programmes in partnership with service users and organisations which support service users, to ensure they are preparing the workforce to meet user needs. Service users and people with lived experience should also be involved in the delivery of training.

Embedding the use of technology in workforce planning

50.The increasing role of technology in the planning, design and delivery of public services was something raised in numerous submissions to the inquiry.

51.There was a broad consensus from contributors that the increased use of technology has significant potential to improve efficiency in public services and support the workforce, both in reducing workloads through automation, or changing how services are delivered, and in making services more flexible.66 The Police Superintendents’ Association stressed that “technology should be harnessed in every way, where it can improve on the mission to protect the public”,67 and Prospect stated that “digital technologies have a key role to play in improving the effectiveness and accessibility of public services”.68 Membership organisation NHS Providers argued :

“New innovative digital ways of working–from advanced robotics right down to simply upgrading computing hardware–have the potential to free up staff to spend more face-to-face time with patients. Along with other transformations underway, this will lead to a more sustainable health service”.69

52.Duncan Shrubsole, Director of Policy Communications and Research for Lloyds Bank Foundation, stressed the importance of developing technology with the user in mind and accompanying the development of technology with efforts to build relationships and trust. While he acknowledged that “public services … are littered with databases that people built … without starting with who was going to use it and why”, when such steps are taken they can be highly effective. He gave an example from Norfolk where service user information could be shared across different services, meaning the service user did not have to repeatedly share the same information and could access different kinds of support faster.70

53.Specific ways increased use of technology has or could improve service delivery and support the workforce included:

• The improved use of data to enhance planning for service demand or need. One example given was the analysis of crime data and forecasting crime hotspots.71
• Increasing the speed at which demand is met. Dr Aveek Bhattacharya, Chief Economist at the Social Market Foundation, shared that, “Small money cases and civil proceedings are increasingly online, and the average time taken to settle those has gone from 14 weeks to five weeks.”72
• Robin Walker MP, the then-Minister for School Standards, spoke about the Oak National Academy, an online school which was set up in April 2020 as a good example of technological innovation being deployed in schools. He thought that technology held great potential for educational settings and emphasised the potential in particular for it to aid in curriculum planning and lesson development. He was clear that he recognised the role of technology to “reduce workforce and maximise the impact of the workforce being available”.73
• Greater accessibility of services for remote service users. Healthcare services such as Livi have supported the development of measures such as remote GP consultations.74 Similarly, in schools, virtual parents’ evenings can be more convenient for both parents and staff.75
• Duncan Shrubsole noted that in the domestic abuse sector innovations had enabled “people to seek help through mobile phones and do alerts”, and shared that services focused on honour based violence had been able to reach more people and people they had not been able to before.76
• Increased automation, such as the use of robots in social care settings in Japan, has the potential to alleviate workforce shortages, and provide greater flexibility for workers.77
• The Department for Work and Pensions has explored increasing the use of artificial intelligence in welfare services, including in “assessing fraud and error risks, monitoring cyber-security, tailoring non-financial support offered to customers and reducing verification demands”.78 If implemented with clear priorities and an opportunity for human intervention, this could more effectively identify potential cases of fraud and make more efficient the process for claims.
• Responding to crises: The Organisation for Economic Cooperation and Development argued that: “Having a workforce that is capable of using digital technologies and data to be proactive and seamless in those services means that the service continues to work effectively when crisis hits.”79
• There is substantial potential for technologies to be deployed in training and development, and we examine this closely in Chapter 5.

Challenges with increasing the use of innovative technology

54.A common concern raised in submissions around the increased use of technology in service delivery was digital exclusion. One in ten people in the UK do not have access to the internet,80 and a significant proportion of the UK population lacks basic digital skills, with this including people in public service roles, and increasing in certain marginalised communities.81

55.Professor Catherine Mangan argued that some technologies, including those using algorithms, could be biased. She shared an example where face-recognition software used in a university was unable to identify non-white faces due to not being coded or developed properly.82 The House of Lords Justice and Home Affairs Committee report, Technology Rules? The advent of new technologies in the justice system, acknowledged this, finding that the use of some technologies in the justice system presented “a real and current risk to human rights and to the rule of law”.83

56.In some areas there is a lack of basic infrastructure needed to support the increased use of technology. NHS Providers stated that: “It is proving difficult to embed [ambitious digital agendas] when basic issues, such as ensuring reliable Wi-Fi across all buildings, remain unsolved.”84 This may account for a lack of uptake in technology—in a speech last year, Secretary of State for Health and Social Care Sajid Javid acknowledged that:

“Too much of the system doesn’t currently have the basics in place, which frustrates patients and makes life harder for colleagues on the front line. One in 10 NHS trusts are still largely operating on paper-based systems. And in social care, research shows 71% of the sector has no digital access to information on the medication of people in their care.”85

57.Despite this acknowledgement from the Government, evidence from NHS Providers suggested such barriers were caused by a lack of longer-term thinking, in favour of a bidding funding model which:

“… encourages a feast and famine cycle that incentivises one-off expenditure on systems and ‘solutions’, while inhibiting long term, strategic approaches that provide sustained operational funding for teams.”86

58.Concerns about ensuring technology was deployed in a way to support staff and service users effectively was also raised. Service users may find it harder to secure face to face time with providers,87 and digital tools aimed at sharing relevant information may not adequately meet their needs.88 Professor Mangan also questioned the impact that an increased use of technology could have on public services staff, suggesting that losing face-to-face time with service users could mean staff “losing a big chunk of the reason they came into public service in the first place.”89 Similar concerns were raised by Dr Ana Canhoto, Reader in Marketing at Brunel University, who stated that by automating “those boring parts of our job … [staff] end up with a much more stressful job because they are always dealing with the difficult cases.”90

59.During our visit to Anglia Ruskin university, we saw how technology can be used for training purposes, including in artificial intelligence simulations, and advanced dummies. It was clear to us that these added value in many ways, enabling practise without encountering patients. They were not, though, a cost-saving measure, nor did they reduce the number of staff required to supervise trainees. Evidence highlighted that the introduction of new technology must be accompanied by comprehensive training for staff, to ensure staff are empowered to use technology autonomously with confidence.91 Such training will need to evolve alongside technology and would need to be available to staff throughout their careers, which would have cost implications.

60.Where new technologies are used in the delivery of public services, substantial attention will need to be paid to safeguards against bias.

61.Technology has great potential to ensure the sustainability of the public services. Government departments should conduct horizon scanning exercises to examine how technology can improve forecasting and planning, improve efficiency, and reduce demand for the public services within their portfolio. This must not be limited to short-term cost saving measures but should consider service-user experience and improving public services in the long-term. Horizon scanning should consider digital literacy, inclusion and bias, and basic infrastructure issues, and should bring forward feasible, realistic opportunities for technological innovation.

Prioritising preventative services and early intervention

62.We have previously stressed the importance of preventative services in our principles for public services reform. They can help reduce deep and ongoing inequalities and benefit service users.92 As it relates to the workforce, their role in cutting demand was a common refrain from contributors, who argued that preventative services can boost workforce capacity by catching problems before they become too complex.93 Sian Elliott, Senior Policy Officer at the Trades Union Congress, reflected that without effective prevention services:

“What happens is that the temporary problems that families face become entrenched, immutable and very difficult to resolve. That creates very complex caseloads … that then become very difficult and lengthy to resolve. They require more and more different services to be involved, and that puts a huge strain on lots of different workloads. If we could invest again in those early prevention services, we could nip problems in the bud.”94

63.Arguments around the value of preventative services in supporting the workforce were not limited to boosting capacity. Smart Social Ltd argued that: “prevention is what most employees actually want to do vocationally, and they don’t so they leave”.95

64.Despite the value of preventative services in reducing demand and therefore increasing workforce capacity to address other issues, we heard that funding for prevention services fell by 47% between 2010–11 and 2019–20.96 This echoes the findings of our previous inquiries.97 The nature of preventative services can leave them vulnerable to being cut. The Police Superintendents’ Association reflected that: “crime prevention is difficult to measure in terms of impact, and in a Service that is often driven by resourcing challenge and value for money, efforts in this area can suffer”.98

65.Greater investment in preventative services would reduce demand for public services, supporting the workforce to address the high level of demand services currently face and resolving issues before they become complex and entrenched. This must be recognised and embedded as a key part of future workforce planning.

66.At all levels of service design and service and workforce planning, providers should prioritise preventative services.

Improving engagement with the voluntary sector and social enterprises

67.Contributors stressed the importance of working with Voluntary, Community and Social Enterprise groups (VCSEs) when looking to develop strategies for the public services workforce. Ian Jones, Chief Executive of Volunteer Cornwall, a charity focused on boosting social capital and wellbeing, argued that working with the VCSE sector should be “fundamental to any reform of public services”.99

68.The value of the voluntary sector was highlighted by many contributors, who noted that the voluntary sector could better engage with local communities, work creatively, and develop specialist expertise alongside playing a key role to meet service shortfalls.100 Duncan Shrubsole highlighted that small charities had developed innovative practice around addressing honour-based violence and domestic abuse,101 and could also boost engagement of people with lived experience in decision making.102

69.The Government has acknowledged the vital role volunteers play in delivering public services, for example in the NHS103 and libraries.104 There are an estimated three million volunteers in health and social care,105 and their contributions can also be seen in education and the justice system.106 The power of partnerships with the voluntary sector has been highlighted during the pandemic, where skilled volunteers for organisations such as St John Ambulance administered vaccines.107

70.While it can be challenging to quantify the economic value of volunteering, Andrew Haldane, former Chief Economist of the Bank of England, suggested it could exceed £50 billion per year, noting that “very few sectors add more value”.108 Figures from the Institute for Volunteering Research indicated that every £1 invested in a volunteering programme yielded an average return of between £3.38 and £10.46, but that high costs can be faced in early years.109

71.Contributors emphasised the importance of including volunteers in public services planning, to ensure that volunteers can take on appropriate roles, foster positive relationships with staff, and have a good experience, encouraging them to keep volunteering.110 This is particularly important given that volunteers also provide a potential pool of engaged, experienced candidates for public services roles. We discuss this further in Chapter 4, but we heard evidence that there were “cultural barriers” to the integration of volunteers. Andrew O’Brien, Director of Public Affairs at Social Enterprise UK, told us that:

“… sometimes when the state considers [social enterprise], it thinks it is all just about a bunch of people coming together with coffee and biscuits … the parity of esteem is not there, and the willingness to understand, integrate and identify that workforce is not always there.”111

72.We heard concerns that there can be an over-reliance on the voluntary sector, and that it should not be viewed as “an ‘army’ or as a large-scale workforce to be deployed by central command”.112 There is also a clear need for training: despite many volunteers being highly skilled,113 almost half of public sector volunteers who were already receiving training wanted further training.114

73.Government approaches to working with the voluntary sector were seen as, in some places, limiting the potential of the voluntary sector. Multiple contributors raised concerns, including that approaches to commissioning and funding are siloed and short-term.115 Others argued that they can compromise place based approaches and effectively shut out small, specialist charities.116 Government’s efforts to develop more integrated services through innovations such as integrated care systems were seen as “giving power and money to the same statutory providers” and withdrawing public service contracts from small, specialist providers who could provide high quality, innovative services.117

74.Andrew O’Brien stressed the need for “collaboration rather than integration”, with third sector expertise being retained in public service delivery. His experience with charities was that he had “had to fight tooth and nail to get social enterprise and charities as potentially allowed to be members of integrated care boards.”118 He had also found that:

“Sometimes our members experience a bit of condescension, a sense of empire building and protection of delivery of services—people saying, ‘We do not want to work with you, because we want to keep the money here, even if you are delivering a really good-quality service and having high impact’… ‘thanks very much for innovating and creating these great services. Now we will bring it back in’.”119

75.The voluntary sector can add immense value to public service delivery through their local and specialist expertise. Current approaches risk alienating and excluding third sector providers from public service delivery, and are a significant waste of talent and capacity.

76.There is a need for a fundamental shift in how the public sector works with voluntary partners. Voluntary sector bodies should be more fully included in, and flexibility introduced into commissioning to ensure that the work of voluntary partners is not artificially limited by inflexible processes.

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