The NHS workforce faces a number of challenges. It’s short of staff in a number of critical areas, morale and wellbeing are low, and retention and attrition rates are unacceptably high. It’s long been a neglected policy area requiring bold action across many fronts rather than piecemeal reform. This is highlighted in the Health Foundation’s third annual workforce report which calls for a more effective and coordinated workforce policy.
Through our recent evaluations of HEE programmes, we’ve identified several areas of workforce transformation which could play a part in addressing NHS workforce challenges:
- Bridging: we’ve been evaluating the introduction of nursing associates, a new role designed to bridge the gap between Healthcare Assistants and Registered Nurses in England. The new role is giving care workers a much needed opportunity to progress their careers and there is emerging evidence that as they perform the new role it is enhancing patient centred care and is allowing nurses to work at the top of their bands.
- Displacing: we’ve identified a range of medical administrator roles across primary and secondary care in the midlands and east region, who are displacing administrative work from clinicians, which is giving them more time to focus on delivering clinical care. We also found evidence that as administration is displaced and clinician’s workloads area eased, this is in turn enhancing their wellbeing and morale.
- Upskilling: we’ve evaluated the piloting of an accelerated training programmes allowing nurses to train as clinical endoscopists. We found that successful trainees have advanced their careers while helping to meet endoscopy service demands in their trust and freeing up medical colleagues to concentrate on more complicated cases.
As these principles and approaches are scaled up and applied to different contexts and professional groups, they have the potential to make a significant contribution to meeting workforce challenges. However, developing these roles is not without its challenges. We’re aware of a number of “pinch points” in the pathway to recruiting, training, promoting, integrating, developing and retaining new roles (presented in the figure below). These span all the way from initial recruitment to education through to retention and progression as part of the workforce, and include wider issues such as perceptions of the role at all levels, and questions about the appropriate size and shape of the workforce. From our research and evaluation we’ve found that if these pinch points are not addressed, the workforce will not be optimised and attrition may result.
Programme leads can maximise the effectiveness of these approaches to developing new roles where a commitment is shown to doing genuine formative evaluation, where efforts are made to embed the evaluation into the programme and where insights are actively used to refine and improve delivery.