Operating framework

Current workforce planning systems for healthcare are based on separate roles of health professionals and support staff - underpinned by separate funding streams and different methods of development. Is this all about to change with the direction of travel being proposed by the latest NHS operating framework? Helen Mooney reports.

Early last year the Department of Health's (DH) then new director general of workforce admitted that she thought many of the NHS' biggest personnel problems should have been tackled years ago. In a frank opening gambit to both the government and the NHS, Clare Chapman said 'a lot of the big challenges could have been predicted three years ago and probably were’, but that the NHS failed to deal with them at the time.

A year on from that remark, 12 months which also saw the publication of a critical House of Commons health select committee report on the 'failure' of workforce planning in the NHS, and the publication of the Government's latest NHS operating framework for 2008/09, the onus of workforce planning for the 21st Century has been firmly placed at the feet of commissioners and SHAs.

The operating framework clearly puts a duty on PCTs as commissioners to help plan the future workforce needs of the providers they are commissioning from, this message is reinforced in the £110 million invested in PCT budgets this year to resource solutions to WTD. The framework states: ‘We expect PCTs, as commissioners of services, to ensure that providers’ workforce, finance and service plans are linked, and that medical and non-medical plans support existing and emerging models of care’. Any shortfall in workforce is a risk that the government also expects PCTs to hold.

'We expect PCTs to have a coherent plan and to have assessed and mitigated any risks to service delivery caused by lack of capacity and capability in the workforce, including compliance with the European Working Time Directive,' the framework says.

Dean Royles, executive director for workforce and education at NHS North West, believes that commissioners should seize the opportunity to develop a future workforce which is suitable for the future services they want to provide to their population.

‘The operating framework puts PCTs in the driving seat, they have responsibility for local workforce planning,' he says.

Mr Royles says that, at present, a lot of workforce planning is driven by acute trusts because one million of the NHS' current 1.3 million staff are employed in the secondary care sector but adds that this needs to change. 'It makes eminent sense to me that if you base workforce plans round commissioning intentions commissioners are best placed to understand what workforce is required,' he explains.

'Some commissioners take the view that it is not their job to determine the workforce but that’s a little bit like going on holiday to a Hawaiian island booking the hotel and then discovering there are no flights when you want to travel.'

There is no doubt that current thinking demands a major change in workforce planning. Most recently Lord Darzi’s interim report - published last October - outlines the need for an overhaul of workforce planning and the commissioning of education and training.

One problem at present is that workforce planning is not seen as high profile in the NHS. It is often seen as someone else’s job and there requires a real shift in thinking around workforce planning so that it becomes an important job in its own right. The Government wants NHS leaders to pave the way for robust workforce planning within and between organisations. As the operating framework states: ‘In particular, we expect SHAs to take responsibility for managing leadership and workforce across the system.’

Neil Sellen, senior workforce development consultant at NHS East of England, says he thinks workforce planning in general is undergoing a ‘sea change’ in the NHS.

‘In the past SHAs have done the workforce planning work for PCTs but the direction of travel from the operating framework is that PCTs must ensure robust workforce plans for the services they want to commission’.

However, Mr Sellen says SHAs also have an important role to play in managing and planning the workforce at regional level. ‘There will definitely still be a role for SHAs, it will be for them to determine the direction of travel at a regional level and make workforce plans dependent on how much money is available,’ he says. The operating framework also envisages a role for SHAs in ‘taking lead responsibility for talent management and encouraging joint training with other organizations on shared issues such as patient/user empowerment and commissioning’.

However, the recent report on workforce planning ‘Aspiring to Excellence’ by Sir John Tooke, commissioned following the Government’s medical training application system (MTAS) debacle questions the decision to devolve workforce planning to SHAs - although it says that removing responsibility for this after only 18 months would be too disruptive.

Instead, the report recommends regional workforce plans be overseen and scrutinised by a national committee with service, professional and employer representation. SHA chief executives should be personally accountable for building relationships with local education providers. It suggests that doing this should be among their annual appraisal targets.

The report also says that the DH should appoint a suitably qualified person at director level to lead medical education policy and work with the medical profession.

It recommends the merger of two training regulators - the General Medical Council and Postgraduate Medical Education and Training Board to form NHS Medical Education England - in order to implement postgraduate medical training. He also warned against an ‘open door’ policy for immigrant doctors when UK graduates are costing up to £250,000 to train. He suggested guaranteeing a postgraduate training place to all those at UK medical schools. Indeed recent changes including the implementation of the consultant contract, the expansion of medical school places, the WTD and the roll-out of the Modernising Medical Careers initiative have all had a significant impact on how doctors train and work. In terms of predicting the numbers of doctors and other medical staff required in the future, the NHS needs a better understanding of whether current medical workforce planning processes are effective and, if not, what could be done to improve them.

Terence Stephenson, dean of Nottingham University’s medical school, says that there are currently two conflicting views on workforce planning. One is that it needs to become more centralised, the other that local accountability is key. ‘Increasingly people are also questioning why doctors should be mollycoddled and cushioned from the big nasty world by being guaranteed jobs anyway,’ he adds. Dr Stephenson says that employers, commissioners, deaneries, SHAs and central Government must all play a key role in determining what form the medical workforce of the future should take, bringing together the needs of patients and medical professionals. One area where deaneries and Royal Colleges could play a key part is in helping NHS organisations to innovate around the WTD. There is currently confusion among hospital doctors as to how best to respond to the many changes in employment conditions that are affecting their working conditions. The WTD will reduce the number of hours worked by both senior and junior hospital doctors. Dr Stephenson says that the WTD will undoubtedly have a ‘big impact’ on the configuration of healthcare services in the UK.

However, engaging more actively with clinicians and other medical staff is something the NHS must do, and something which the Darzi review has already set in train. As the operating framework says: ‘Using a clear clinical vision to improve workforce planning is a priority.’

It continues: ‘Staff who deliver NHS services tell us that they want to be more involved in designing ways of improving services. All too often, reform and change can feel very technical and distant’ we therefore expect providers to focus on staff engagement and satisfaction’.

There is no doubt that both the operating framework and the government’s Our Health, Our Care, Our Say white paper will require a major sea change in the NHS’ attitude to its workforce. It needs to develop and educate a workforce to meet the future challenges. Current workforce planning and education systems for healthcare are based on separate roles of health professionals and support staff. This has been historically underpinned by separate funding streams and different methods of training and workforce development. Workforce planning must rise much further up the agenda for individual organisations and commissioners especially to understand the onus that has now been placed on them to ensure an adequate, high quality future healthcare workforce. ‘It is no longer right to take a national edict on workforce planning and turn it into a local plan, delivery should now be based on service needs first, we can’t have top down planning for workforce, we need a mix of national, regional and local,’ says Mr Sellen.