This time of year we are required to finalise and submit our workforce plans. If I’m honest, I haven’t paid much attention to these in the past, because they never felt real enough to describe the future, or use as a working plan.
But I was wrong, and I am interested now, for two reasons.
Firstly, most hospital Trusts struggle with cost improvement programmes – on average we achieve maybe 75% of the planned savings. I’m now thinking we would do better to monitor achievement against a matched workforce plan – get this right and the costs would surely follow?
But secondly, and crucially, they should provide a narrative for the transformation we must implement in the coming years. They should describe the contraction of the acute sector, the growth in community services, and the training we must start in order to create the new roles that will underpin this such as advanced practitioners, physicians assistants, reablement specialists, and experts in home care delivery.
A good plan will show a smaller administrative workforce, with remaining staff being multi-skilled in all aspects of a new digital infrastructure that will allow immediate advice, guidance and booking of all steps in the patient pathway. Behind this will be an electronic patient record that is accessible to patients and shared between hospitals, general practice, and community carers, and without referral letters, discharge summaries, or clinic letters in paper form.
Forward-looking workforce plans should show that smaller A&E services will transform into urgent care facilities combining roles currently carried out by hospital doctors, GPs, extended role and specialist nurses, and paramedics. They will describe too how hospital, primary care and community sectors will jointly staff merged services to support the frail elderly or those with long term illness, with corresponding adjustments in traditional GP or specialist numbers.
Acute Trust plans should detail a reducing headcount, commensurate with bed base reductions. They may describe how staff will move into community-based reablement teams that focus on early discharge and prevention of readmission? If so, corresponding changes should be evident in plans from more traditional community service providers.
Staff numbers will increase in our Informatics and IT services, alongside a reduction in administrative functions. Support services will also show reducing numbers as outsourcing and cross-system rationalisation plans are implemented.
Overall, credible workforce plans must show at least 3% less staff each year, given that we need a 5% cost reduction each year across the system and 60% of costs are in staff?
So does the workforce plan for my Trust show all of these things? Er no, it doesn’t. We followed a good process, with wide involvement from all areas, but our amalgamated plan projects a reduction in staff of 96 over 5 years. With a workforce of circa 11,000 that is a drop of just 0.17% per year!
This tells me that many of our clinical leads feel their area is set to grow. Understandable, given their past and current experience of remorselessly increasing activity levels, but completely unaffordable. Whether we work in the acute sector, primary care, community and social care, or commissioning – somehow, together, we have to turn this demand downwards. Not by rationing care, but by putting aside our narrow interests and working differently in order to maintain health and reduce the need for expensive interventions.
I have submitted our workforce plan, but I’m embarrassed because I know it isn’t realistic. It can’t be. I did send an accompanying letter, describing our planned transformation programme and promising it would look very different when updated next year. It must, because if it does not we will most definitely not be an organisation that is fit for the future.