A flexible workforce

The NHS procurement market for agency staffing services is complex, convoluted and controversial. But in the government’s much anticipated NHS Procurement review, ‘Better Procurement, Better Value, Better Care: A procurement development programme for the NHS’, published over the summer, the opportunity to review the total workforce strategy for the NHS was not taken up. Whilst we welcomed the call for greater transparency and improved opportunities for SMEs, we believe that it needed to be more explicit that better supplier engagement will be essential to improve NHS workforce management going forward in a changing health environment.   
Supplier engagement has improved over recent years but increasing it will be essential to build sustainable supply chains that deliver value for the NHS. This is all the more important as we believe that in debates surrounding the future of the health and social care system in England, matters concerning the workforce are all too often ignored. The NHS is currently undergoing a period of large scale reorganisation and social care services are struggling to cope with increased levels of service demand and limited resources.
Andrew Hine, the UK head of healthcare at KPMG, cautioned in October 2012 that very little attention has been paid to staff in this changing health and social care environment, “the very people at the heart of our healthcare system.” With NHS organisations and local authorities striving to reach stringent efficiency targets, more effective workforce management and use of resources (such as flexible staffing) is needed if standards of care are not to be compromised.
The recent controversies surrounding standards of care in some of our hospitals, and the fallout from the Francis Report, have served to underline that the quality and management of staff is of the utmost importance in health and social care services under considerable financial strain. If there is to be an important shift, from an acute to a community driven health and social care service that strikes the right balance between national entitlements and local flexibility to plan and deliver services, then the staff will have to feel ownership of the processes that achieve this. In short, whilst patients have to be an integral part of care decisions in the health and social care system so that services are geared to their local needs and expectations and that resourcing decisions are taken to reflect these, so do the staff who actually deliver these services on the ground.

The health and social care workforce in England is currently in crisis. Our members have long reported that they are seeing increasing numbers of doctors and nurses, as well as other categories of staff, choosing to leave NHS and local authority social care services to work in a flexible capacity or leaving England to work overseas. Figures from the Health and Social Care Information Centre issued in 2013 illustrated that the number of district nurses fell by 39 per cent between 2002 and 2012, whilst modelling work from the Centre for Workforce Intelligence predicts that there could be a shortage of 190,000 registered nurses by 2016.
We believe that with the current workforce models in place, sustainable and safe nurse staffing levels are fast becoming unobtainable. The Royal College of Nursing’s 2012 UK nursing labour market review entitled ‘Overstretched. Under-resourced,’ highlights an overall staffing decline in the NHS. In the review, it is clear that a relentless focus on cost has contributed to reductions in the numbers of commissioned training and education places, to reductions in staff numbers, pay freezes and reduced training budgets for the nursing workforce. Whilst the lack of data is a big issue in seeking to understand trends in the workforce, the review indicates that shift demand for agency and temporary staff has been increasing steadily in England. The Recruitment and Employment Confederation and KPMG Report on Jobs – published in association with Markit – provides the most comprehensive guide to the UK labour market, drawing on original survey data provided by recruitment consultancies. Recruitment consultants are asked to specify whether the demand for staff from employers has changed on the previous month, thereby providing an indicator of the number of job vacancies. The summary indexes are derived from asking recruitment consultants to report whether availability of permanent and temporary staff has changed on the previous month, leading to the calculation of an overall indicator of staff availability.
The nursing/medical/care sector has consistently been one of the top performing sectors. In the September 2013 REC/KPMG Report on Jobs the nursing/medical/care sector was the second strongest performer in terms of temporary employees, having been the strongest the previous month. The respective index posted 67.9 (scores over 50 indicate growth on the previous month) for the August 2013 period, having stood at 68.3 for the July 2013 period.

The RCN’s 2012 nursing labour market review also provides a stark warning that in the international competition for clinical talent, England and the UK as a whole is falling behind: “In the international context, the UK has moved from a situation of net inflow of nurses to a position of net outflow in recent years, meaning that more nurses are moving abroad than are coming to the UK to practice. The main destinations are Australia, Canada, New Zealand and the USA.”
The REC would join organisations such as the RCN in calling for a new health and social care system in England to have medical workforce planning and increased flexibility at its heart. Temporary and locum staff are an indispensable element of the NHS workforce, allowing services to meet spikes in demand and cover unexpected absences. How they are managed and used efficiently alongside other staff will remain important and is likely to become more so in an evolving NHS.
Increasing competition between procurement providers, critical shortages of important staff such as nurses, and international competition for clinicians, means the NHS has to get its total workforce strategy right if it is to continue to deliver world class care at a time of limited resources and unprecedented structural transformation.

Flexible staffing is a major opportunity in an NHS under pressure. With the latest statistics from the Health and Social Care Information Centre highlighting that the average sickness absence rate for the NHS in England has risen, staff are needed to plug the gaps to ensure patients get the care they need. If services are to respond to unexpected circumstances and do more with less as NHS Trusts strive to hit efficiency targets and meet increasing levels of demand, then innovative ways of working and different models of workforce planning will be required.
Health Minister Dr Daniel Poulter MP and others in government talk about efficiencies and productivity. In this time of transformation for the NHS following the Francis Report, the debate needs to be about safety, quality and new ways of working. As part of this, properly managed agency staffing must be seen as part of the solution rather than part of the problem and better supplier engagement will be essential.


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