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Written by says Tom Hadley, director of external relations at the Recruitment & Employment Confederation
In recent weeks, the Chancellor has announced that £6 billion worth of cuts will be made to public expenditure over the next year. This cost-cutting exercise could have a series of ramifications for both services and staffing within the public sector. Rather than making knee-jerk reactions to these changes, public sector employers need to carefully consider the long-term impact of their actions to ensure that frontline services are not compromised and that existing staff are not put under undue pressure.
One of the first areas that is likely to come under pressure is temporary staffing costs. However, rather than being an additional cost, flexible staff, such as locum doctors are actually part of the cost and resourcing solution. The NHS is already very reliant on these workers to fill staff absences or help deal with peaks in demand. Cutting them out of the equation to save costs simply won’t work. If anything, if the NHS is to become more cost efficient for the long-term it needs a flexible workforce that can grow and reduce to match demand now more than ever.
In addition to public expenditure cuts, the new coalition government has also announced its key policies for healthcare and its vision for the future of the NHS. To successfully deliver these new policies and to provide constantly improving service for patients, having the right staffing solutions in place will prove essential.
Manning out-of-hours care
One of the key challenges for the new government is to assure the public that they will receive quality care around the clock. The recent case of a German doctor who accidentally killed a patient on his first out-of-hours locum shift in this country very publicly highlighted not only the resourcing challenges already facing the NHS but also the complexities of using health professionals from the EU.
According to the plans outlined by the health secretary Andrew Lansley, family doctors will be forced to take back responsibility for out-of-hours care, although this will not be a straight forward return to the old system where GPs had to be on call around the clock. The intention is for budgetary responsibility to be handed back from Primary Care Trust to GPs who will commission services or provide them by working on a rota system through local groups.
Despite the focus on new rota systems, careful consideration must be given to all forms of flexible working arrangements that would allow patients to receive the right level of care in the most cost-effective way. Specialist recruitment agencies continue to provide cost-effective means of ensuring that the right staff are in the right place at the right time and that every patient receives the care they need.
Locum doctors and other temporary staff provide crucial front line services and their contribution must not be marginalised, especially as working time rules now place strict limits on individual GP working hours.
Resourcing international talent
At the end of 2008, figures issued by the Department of Health showed a shortage of 2,000 doctors. The British Medical Association has attributed this to the implementation of the Working Time Directive. The NHS has in the past used flexible working arrangements to fill this gap, drawing on the skills of both temporary workers and talent from Europe.
The government’s plans to tighten immigration however could pose some problems for healthcare professionals. While the government’s new policy aims to allow skilled migrants into the country where there is a specific need, changes to the immigration system will undoubtedly add pressure on resourcing.
As part of the policy on migrant workers in the NHS, the government has announced plans to introduce language requirements for foreign healthcare professionals.
GMC’s Chairman Professor Peter Rubin has recently spoken about the legal advice that the GMC has received on the issue of language testing. According to professor Rubin, the legal advice showed that “it is a consequence of UK legislation not the European legislation that we are currently unable to test the language skills of EEA medical graduates”. Professor Rubin indicated that, due to the new government’s policy priorities, a change in legislation that would allow the GMC to test language abilities is very likely.
Even if such tests were introduced, there will always be a need for an effective assessment process at Trust level, which looks at whether the doctor has the right qualifications and relevant experience for the position, and which verifies references, and which runs ID and vetting checks. It is essential that these checks are carried out both to ensure quality of care and to put the public’s mind at rest about the use of medical professionals sources from overseas.
NHS Trusts need to look at how they can achieve comprehensive recruitment processes that safeguard the patients and that ensure the right doctors is recruited in the right position, and how they can undertake this process in the most cost-effective way possible. Specialist recruitment agencies play a vital role in providing the Trusts with the support they need as they are already used to carrying out candidate checks across the healthcare industry as well as in teaching and childcare. By drawing on their expertise in this space, NHS employers can save time and money and be confident that all necessary checks have been done to ensure the quality of candidates.
The findings of the 7th Annual NHS Staff Survey for the Care Quality Commission were released earlier this year and underlined major resourcing challenges. As many as 45 per cent of those surveyed felt that there weren’t enough staff for them to do their job properly, highlighting current staffing levels as a key concern amongst NHS workers.
Unmanageable workloads can create a downward spiral of increased stress related absences which will only add to the resourcing challenge. The survey also found that only 44 per cent of NHS staff felt that their Trust was committed to helping its staff to balance their work and home life so there is clearly more work to be done by Trusts and other NHS employers to boost staff satisfaction levels and encourage staff retention within the NHS.
As well as helping employers, flexible resourcing is also of benefit to individual workers in the NHS. Many already choose to work through agencies so they can pick and choose the hours that they work and fit work around family commitments, for example.
The NHS and provision of healthcare in the UK has reached a crossroads. NHS staff already feel that there are not enough staff in order to provide quality care and with the public expenditure cuts now in place, this situation can only intensify. Rather than making random cuts across the workforce, and across temporary workers in particular, both the government and NHS employers should see this current chapter as an opportunity to bring about sustainable reform to public sector resourcing. A flexible workforce should be central to this and is part of the cost solution, not the problem.
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