Workforce transformation

Imagine the chaos faced by healthcare providers this winter if a worst case scenario for the swine flu pandemic is realised. With 12 per cent of the workforce absent from work – struck down during the second wave – those remaining will be working in a hugely pressured environment; at the same time struggling to cope with a massive increase in patient demand.
    
Alternatively, consider the UK’s demographic time bomb – not only do we have an ageing population increasing the pressure on healthcare services, but the healthcare workforce itself is ageing. However one looks at it, it’s going to get increasingly difficult to satisfy the requirement for ever-increasing healthcare quality.
    
These are just two scenarios. In addition are the sociological, financial, technological, and policy trends that drive change within the sector on an ongoing basis. For these ever-shifting service demands to be met, we need a healthcare workforce that is flexible, affordable, sustainable and appropriately trained.

Achieving the optimum workforce
Whether public, private or voluntary sector – and regardless of location – the optimum healthcare workforce will have the right staff with the right skills in the right place at the right time. Such a workforce doesn’t come about by accident. It requires ongoing investment in workforce design, planning and development.
    
Historically, planning the healthcare workforce concentrated on ensuring that the required number of people were employed and trained within each traditionally defined job role. However, today’s healthcare workforce cannot afford to be so prescriptive. Adaptability is crucial; and so is quality. The sector needs skills that are flexible and portable.
    
An effective way to achieve this is to focus on the job functions people are performing rather than on their job roles. Each function can then be broken down into recognised national workforce competences. These describe what individuals need to do, what they need to know, and the skills they need to demonstrate, in order to carry out a particular activity.
    
Such a measurable approach to workforce design ensures that each activity is carried out to an agreed and recognised standard – no matter who is doing it, or where in the UK they are based. It enables staff to respond quickly to the ongoing changes faced by their organisations, and it also means that, should the need arise, staff members can be redeployed confidently within the region – or even across the UK.
    
Adopting a function and competence-based approach can provide a way to look objectively at workforce design. Skills for Health has developed a comprehensive database of competences, which can be used to define all clinical and non-clinical roles across the entire healthcare workforce. These are freely available for use by employers.

Competences in action
Competences are essentially building blocks. When used in context, it is the workforce challenges they help to solve that impact directly on service delivery.
    
In some instances, clusters of competences and related activities have already been amalgamated into Nationally Transferable Roles (NTRs). In partnership with employers, service leads and education providers, Skills for Health is developing a suite of NTR templates. The templates are aligned to the Career Framework for Health and define specific job functions – describing what is involved and outlining the core, role-specific and locality-specific competences required to perform each task. NTR templates are currently available for advanced practitioner, assistant practitioner and administration roles.
    
NTRs speed up the definition of specific roles, saving time and resources. Service delivery can be reconfigured more cost-effectively and the skills mix reorganised more readily. Additionally, recruitment for these roles is made simpler and transferability is increased because skills and competences are consistent, applicable and replicable anywhere in the UK.
    
The use of NTRs also has a knock-on effect on service outcomes; such as patient satisfaction and reduced waiting times. From an employee perspective, the portability of individuals’ qualifications, skills, and learning and development, results in increased opportunities for progression across the career framework – without the need to repeat education and training.
    
In collaboration with other partners, Skills for Health has also developed approaches to Modernising Healthcare Careers and New Ways of Working. More than a dozen projects have already taken place around New Ways of Working to improve working patterns in the NHS. These cover both extended roles – for positions such as Radiographers and Physiotherapists – and the introduction of new roles; including Emergency Care Practitioners, Associate Practitioners, Spinal Pathway Co-ordinators and waiting time Tracker Co-ordinators for example.

First things first
Prior to adopting a competence-based approach to workforce design, an organisation must firstly be clear about service need and be aware of what skills and talents are present within its existing workforce to address that need. After reviewing current workforce skills, a strategy can then be developed to tackle shortages, fill any gaps, secure the current workforce and put routes in place to attract and develop new recruits. This workforce strategy is the cornerstone of effective workforce planning.
    
Addressing the requirements outlined in the workforce strategy, the workforce plan then examines different ways to make best use of existing and potential talent – whether this involves a team, a department, or the whole organisation. The end goal is optimum service delivery based on service need. The workforce plan considers how best to configure and manage existing skills and talents to achieve this. Without it, optimum service delivery is impossible.
    
Regional Labour Market Intelligence can be downloaded from the Skills for Health website to help organisations understand the forces affecting service change and consider the implications of national and regional policies and other drivers affecting workforce strategy. To assist in workforce design, planning and development, Skills for Health has developed a range of tools – each of which is designed to provide an easy and time effective way of obtaining, filtering and saving information. Through the Healthcare Workforce Portal, support is also available to for organisations looking to develop their workforce planning capability and capacity. Visit www.skillsforhealth.org.uk to find out more.
    
Skills for Health is the Sector Skills Council for the UK healthcare sector, encompassing the National Health Services, independent healthcare providers and voluntary organisations. Its purpose is to help develop solutions that can deliver a skilled and flexible workforce to improve health and healthcare.

The six-step route to effective workforce planning
Skills for Health has developed a number of tools to assist in workforce planning. These include the Six Steps Methodology to Integrated Workforce Planning tool, which breaks the process down into six clear stages and shows how to map service change, and define, plan and deliver the workforce required. The methodology can either be used as an educational resource or referred to as a guide to best practice when developing workforce plans.

Step 1 – defining the plan
Be clear why a workforce plan is required and what it will be used for. Determine the scope of the plan: whether it will cover a single service area, a particular patient pathway or a whole health economy. Then be clear who is responsible for ensuring the plan is delivered and who else will need to be involved in the planning process.

Step 2 – mapping service change
The first of three interrelated steps towards service redesign in response to patient choice, advances in care or financial constraints. Be very clear about current costs and outcomes and catalogue the intended benefits from service change. Identify those forces that support the change or may hamper it. Create a clear statement about whether the preferred model better delivers the desired benefits or is more likely to be achievable, given anticipated constraints.

Step 3 – defining the required workforce
Map the new service activities, identify the skills needed to undertake them and specify the types and numbers of staff required. This will involve consideration of which types of staff should best carry out particular activities in order to reduce costs and improve the patient experience. On occasions this may lead to the development of new roles and new ways of working.

Step 4 – understanding workforce availability
Describe the existing workforce in the areas under consideration. Cover existing skills and deployment, and assess any problem areas arising from demographics and staff turnover. It may follow that the ready availability of staff with particular skills – or, alternatively, the shortage of such staff – contributes to service redesign; in which case Steps 2 and 3 will need revisiting. Consideration should be given to the practicalities and cost of any retraining, redeployment and/or recruitment activities that could increase or change workforce supply.

Step 5 – developing an action plan
Reflect on the previous three steps and determine the most effective way of ensuring the availability of staff to deliver redesigned services – even if this means some further service redesign. Develop a plan for delivering the right staff, with the right skills, in the right place – incorporating milestones and timescales. Incorporate an assessment of anticipated challenges – including clinical engagement – and consider how a momentum for change can be achieved.

Step 6 – implementing, monitoring and refreshing
Following implementation, the plan will require periodic review and adjustment. Be clear from the outset how success will be measured, at the same time remaining aware of any unintended consequences of any changes so that corrective action can be taken.