The COVID-19 Pandemic has clearly shown us all that challenging the status-quo and seizing the opportunity to do things differently can revolutionise our workforce’s contribution, both in the immediate and longer-term by building teams focussed on skills required, not professional backgrounds.
There are already great examples in mental health, where we’re ‘stepping up’ professionals, such as physician associates and mental health nurses to take on elements of care traditionally done by psychiatrists. Partly this is because we know we are not going to be able to recruit the numbers we need immediately but also because using a wider range of professionals ensures care is delivered by those with the right skills. If we stick to the way things are traditionally done and continue to accept the workforce gaps then patients suffer. The increase we have seen in doctors wanting to train as Psychiatrists is welcome and we are more likely to continue this increase if service delivery is supported by a workforce team approach.
The fast thinking and innovative use of skills-based deployment during COVID-19 shows that these changes utilising individual clinical skills can be made, and demonstrates the reality of a future where there are more staff – the right number of well-trained people with the right skills - working differently and flexibly. Technology and innovation is key to this but so is a recognition that teams will look different as they develop a flatter hierarchy with flexible and adaptable professionals working together.
Most recently, as staff were deployed to work in the Nightingale Hospitals, we played a significant role in determining education and training requirements, ensuring all staff – many of whom had never worked in acute care - were upskilled in areas such as ventilation therapy and management of arterial lines. This exercise has presented us all with the opportunity to think differently about developing our workforce and indeed challenges us all to think about a new and different workforce as we move beyond the pandemic. For example, is there a role for a community healthcare worker, a role that exists in Australia, dedicated to a specific locality, responsible for following up track and trace and monitoring the community for symptoms? Food for thought.
Population health needs and changes are not the same everywhere and need to be carefully considered in order to achieve better and more sustainable outcomes. This has been the key focus of regional workforce hubs supporting the response to COVID-19. When we emerge from the lockdown, it will be into a different world and these regional workforce hubs will be essential in bringing all parts of the system together to design place-based workforce models with new, diverse roles and skills that better reflect changing patient needs and models of care. Earlier this year in HEE we appointed our first tranche of Population Health fellows from a wide variety of clinical backgrounds and I look forward to hearing their reflections and thoughts as we step into the re-set phase of NHS work.
On a national level, distribution of training and education resources and funding is a challenging and frequently debated issue. HEE’s duty is to ensure education and training funds are used effectively and distributed equitably in relation to patient need. Across the NHS, we must have open and honest conversations, based on evidence about effectiveness, outcomes, and value for money, about how this money is currently spent and whether it can be spent better. As we look at the impact of more students entering healthcare professions, the new medical schools and the expectations of better health outcomes for all we need to be frank about how resources, both financial and human, are allocated. Tradition and historical pathways have their place but if we have learnt anything from the pandemic it is that simply doing more of the same may not be the best way forward.
I’d like to end my reflections about the past, present and a ‘new future’ for our workforce with a quote from Sir Michael Marmot, Director of The UCL Institute of Health Equity, which amplifies the true impact of the opportunity we now have to collectively, plan, recruit, educate, and train the health workforce of the future, “If we put fairness at the heart of decision-making policies, health would improve, and health inequalities would diminish.” Surely, this is what we all want to achieve.