On Monday 19th of February we launched the UK cut of our Time to care report at a jointly sponsored Cambridge Health Network event at the Deloitte offices here in London. Our UK report builds on our larger European study, launched last November, which examined the workforce challenges and actions needed to secure a sustainable clinical workforce for the future in 15 countries across Europe. Our UK report takes a deeper look at the research evidence collected for the European report, including the crowdsourced survey of hospital doctors and nurses. We supplemented the research with further interviews, data analysis, literature reviews and insights from Deloitte staff working with NHS and private sector clients across the four UK countries. Although we acknowledge the significant challenges currently facing the hospital and wider healthcare sector, we identify a huge amount of positivity and commitment from employers and staff and highlight 17 evidence based case examples of innovative approaches to tackling staff recruitment, retention and deployment.
The scale of the hospital workforce challenge
As for most other countries, the UK’s approach to workforce planning, education and staff deployment has evolved over time, in response to changes in the cultural, economic and political environment. Despite decades of rhetoric and initiatives aimed at delivering more care closer to home, the UK health system still relies on hospitals as the default provider of healthcare. Moreover, the four UK countries face enormous challenges in achieving their strategic and operational workforce goals. Many of these challenges are widely acknowledged and well documented, these include:
- relentless increases in the demand for hospital care from a growing ageing population with increasingly complex health conditions
- significant reductions in funding growth (the long-term average funding growth since the NHS’s inception is around four per cent per year but since 2009-10, funding grown at only 1.2 per cent per annum)
- for eight years, stringent austerity measures have been applied to the NHS, such as national pay restraints, caps on the use of agency staff, and reductions in tariff payments and management costs
- reductions in the number of hospital beds (while other European countries have also reduced bed numbers, the UK has gone further than most and now has fewer hospital beds per head of population than any other comparable health system)
- reductions in average length of stay
- increases in unfilled vacancies
- reductions in the number of applications to study medicine and nursing at university.
In addition, the UK continues to place a high reliance on agency and locum staff and in recruiting staff from overseas. This latter strategy is unlikely to be sustainable in the longer term given the WHO estimation of a global shortfall of some 18 million health professionals by 2030, a problem that for the UK is exacerbated further by Brexit.
In recognition of the growing workforce challenges the governments of the four UK countries have each developed new national workforce strategies, indeed Health Education England is currently consulting on its first workforce strategy for 25 years. During our research we identified numerous solutions being implemented across the UK to address these challenges. It is the identification of these solutions that we see as our contribution to the consultation and the implementation of the four workforce strategies.
Finding and implementing solutions
During our research the three major themes helping to alleviate the immediate pressures and secure a future for the hospital workforce, included:
- Improving employee satisfaction: Satisfaction, workload and wellbeing were highlighted as key factors in enabling an organisation to fill immediate staffing gaps and retain healthcare professionals. Our research indicated that the majority of doctors (70 per cent) and nurses (67 per cent) remain generally satisfied with their jobs. For nurses the top four drivers were support from immediate team, ability to use skills, recognition and amount of time to engage with patients; whereas for doctors they were recognition, pay, opportunities for CPD and support from their organisation. Meanwhile, drivers of dissatisfaction for both doctors and nurses were pay, amount of time to engage with patients, flexibility of shifts and work-life balance. Our respondents also indicated that when compared to five years ago, their workloads have become harder to manage, with 62 per cent of doctors and 58 per cent of nurses indicating that they found their work difficult or quite difficult to manage. Over 50 per cent of staff reported working additional unpaid hours. The top two reasons for these shifts in manageability were staff shortages and increased patient numbers.
- Reducing the outflow of staff: Due to the pressures placed on the workforce and the limited pool of professionals to draw from, the NHS is also facing challenges in recruiting and retaining the right types of staff to adequately meet the demand. Our research indicated that 40 per cent of doctors have thought about leaving the country to practice elsewhere, whereas 36 per cent of nurses have thought about leaving their current job for employment within the same country. Moreover, reducing hours to part-time working and changing their career altogether were being considered by both. Our survey respondents also indicated that the top three actions their employers could take to keep them are increase staffing (33 per cent), increase salaries (21 per cent), and improve efficiency (21 per cent).
- Adopting technology to help improve productivity: Workforce productivity is a multifactorial issue that requires new ways of multi-professional working. A productive workforce requires a strong platform on which to develop, with the adoption of new technologies and a confidence to use technology providing such a platform. Our research indicates examples of technology adoption to improve hospital systems and processes but that these are not adopted at scale. These included use of electronic health records (EHR), point of care diagnostics and digital vital signs monitoring. Some doctors highlighted the use of RFID technology, whereas nurses mentioned use of e-rostering. However, neither nurses nor doctors expected emerging technologies, such as AI and virtual reality, to have a significant impact on improving the efficiency of patient care. Though this may be due to low exposure to these new technologies.
Addressing the immediate pressures requires organisations and teams to take a more active role in listening to the feedback provided by individuals. Across the UK, teams have implemented processes such as anonymous real time feedback, programs to provide more comprehensive health and wellbeing packages, and reward strategies such as recommendation schemes and monthly staff awards to improve recruitment and retention. Though there are small groups of teams and individuals working tirelessly to realise the future, the NHS as a whole is still behind the curve of cultural, managerial and technological change.
The future of health care
The future of the hospital workforce is bound to the changing expectations of a new generation of health care professionals and the integration of technologies to increase efficiency and enable better patient care. Crucial to this is the development of a multi-professional and multi-skilled workforce that is able to circumvent traditional silos and implement new ways of working. Building the future will require all stakeholders to come together in order to design digitally enabled services that are able to deliver value to entire populations of people. This will require stakeholders to;
- Collaborate in leadership and quality improvement
- Adopt technology
- Build a strong pool of health professionals.
However, instigating new models of working and changing the way our workforce is currently utilised, managed and delivers care will not be an easy task. As our report demonstrates, there are a number of teams across the UK implementing new ways of working, blurring the lines between roles and integrating technology in their daily work. Realising the ambition of these teams at scale will allow the UK health care system achieve the quadruple aim of health care and help to secure a future for the hospital workforce in the UK (Figure 1).
Figure 1. The quadruple aim of healthcare: staff wellbeing is crucial to secure the future of health care
Source: From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider, Annals of Family Medicine, 2014.