A survey of NHS leaders in Wales last year found workforce recruitment and retention to be the top challenge facing NHS Wales in the next five years. Here the head of the Welsh NHS Confederation considers the scale of the challenge and how to turn the issue on its head.
A vital component to any successful organisation is having a skilled and motivated workforce.
The NHS in Wales is no different. As the biggest employer in Wales, with around 86,500 staff, almost everyone will know someone who works in the NHS. This also makes the health service a significant driver when it comes to the economic health of the nation.
People working within the NHS and social care are our biggest asset. Without their hard work and dedication the health and care service would collapse. We know how hard members of staff across the health service work to deliver care, with figures showing that every year in NHS Wales there are:
- 18 million patient contacts with local primary care services
- 500,000 ambulance 999 calls
- 1 million emergency attendances
- 400,000 emergency admissions
- 4 million outpatient attendances
- 350,000 elective operations.
But with this high level of demand – which is set to
increase in future years – comes challenges for the health service and those
that work in it. It is vital that the workforce is ready to evolve and respond
to the changing needs of society, including an ageing population and
increasingly complex and chronic conditions.
More nursing posts now exist in NHS Wales and there are more
nurses employed than there were in 2009, but the number of trainees has not
kept up. In the wake of the 2008 financial crash, the number of nurse training
places commissioned was reduced as a response to reductions in workforce
planning projections. These reductions were mirrored across other health
professions and while places have increased in recent years, the
long lead-in times for training means it will take time for the NHS workforce supply to
get back into balance.
Another significant factor has been the response to the
report following the Mid Staffordshire Inquiry. This identified a shortage of nurses as a key factor in the
poor care of patients in that trust. Since the publication of the report health boards and trusts have increased their nursing numbers and revised workforce
planning projections to a level in excess of the previously predicted demand.
This has led to pressure to
recruit more staff, but with an imbalance between supply and demand (for example, a
shortage of qualified nurses). Health boards have had to use expensive agency staff which, in turn, has led to a significant increase in expenditure in this area.
Alongside addressing this rise in demand, there is a need to make sure that health care staff are used in the most appropriate way. Part of
the response is for those working within health and care to develop new ways of
working to ensure that their skills are focused on areas where they are
making the greatest impact and securing the best outcomes for patients and
While this may alleviate some concerns about the
continued shortfall in the future NHS workforce, especially for certain types
of jobs and in different regions of Wales, there is still a challenge of
under-supply of health care professionals.
The retention of the current workforce and recruitment of
new staff have been issues for the NHS in Wales for some time, particularly
retaining experienced staff nearing retirement. In a survey of our members, conducted last
year, recruitment and retention was listed as the top challenge facing NHS
Wales in the next five years.
If our NHS is to meet the needs of a future population, a
sea-change in the way services are designed is required. A key aspect to
driving this, and successfully putting the health service on a sustainable
footing, is the workforce.
But 41 per cent of respondents said staff shortages or the
availability of a skilled NHS workforce are the main barriers preventing their
organisation from tackling the challenges facing the health service.
While our members are working hard to address these
challenges – and some progress is being made – further work is needed to make
sure the workforce is geared up and supported to meet the demands being placed
upon it, both now and in the future.
In Wales, we are taking a more collaborative approach across
organisations to identify solutions to some of the challenges we face.
Members of the Welsh NHS Confederation’s Policy Forum
recently published ten key actions that will help the health and social care
workforce across Wales.
Endorsed by more than 30 organisations, the document
outlines the steps which need to be taken to help address key areas including
workforce planning, recruitment and retention, education and training and
skills and technologies.
It also includes a call for a long-term vision for health
and social care to clarify how the workforce will need to change to deliver
integrated, person-centred care closer to home and the investment and support
required to achieve this.
And following May’s National Assembly election, we now have
an opportunity to develop this long-term vision which acknowledges the changes
required to achieve integrated, personalised care closer to home.
It is only by working together that we will build a
workforce that can deliver high quality services and change the way the NHS
works in order to meet the needs of communities across Wales in the future.
Vanessa Young is director of the Welsh NHS Confederation. Follow the organisation on Twitter @WelshConfed
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