Investment in healthcare infrastructure – both physical and digital – will be critical to achieving the productivity improvements assumed in the new NHS Long Term Workforce Plan, published on Friday.
Most of the headline interventions to recruit, train and retain more staff are focused on clinical and clinical support roles. However, the Plan does include substantial sections on organisational culture, the responsibility of ICSs, the NHS as an anchor institution within its communities and what that means for recruitment, the role of artificial intelligence and the working environment.
On infrastructure, the Plan states: “Significant training expansion and workforce growth are only possible if there is sufficient physical capacity for staff to be trained in and work in. Labour productivity is dependent on the quality and capacity of physical and digital infrastructure.”
The Plan makes some fundamental assumptions about service demand, workforce productivity and retention over the modelling period. It is based on what it describes as an: “ambitious labour productivity assumption of up to 2% (at a range of 1.5-2%).” Critically, if productivity improvements fall towards the lower end of the range, the predicted shortfalls in NHS staffing would persist, having a negative impact on the ability of the NHS to deliver health services to the agreed standard.
The Plan further states that achieving the productivity improvements assumed in the Plan is dependent on two key factors. “First, it requires a sustained increase in capital investment in the ageing NHS estate, including in primary care, to replace equipment that has passed its recommended lifespan, and expand capacity to accommodate the increased demand for healthcare from an ageing population. This would enable staff to function more efficiently, and shorten diagnosis and treatment times in areas such as cancer. Second, it requires investment in digital infrastructure throughout the NHS, including appropriate training and support, to enable NHS staff to make the most of new technologies.”
Responding to the Plan, Richard Murray, Chief Executive of The King’s Fund, cautions: “There needs to be realism about the investment in buildings, technology and equipment that is needed to realise those productivity gains.”
The working environment is also key for staff wellbeing, experience and retention. The Plan recognises that staff need time and space to rest and recover from work. It highlights that: “getting the basics right, such as providing access to good quality rest areas, food and drink options and safe storage of personal possessions should not be underestimated.” All NHS organisations are urged to review the NHS Health and Wellbeing Framework and the National Standards for Healthcare Food and Drink, to be certain they are providing a working environment that supports the health and wellbeing of staff.
E&F roles
Whilst it is understandable that the focus of the Plan is on clinical and clinical support roles, as any estates or facilities manager knows, the workforce challenges within the NHS are much broader. The national E&F team published its own E&F Workforce Plan in July last year, and at HEFMA’s Forum in May, statistics were shared that outlined the particular nature of the workforce challenges in E&F roles in the NHS, such as the ageing workforce. Nearly 70% of the E&F workforce is aged 45 or over, whilst across the NHS overall this figure is around 46%.
Sara Gorton is Head of Health for UNISON, the union that represents many E&F workers. She says: “Plans to recruit more doctors and nurses cannot ignore the desperate NHS shortage of porters, cleaners, 999 call handlers and other support roles. Staff in non-clinical jobs are most at risk of being lost from the NHS for better paid, less stressful jobs elsewhere.
"The absence of proposals to mend social care is perhaps the biggest gap. Without action to fix care, the NHS will have to go on picking up the pieces of that broken system. There must be a national care service that mirrors the NHS.
"Increasing apprenticeships and nursing associate numbers are important aims as is growing the domestic workforce. They must be backed up with proper funding and infrastructure support."
Starting point
Also commenting on the Plan, Jon Czul, Head of Consultancy and Research at Skills for Health, adds: “As ever, the devil is in the detail, and we echo the cautious optimism with which this plan is being greeted, recognising that whilst this is only a starting point, it at least sets out an ambition (if not a roadmap) to begin to tackle the NHS’s workforce challenges.”
The plan will be refreshed every two years.
