The Ward Round: A long-term workforce plan, at last?

It is disappointing, although not surprising, that the government has not heeded requests from Jeremy Hunt and others to introduce annual official reports on workforce supply and shortages in its draft Health and Care Bill. Expect the idea to come back again in the autumn when the legislation enters committee stage. The government will be under pressure to make concessions.

It may remain reluctant to create such a rod for its own back, but the measure would strengthen workforce planning and could lead to reduced staff shortages. It would bring this crucial modelling work, which is so often shrouded in secrecy, into the public domain.

The Ward Round has discussed the enduring problems with workforce planning and “short-termism” before, and the lack of substantial money available to back up any long-term plan. 

So the announcement last week that the Department of Health and Social Care has commissioned Health Education England to “review long-term strategic trends for the health and social care workforce” is welcome, if long overdue.

The aim of the review is to renew HEE’s existing long-term strategic framework for the health workforce, to ensure it has the right “numbers, skills, values and behaviours” – and for the first time it will be extended to include registered social care professionals too.

The work will look at “key drivers of workforce demand and supply over the longer term” and identify how they could affect the size and shape of the future workforce.

The first step involves HEE issuing a call for evidence, to identify factors that may have the greatest impact on demand on the health and care sector over the next 15 years and what this means for workforce supply.

HEE chief executive Navina Evans said the work would act as a “reference point” and “guide decisions” on how the NHS and social care approaches problems in the short, medium and long term.

All sounds sensible — better late than never (why not in 2017 when HEE published its draft workforce strategy?) — but that all sounds like a lot of wonkery when people really want to know what does this mean for funding for training, numbers in training, and numbers coming out of training?

How does this link to the People Plan? And what political motivations lay behind this idea cropping up now, shortly after the appointment of Sajid Javid, and with a spending review in the autumn which many in the NHS will hope will produce a long-term training settlement?

No one has been able to answer that clearly, but my sources indicate that, while the work may inform some short-term spending review decisions (there isn’t much time left after all), it is largely a more longer term forward-looking project.

Danny Mortimer, chief executive of NHS Employers, described the idea as a “very important and positive step” — but also makes the crucial point that it “should not obscure the urgent need for decisive investment in addressing the chronic staffing issues facing the NHS and social care”. 

In other words, don’t let this mean that proper funding for growing the workforce is yet again in the long grass. That will be the marker as to whether politicians and policy makers are now more serious about staffing.

Stark evidence for inequality

Another important publication to take note of this week was the inaugural medical workforce race equality report, which has been described by chief people officer Prerana Issar as a “baseline” to “quantify discrimination” in the NHS trust-based medical workforce.

The good news: the report highlights that ethnic minority doctors and dentists make up 42 per cent of the workforce and this has increased from data collected in 2017 which suggested around 38 per cent of the medical workforce was from an ethnic minority background.

The report quite rightly shone a light on the glass ceiling for ethnic minority medics; it found the percentage of ethnic minority medical directors was not representative of the numbers of EM doctors in the workforce as a whole.

It also found ethnic minority doctors had to apply for more posts before finally being appointed to a consultant post and were less likely to be offered a consultant job. It called on trusts to urgently overhaul their consultant recruitment policy, and suggested royal colleges could have an important supervisory role in this process.

The inequality spans the spectrum of medical training and work. It was found ethnic minority applicants were less likely to be accepted into medical training when compared to white applicants, which was true for both UK trained and international medical graduates. ARCP outcomes were also more likely to be unsatisfactory.

NHS England has charged medical schools, HEE and royal colleges with publishing data on race and introducing equality diversity and inclusions panels.

And finally, doctors from an ethnic minority are almost twice as likely as white doctors to have personally experienced discrimination at work from a manager, team leader or other colleagues, and within this, specialty and staff grade doctors experienced the highest levels of discrimination.

The royal colleges also have a serious case to answer; according to the report the data quality for the membership and council members for the majority of royal colleges was “not robust enough to enable a valid analysis”.

The leadership and council of royal colleges must reflect their membership, and numerous recommendations give the royal colleges a key role: of ensuring employers, medical schools and others are held to account. There is a valid question as to how they can do this when they do not adequately scrutinise their own equality record.