How system-wide workforce management could help ICBs tackle the NHS’s staffing challenges

“We are still delivering care in a way that Florence Nightingale would recognise. We haven’t transformed in the way we’ll need to if we’re going to become a modern environment for people to work and to receive care – so thinking about how we transform our end-to-end care pathways is incredibly important,” North Central London Integrated Care Board chief people officer Sarah Morgan told the webinar.

For Ms Morgan, Integrated Care Systems present a great opportunity both to re-engineer those pathways and to strengthen the offer to employees, restoring morale and addressing the NHS’s dire staff shortages. She made clear that fast-rising public need and vacancy rates make transformation essential: in her ICS alone, “if we carry on delivering care as we do now, we’ll have a shortage of 17,000 staff by 2028”.

To avert that risk, Ms Morgan said ICSs must help create “environments where people want to work, and where we can deliver health and care in a sustainable way”.

The focus must be on “employee experience”, added DXC Technology global SAP offering leader Coppelia Rose. This included “having career paths, performance management, and succession management in place, so people feel that they’re being trained and developed; that they’re recognised; that they have a career”. This works much better at the system level, she argued, with collaboration across organisational boundaries strengthening the opportunities available to the workforce.

That workforce reaches well beyond the NHS, pointed out South Yorkshire ICB chief people officer Christine Joy. “Our workforce includes anyone with a role in health and care, paid or unpaid, so that shifts our vision from 70,000 employed people across South Yorkshire to 320,000 people,” she said. “If we understand that resource, we can make better use of those roles to improve patient care.”

Centralising NHS operations can also improve care, commented Ms Morgan: “In North Central London, for example, we’ve consolidated a lot of our people services: we’ve got shared recruitment, occupational health, and collaborative bank.”

Ms Morgan added that ICSs can also work together to manage demand for more junior roles, building pathways into work for local people. She explained how working alongside the Greater London Authority, her ICB has changed its advertising and hiring practices to bring people from “underserved communities”, care leavers and people with long-term health conditions into roles such as trainee nursing associates. “The economies of scale allow us to do that efficiently and effectively,” she said, plugging staffing gaps while providing “good work as a population health intervention”.

ICSs can also assist when staff suffer from worsening health conditions, added Ms Joy: if a particular employer lacks a suitable role, “we can see if we can find work for those individuals across the whole health and care sector”.

Asked how national health bodies can help ICSs, Ms Joy suggested chief people officers need better ways “to connect nationally with finance and performance colleagues so that the conversation and thought processes are integrated right from the top. We’re trying to do it bottom-up, and that’s really challenging.”

ICS HR teams would also benefit from more direct support with strategy and delivery, commented Ms Morgan, helping them to “build that expertise in our own teams, which are tiny in many ICSs”.

Bath, North East Somerset, Swindon and Wiltshire ICB director of resourcing and retention Penny Smee called for assistance in identifying best practices from ICSs around the country: “We haven’t got big teams. We can’t reinvent the wheel. If someone’s doing something really great, the national team could connect us into that work.”

Helpful projects and techniques are shared between ICSs across the South West, Ms Smee added: “If we do something, it sends a ripple across the region; it has an effect in Bristol, Cornwall, Devon.” However, she pointed out that replicating the same dynamic at the national level would require more coordinated action.

One frustration that united the chief people officers was the difficulty of gathering accurate data on the skills, deployment and working practices of workforces that encompass dozens of organisations and straddle the public, private and voluntary sectors. “Trying to get a picture of that, in order to do any effective workforce planning, is really challenging,” said Ms Joy; most ICSs have gaps and lags in their workforce data, particularly in primary and social care. Yet leaders must understand their existing workforces before they can be rebuilt around new forms of service delivery.

Here, ICSs are moving in the right direction, said Ms Smee. Hers operates a tool allowing all 23 member organisations to share information on staff shortages and pay rates. Introducing cross-system workforce management tools such as e-rostering also provides valuable data, commented Ms Joy.

Meanwhile, Ms Rose pointed to a link between better workforce data and the service transformation at the centre of ICSs’ ambitions. Traditionally, NHS organisations build service delivery around a fixed set of job descriptions. But given comprehensive data on the skills and competencies of their staff, they can ask: “Do we actually need a single person here, or could various folks take the load off the registered nursing community by doing other tasks?” By creating “libraries of clinical competencies,” Ms Rose explained, providers can “get that view and start working a little bit smarter” – finding new ways to deliver services.

Ms Rose added that creating a “uniform approach to skills and competencies” also strengthens performance management, skills development and career pathways across the system, improving the staff offer. This can be achieved without rebuilding organisations’ HR and operational management systems from scratch: an additional digital layer can pull together data from existing platforms and this is where organisations like DXC Technology can assist and work in collaboration with the NHS, she explained.

ICSs have barely begun to realise the potential of cross-system workforce management; but the duty to collaborate is having an impact, said Ms Joy, and ICS member organisations are seeing concrete benefits – building the enthusiasm for collaboration.

“When I took on this role, a couple of years ago, there was competition in rates for bank and agency staff; rates were on an upward spiral,” she said. “That’s really changed. We’re working much more collaboratively, actively managing the market and driving down the rates. We’re starting to see the workforce as a regional workforce, as opposed to an organisational workforce.”

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