Taking a system-wide approach to NHS workforce challenges

Since the inception of sustainability and transformation partnerships and integrated care systems we have seen the NHS move towards greater collaboration. New five-year strategic plans will be expected to demonstrate how local systems will work together to deliver more preventative, integrated and joined up care.

We often hear about the workforce crisis in the NHS, including the 100,000 vacancies across the service, but we hear less about the impact of system working on the workforce. Even less often do we hear about the opportunities that system working might bring for NHS staff and for trusts and their local partners. But there is now evidence that systems are beginning to think about how they can solve critical workforce issues, and join forces to make their organisations attractive places to work.

Our recent briefing, produced in partnership with health and social care lawyers Hempsons, shows that trusts are developing innovative ways to support their local workforce to operate within the context of system working – and to adapt to ensure valued and skilled staff can best support the needs of local populations. From developing joint, system-wide plans for the workforce, to creating collaborative bank and passporting agreements, or adopting a more joined up approach to growing the workforce, trusts are using relationships in their local systems to think differently about how they work with system partners to tackle workforce pressures and plan for the future.

The question of relationships

Trust leaders agree that getting people around a table to work towards a common goal – improving the health of the population they share – is key. While this may appear simplistic, it’s widely acknowledged as having a major influence on how quickly and effectively system working progresses.

Effective collaboration relies on meaningful engagement with stakeholders, all of whom have a part to play in identifying and meeting the workforce needs of the system. Partner organisations also benefit from more practical measures like meeting face-to-face regularly, or co-locating teams to increase contact between individuals working together on workforce solutions.

As primary care, social care, the provider sector and local authorities become more integrated, cross-sector relationships are becoming an important part of system working. Some trusts, such as Leeds Healthcare Community Trust, are working to support primary care networks with HR functions as they mature and employ staff in additional roles.

Recruiting and retaining staff as a system

Recruitment and retention is an increasingly pressing challenge across the health and care system, and it is this “burning platform” on which trusts and their system partners are beginning to think differently about how they bring staff into a local place or system and incentivise them to stay.

A younger generation of staff seeking varied and stretching careers can benefit from a more joined up approach to recruitment and retention. Trusts with a strong international recruitment effort, organisations with inroads with local education providers, and others with significant admin and HR resource, can pool assets to ensure the system benefits from any push to recruit staff and fill workforce gaps.

In rural areas, for example, a collaborative approach to promoting the benefits of coming to live and work in the area is supporting organisations to attract staff they would otherwise struggle to reach. Systems are partnering up to reach out into local communities, and coming up with innovative ways to make it more attractive for staff to remain in the system – like in Cambridgeshire and Peterborough STP, where health and care organisations joined up to launch an initiative to promote a career in health and care locally.

This lends itself well to an overall aim of fostering a system identity among staff, rather than simply an organisational identity – something which trusts are considering carefully in their work towards supporting the wellbeing of staff and ensuring the staff feel included and empowered to take ownership of changes to the way they work.

Flexible working in a system

By creating a system-wide offer, whether through enabling staff to move more freely between employers, carrying across staff benefits when they change jobs within the system, or collaborating on staff banks to enable “spare” resource to flow to where it is most needed, system working presents a variety of opportunities for systems to minimise the impact of staff shortages.

There are considerations to bear in mind – contractual, procedural and financial barriers can arise and trusts describe the need to move slowly and collaboratively to manage hesitation among trust leaders accountable first and foremost for the performance of their organisation, and an open-minded, permissive culture is seen as a key determinant of whether initiatives to collaborate in the workforce arena will be successful and accepted by the workforce.

We expect the People Plan to set out clearer expectations of how workforce planning might be delivered at the level of place or system, however, our recent research shows that measures like these are already being put in place across local systems. Clearly, the workforce has a key role to play in bringing organisations together – if we want to integrate a care pathway, or create a more streamlined experience for people using multiple services, it is the workforce which helps make that happen.