The NHS must prepare for the global workforce war

We are hurtling towards a global healthcare workforce crisis. The only way to avoid it is to liberate the talent and productive capacity of our staff and see investment in healthcare in terms of national health and wealth creation.

There are plenty of solutions that exist worldwide but they haven’t – as yet – been coherently orchestrated in a single country.

The truism that “there is no healthcare without a workforce” is universally acknowledged but poorly acted upon. Over the past decade, working in 77 countries, I have concluded that no country consistently gets workforce planning right.

The WHO estimates we will be short of 18 million health workers by 2030, roughly a fifth of the number that will be needed to provide care. If we do not act, patients, families and communities will suffer.

Across the globe some politicians, officials and employers exhibit amazing levels of cognitive dissonance; they hold contradictory ideas and values simultaneously.

They proclaim their love for healthcare staff yet persistently underappreciate them; they celebrate extra jobs created but fail to plan for a healthy supply of staff to fill them; and they extol the virtues of technology without planning for enormous digital disruption.

In short, they say one thing and do another. And time is running out.

Global workforce crisis

The richest country on the planet, the US, is forecast to be 105,000 doctors short by 2030 and need one million extra nurses by the middle of the next decade. India is launching the greatest movement towards universal healthcare in history but is almost four million workers short.

When China announced the relaxation of its one-child policy to combat a rapidly ageing society it didn’t plan for the extra 180,000 obstetricians that will be needed.

Workforce planning is technically difficult and often disconnected from financial and clinical service planning and the wider forces shaping society and our worldwide labour supply

In Japan, the number of nurses tripled from 550,000 in 2000 to 1.7 million in 2013, but incredibly it is now seeking to add a further 250,000 over the next decade. Germany expects to need an extra 300,000 nurses by 2030.

I decided to write my latest book on the workforce crisis because I believe it is the greatest challenge facing healthcare worldwide. I also believe human beings can solve this problem if we think differently and act with much greater urgency.

Workforce planning is technically difficult and often disconnected from financial and clinical service planning and the wider forces shaping society and our worldwide labour supply.

Improve workforce productivity

My central argument is that we should reposition the debate over workforce to one of productivity, prosperity and national health and wealth creation. Educating, training and developing health staff is a great value creator and not simply a cost.

As the country’s biggest employer, the NHS could make a major contribution to tackling the scourge of low UK productivity.

A coordinated push across the factors that drive healthcare productivity – education and skills, infrastructure, research, technology, enhanced care models, innovation and fast adoption – will enable the NHS to support Britain’s economy better as we face Brexit.

Productivity is about working smarter, not harder. It should not be confused with efficiency

While the ONS reported that the NHS secured productivity growth of 3 per cent for 2017, over a 20-year period it was a sluggish 1.25 per cent annually. Productivity needs a long term, orchestrated plan, not thrashing and trashing staff through overwork.

Productivity is about working smarter, not harder. It should not be confused with efficiency.

In my book, I offer 10 solutions – affecting everything from how we make our staff feel loved to how we manage the interactions between humans and robots – which could create an extra 20 per cent capacity to care by 2030 if they were adopted and adapted at scale and speed.

Early adoption pays

Across the world, I have seen health systems where these solutions are already working. For example, some countries have already had the courage to move from an undersupply to an oversupply of clinical staff, safe in the knowledge that many extra jobs will be needed over the coming decade and beyond.

Countries that grasp this strategy early – and reshape the workforce for greater agility in a digital age – will have a big advantage in the global war for talent which will inexorably occur in the years ahead.

Some health systems are freeing healthcare professionals to work at the top of their game (not to be confused with working flat out). An OECD global survey of nurses and doctors found 79 per cent and 76 per cent respectively performed tasks for which they were over-qualified.

In the UK, the Royal College of Nursing estimates around 18 per cent of nursing time is spent on non-essential tasks, similar to the 15 per cent reported by the British Medical Association for doctors in training.

My book is called Human because I believe the kind touch and warm heart of a human being is the essence of care and will not be replaced by a machine anytime soon, and because I have faith in our ability to secure the fulfilled, productive, motivated workforce we need if we take decisive, sustained action now.