2024-25: As we near the halfway point, what have we learned this year?
By Kate Harper, Director of Research, Thought Leadership and Insight, NHS Professionals
We entered 2024/25 fully aware of the emphasis on productivity and the consequent challenge of balancing long-term workforce needs with short-term financial targets. Helping our NHS clients to reduce spending on temporary workers was centremost in our thinking along with strategies for optimising the utilisation of the current workforce (substantive and bank) through training and development. We also knew, that 2024 would be an election year and one in which we would need to be agile and able to respond to policy reform and market change. Like everyone else, we weren’t quite prepared for the early election and the speed with which change happened!
During times of change, close monitoring of the market and operating environment is paramount. Conferences and events, as well as providing opportunities to showcase products and services, are also a valuable means of hearing from our peers about the challenges keeping them up at night, the actions they are taking and areas in which they are seeking support. Through the panels and workshops we participate in, the sessions we attend and the conversations we have on our stands, we are constantly 'taking the pulse' of the sector and reacting in ways which mean we remain at the heart of the conversation.
The two events that stand out most in our calendar to date have been the HSJ Provider Summit (featuring some of the most senior NHS leaders – including our Chief Nurse and Managing Director of the NHS Professionals Academy, Juliette Cosgrove) and the industry’s showpiece event – Confed. Other events (including online events and webinars) have also added much to our knowledge and thinking.
So, what have we learned and what is on our radar for the remainder of the year?
Theme 1: The Financial Factor
NHSP’s core business is managed bank services so we are always keen to hear what people had to say about where the temporary workforce fits into their current thinking. Our conversations have confirmed that there is considerable challenge between short-term financial considerations and longer-term workforce capacity requirements. Demand for temporary workers has fallen markedly as providers look for ways to reduce spending and drive productivity. There is also a discernible trend towards prioritising substantive workers – many of whom rely on additional shifts to supplement their income or gain further experience. So, what role is there for bank only workers? Providers recognise that this group may be seeing fewer opportunities to access shifts; there is currently increased competition for bank shifts and various recruitment challenges may lead to bank workers finding it more difficult to re-enter the substantive workforce. Thought needs to be given to ensure the skills of this workforce are retained to avoid losing them to other industries in the short-term.
It is also the case that, for many providers, efforts to grow capacity (recruiting to new roles, recruiting international nurses or bringing in doctors that have undertaken their training outside the UK, such as through our Doctors' Gateway Programme) are also challenged. However, providers believe this is a temporary situation as they align workforce and productivity back to pre-pandemic levels. The targets set in the Long-term Workforce Plan seem to remain the ambition – including the need for a skilled temporary bank workforce that will give the NHS the agility it needs to respond to fluctuations in demand.
Theme 2: Emerging Cross-System Opportunities
There are, of course, things that can support the temporary workforce and we have discussed these at length with the people we have met at various events. Emphasis today is not just on recruitment, but on retention too. Collaborative banks potentially give rise to a wider pool of opportunities for workers – particularly where these extend to cross system opportunities in primary and community settings.
Informal arrangements through staff sharing and passporting can also create the same outcomes with vehicles like our National Bank service, providing a means of pooling and deploying workers across both different acute providers and different parts of an integrated care system.
Our conversations have touched on the potential for designing bespoke training that will allow us to deploy more staff into shortage areas where there is still a reliance on agency (Including tertiary and out of hospital care and specific roles such as ADHD or continuing healthcare assessments, discharge and care navigation) extending the recruit-train-deploy model that we already offer for healthcare support workers.
In essence, the message we have been hearing is that regional workforce leads are advocating for flexible workforce supply to be managed on a cross-system, rather than individual provider basis. At Confed, the event session – 'Joining up our Workforce Plans to Benefit Patients and Deliver More Integrated Care,' provided a clear message: all parts of the system need to work together to mobilise a 'new workforce.' This should include cross-system knowledge and skills which shapes healthcare in the way that patients consume it, through pathways that start in the community and end back in the community.
A shared, upskilled/right skilled temporary workforce may well be a start which is why NHSP's Academy is now exploring how we can prepare the workforce for providing high quality healthcare in every patient setting. As Dr Navina Evans Chief Workforce Officer at NHS England (NHSE) suggested: "the challenge is about skills, not roles."
We are also committed to championing the flexible workforce with the new Government and exploring ways in which our talented bank members can play a role in supporting the initiative for providing 40,000 extra appointments per week.
Theme 3: Engaging the Next Generation of Workers
An enduring theme through various events has been the need to engage the next generation of workers. Despite the recruitment challenges discussed, there is recognition that, in the long-term, we will need to attract, train and deploy workers from different backgrounds and qualification pathways if target numbers in the Long-term Workforce Plan are to be met.
According to the Institute for Fiscal Studies, one in 11 workers in England will work for the NHS in 2036-37, down from one in 17 (6%) in 2021-22. In addition, the Health Foundation states the proportion of first-year higher education students in England training to be NHS clinical professionals would need to increase by 50%, from one in nine first-year students in 2022-23, to one in six in 2031-32.
These numbers suggest that we need to continue to build and promote the NHS employer brand and make it easier for the next generation of workers to apply for roles.
This will require a significant change in our attraction and recruitment processes, a message which the 'Supporting People to work in the NHS' session reinforced. The session showcased a project in Gloucester to develop a video to promote the NHS to young people (mapping individual interests to healthcare professions) and work undertaken in Southampton to co-design new healthcare-related T’levels.
The advice was clear: we need to 'throw out the rule book' for how we recruit today and work with young people, and those from less traditional recruitment pools. We need to understand how to win hearts and minds and make it easy for them to engage with, and apply to jobs in, all parts of the health service.
Our conversations show, however, that people are at different stages in their thinking about this next phase so more guidance may well be needed.
For NHSP the 'direction of travel' in terms of modernising recruitment could not come at a better time. As we work through the final design stages of our refreshed recruitment process, which we will launch as part of our technology eco-system transformation, the message to modernise and simplify is clear and very relevant.
Theme 4: Technology
Linked to the above, technology is now being routinely discussed at most NHS events. The technology workstream at Confed for example, and demonstrations across exhibitor stands, revealed the scope of growing investment in digital and AI workforce solutions. From engagement through recruitment and workforce management and on to training, development and retention, digital technology (and AI) is playing an increasing role. The big question, of course, is how do you keep up?
NHS Professionals is not a pure play technology provider. Our purpose is to use the right skills and technology that provide workforce solutions that drive down agency spending and temporary workforce costs, add new capacity and help develop capability. Our financial model is predicated on returning a surplus to our only shareholder, DHSC, which they can re-invest in the wider healthcare system.
Our digital strategy involves selecting the best partners through which we can access state of the art and continually evolving solutions. This shaped our decision making when we selected our lead partners for our current transformation programme and is very much a part of our innovation and solution development strategy as we create and bring to market new products and services. The conferences we attended this year so far have provided a rich source of new ideas and thinking for our teams – not least levels of interest in digital and virtual learning – something already in focus for our Academy training team.
Theme 5: Leadership
Our final takeaway also has relevance for the NHSP Academy. At both the last two Confed events, keynote and panel speakers talked about the importance of 'leadership' in all of its many guises. They reminded us to revisit the recommendations made in the Messenger Review, in particular, the need for leaders to foster collaborative behaviour to promote integrated working, tackle poor behavioural cultures and develop knowledge and skills so they can lead across systems and promote inter-professional working.
Notably, Amanda Pritchard. Chief Executive at NHSE talked about a new, multi-disciplinary NHS Management and Leadership Framework and a new code of practice for all managers and leaders with clear standards, competencies and curricula for training the people we need – from entry level and ward to Board.
As we move into the second half of the 2024/25, we expect to hear more about how the sector is responding to new Government policy and thinking – both with regard to NHS recovery and improvement and wider workforce development (including initiatives to improve the quality of work). High on our agenda are NHS Employers' Strategic Workforce Forum in Nottingham on 25-26th September and the HPMA Annual Conference in Belfast on the 3rd and 4th October. Please feel free to come and find us for a chat. We would love to add you to our conversation!