Back health and care workers now or our current national crises will get worse
Professor Sam Shah
Director of the Faculty of Future Health, Ulster University, NHS clinician and former Director of Digital Development, NHS England
The current crises in climate, energy and obesity are adding to the burden on UK healthcare. Professor Sam Shah, digital health consultant and former director of digital development at NHS England, argues that we need incoming politicians to back the workforce and pull the right levers for change if we are to respond effectively.
The UK is facing multiple challenges, with each having a huge impact on the population’s health and wellbeing.
Fuel costs are spiralling out of control. Colder homes increase the risk of falls and respiratory problems. Meanwhile the evolving climate crisis exacerbates risks for those with underlying health conditions, who are more likely to suffer from the effects of extreme heat and cold.
Obesity is a growing problem. Figures show that 2.6m children aged under 18 live in households without access to a healthy and affordable diet. Rising inflation means this will be made worse by the rising cost of staple food items.
The answers to these problems lie outside the hospital door. However they have a huge impact on health and care, with growing waiting lists, missed diagnoses, and avoidable patient harm.
Inevitably, the pressure on the workforce is unsustainable. It looks set to get worse. Research by the Health Foundation’s REAL Centre shows that the NHS is short of 94,000 staff. Social care is short by 112,000. Such numbers are set to grow almost tenfold in the next decade.
To have any chance of dealing with current pressures, we need to back and fund the current workforce. We should not be distracted by quick-fix solutions that mask the real issue of a lack of capacity.
Focus on the right things to support the health and care workforce
It is the people – not the process and technology – that really matters. This is where policymakers and system leaders need to focus.
Take virtual wards, for example. The NHS is making £200m of funding available in 2022/23, with more to follow.
The idea is to bust the backlog with more home-based care. But it’s all rushed and very reactive. We’re not spending enough time considering how best we can do this. Where are the workforce impact assessments? Who will monitor the monitors?
Whilst they may well be a suitable long-term solution, there’s only so much short-term money that we can pump into the system to play with virtual wards. There isn’t the workforce around to actually deliver against their ambitions. We cannot assume the capacity is there.
The workforce problem for health and care is much bigger than increasing pay rates, although inflation makes this an urgent priority.
Retention is a huge issue. One in nine hospital and community staff left active service in the year to September 2021. The Nuffield Trust notes that the rate of people leaving the NHS who cite a lack of opportunities or want better rewards packages has more than doubled. High-profile departures to the private sector seem to be increasing in popularity.
We have to act now with long-term investment in developing the extra workforce needed to help us weather the growing social storms. We have to attract talent from other industries, and pay equitable rates to individuals to actually do those jobs. We must improve working conditions for all.
Take the Digital, Data and Technology (DDaT) workforce. Staff are leaving the digital workforce now. Yet the new digital health and care plan set the deadline for the recruitment, retention and growth of the DDaT workforce by an additional 10,500 full-time staff by March 2025!
Integrated care systems can pull the right levers for change
Each integrated care system is now charged with retaining, recruiting and, where required, growing its workforce to meet future need. They have the opportunity and remit to work with others to identify these needs across the whole system.
However the initial signs suggest we should expect more of the same thinking and approaches that have led us to where we are now.
Are we going to get where we need to be to address our population health challenges? No. There is no extra money for prevention, for example. The public health budget has all but disappeared in the last 15 years. This won’t reduce the demand or the resultant pressure on the workforce.
How much freedom do integrated care boards (ICBs) really have? None whatsoever. All the levers at the centre remain unchanged. Top-down government control is still the norm.
At the regional level, will the big acutes still be dominant? Of course. They are treasury debt. They will continue to sit at the centre of a system desperate for a change that may well lessen their influence. ICBs just do not have the right composition to achieve the intended outcome.
The intention for integrated care to bring together stakeholders who could make a difference is good. Yet there is a real fear that with the same faces, the same lack of control and without the levers they need, we will have tied the hands of those delivering integrated care before it has even started.
Facing the future of health and care
The issues of the health and care workforce will not go away. It can only get worse, unless politicians listen to, support and invest in this workforce for the long term.
Power has to be truly devolved to those at the frontline of care. We need a model that is based in the community and primary care, with the individuals and groups who are familiar with what people really need. They should be trusted and empowered to create, design and implement solutions that can help address wider inequalities.
Currently I think the argument for this has already been lost. GPs and the rest of primary care are struggling to have a voice; the voluntary sector is fighting to be heard. However if those on the frontline can work closely together, we can move towards more people-powered health with the workforce we need.
Only then will we have a chance of addressing the crises we are facing.
Sam is a member of the Silver Buck Advisory Board, who we work with to help our clients build relationships in the digital health industry. Get in touch to find out how.
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