The Changing Face of the Healthcare Workforce

Kerry Hemsworth Assistant Director of Education and Commissioning

History of Medicine
Medical practice can be dated as far back as the ancient Egyptians Imphotep was the physician to King Zozer and lived in about 2600 BC

History of the non-medical professions

Nursing has existed in various forms in every culture over millennia, e.g. wet nurses Americas first trained nurse graduated in 1873 The most significant development was during war time when Florence Nightingale laid the foundation stone for professional nursing

History of other professions

Physiotherapy practice dates back to BC times, for example in ancient Greece and the practice of hydrotherapy In 1894 the UK recognised physiotherapy as a specialised branch of nursing The polio epidemic was a turning point for the physiotherapy profession and its establishment in its own right

So what does the history tell us?

The practice of healthcare and medicine has been around for a long, long time in various forms The practice of healthcare and medicine has been consistently valued and has evolved in accordance with demographic requirements The various professions have evolved in accordance with demographic requirements

History of the NHS

The NHS was born on July 5 1948 officially started by Aneurin Bevan Good healthcare should be available to all, regardless of wealth For the first time doctors, nurses, pharmacists, etc. are brought together under one umbrella organisation

The Timeline
1948 the NHS commenced 1953 the structure of DNA was discovered 1960 the first kidney transplant 1967 the Salmon Report 1978 the first test tube baby 1980 keyhole surgery 1988 breast screening introduced 1990 internal market introduced 2007 robotic intervention

Healthcare professions of today

Doctors and dentists Nursing and midwifery Allied health professions Healthcare scientist professions and the smaller professions Healthcare support workers Management, ancillary and other staff

Fields of practice
More than 15 specialties of medical practice with additional sub-specialties 4 main branches of nursing with enhanced specialisation in practice multiple sub-specialties Around 12 allied health professions with multiple sub-specialisms Over 30 healthcare scientist professions with a host of sub-specialisms Primary, secondary and tertiary care settings Integrated services e.g. with social care

Changes in practice
At one time, nurses and other professionals couldnt take blood pressures this was a medical procedure
We now have highly skilled practitioners who undertake a range of procedures and are also responsible for diagnosis e.g. advanced practitioners in cervical cytology

What does this say about current healthcare practice?

Its complex! Its reliant on a range of practitioners in different settings and sectors with the appropriate skills Technology advances and will continue to advance

Healthcare workforce a recent history

The 1990s saw serious workforce shortages Health Select Committee enquiry into workforce planning in 1999 NHS Plan produced in 2000 a 10 year strategy

NHS Plan Headlines

More staff, better paid Modernisation of workforce and services Improved outcomes Critical targets

The Key Workforce Messages

MORE STAFF WORKING DIFFERENTLY

Workforce Objectives
150,000 more staff Doubling in applicants and 60+% more trainees Explosion of new roles
Delegated tasks e.g. prescribing Extended roles e.g. nurse endoscopist New roles e.g. advanced practitioner

Positive staff survey results Lower vacancy and sickness absence rates Over 90% of staff on new pay systems

Where are we now?

New workforce planning crisis
Graduates in some professions unable to find a job in their vocation

New Healthcare Select Committee Enquiry in 2006 New attempts to ring-fence education and training and strengthen workforce planning

Swinging pendulum

Policies since the NHS Plan

Payment by Results
Tariff-based commissioning system

Choice and Competition

Stronger patient opinion and voice

Practice Based Commissioning

Stronger role in primary care

Commissioning a Patient Led NHS

Major reorganisation

All have had an impact on workforce..

 A world class NHS

Fair equitable to all Personalised tailored to the needs of the individual Effective outcome-focused Safe public confidence

Eight defined areas of care

Maternity and newborn Childrens health Planned care Mental health Staying healthy Long term conditions Acute care End of life

to

The focus on workforce

The NHS employs over 1.3 million people 70% of costs are staffing The NHS spends over 4 billion annually on education and training Need to overhaul the system and strengthen workforce planning and commissioning education and training Need effective clinical leadership Need to avoid repeats of the boom and bust

What are we aiming to achieve

We need a workforce with the right skills in the right quantity in the right place at the right time A workforce that is appropriately educated and trained to deliver the service A workforce that can deliver quality care to patients

How is the workforce planned?

Not dissimilar to history its based on demographic requirements, however the healthcare arena is significantly more complex today Workforce planning is designed around the patient Based on the skills and competencies to deliver the required services Planned in harmony with finance and services

3 current key priorities in NW

18 week wait where are the workforce gaps? Public health and health promotion what are the workforce needs in terms of education and service delivery Health inequalities some significantly deprived areas - need to ensure appropriate workforce with correct skills is available

Current and future skill mix

Blurring of professional boundaries

The average patient sees over 40 different people associated with delivering their care during a single episode of care A patient is often assessed more than once Many of the professions have overlapping skills and roles in patient care Many of the professions dispute who should be carrying out particular roles

Workforce modernisation
Modernised roles focused on delivering the care pathways and targets A workforce that demonstrates the appropriate attitudes and aptitudes Breaking down of professional barriers where appropriate A flexible workforce A workforce that embraces continued professional development, advancing technology and evidencebased practice.

.A workforce capable of delivering world class st century healthcare in the 21

You know you work for the NHS when

Discussing dismemberment over dinner seems perfectly normal You firmly believe unspeakable evils will happen when someone says Wow its quiet in here You have ever had a patient who looks you straight in the eye and says I have no idea how that got stuck in there

Thank you for listening

kerry.hemsworth@northwest.nhs.uk