How are NHS bank and agency staff part of the solution to ICS workforce problems?
In Human Resource Management textbooks, the concept of a core and flexible workforce has been identified as a key method for developing workforce plans in mature organisations. The notion is that there is a core, substantive workforce for business as usual and that a flexible workforce is then used at times of peak demand to safely fill remaining vacancies. This model is seen as a strategic, efficient, and effective approach to workforce planning. Organisations that use this model of deployment recognise that to maximise this approach, it is essential to value and effectively manage both parts of the workforce. The flexible or contingent part of the workforce is not seen as a workforce of last resort or inferior to the substantive workforce, but instead should be seen and treated as valuable members of the team.
In the NHS, we often see the management of this contingent workforce as a problem to be solved. We have been told that it is better for patients and quality of care to have permanent NHS staff that know the work area compared to staff who are unfamiliar with the specific department or working environment. There is of course a degree of truth in this. Yet in my experience, NHS bank staff and agency locums often cover long-term vacancies for several weeks or months (and in some cases years!) and often work in organisations that they are already very familiar with. And, of course, having an insufficient number of staff is of course a far higher risk to patients.
We have created a narrative that sees the substantive workforce as higher quality and those NHS bank staff that choose to work flexibly as a last resort rather than part of the solution. In NHS Trusts, board papers often highlight the risks of a contingent workforce, as well as the costs and anxiety about the overreliance on these flexible workers. There is not often a positive commentary on the enormous contribution these staff make to our healthcare system. In a post-Brexit, post-COVID world, we have to change this narrative. There is a different approach.
We know that the health and social care workforce crisis will not be solved quickly, we know that more people want more flexibility in choosing when, where and how they work, and we know more work can be done remotely and with a more agile workforce. We also know that organisations often consider it easier to move patients to where staff are (through diverts and patient transfers) than it is to move staff to the patient. With increased system working through Integrated Care Systems (ICSs), it is possible to safely deploy a region-wide workforce to where patient need is greatest, improving the patient experience and flexible working opportunities for staff as a result.
For any long-term workforce plan to be successful, we need to reset the relationship between employer and employee. I have three suggestions for how we could see the contingent workforce as a help, rather than a hindrance. Some of these impact national and local policies. While these touch on some challenging issues, I think the debate is essential.
- We need to turn our attention away from bearing down on the cost of the contingent workforce. Dismissing the value of NHS bank staff and agency locums when they are needed can, perversely, lead to increased unit costs in the long term. Instead, the focus should be on the efficient use of these staff and reducing overreliance when cost-effective alternatives are available.
- There is much focus on vacancies, and understandably so, but this does not tell the full story. Many vacancies are covered by bank and agency staff. Instead, a greater focus should be placed on unfilled hours. This measure is crucial when managing safe staffing levels across a system.
- We should acknowledge that there is a premium to be paid on salary for those that are willing to work more flexibly, geographically and in different healthcare settings. These are staff that may often have enhanced skills and training.
I know that many reading this blog will note the importance of connecting a consistent pool of workers within an organisation and the benefits that come from working as a cohesive team, and I don’t want to dismiss those views in any way. However, many staff that work in community settings often change their location and work with different people. We also know that effective teams can be created with colleagues working remotely and with different employers – for example, local authorities that employ social workers, or staff employed in charities such as Macmillan Cancer Support. The important aspects of effective team working can be achieved by creating a compassionate connection with patients and with wider values shared across ICSs.
The workforce crisis in the health and care system won’t be solved by trying to replicate yesterday’s employment models. But by recognising the need to think differently about the future workforce and creating a new work dynamic that equally values the core and the flexible workforce, it is possible. Getting this right is essential to the way we value all staff and to ensuring high quality, compassionate care.