We have the data to transform our NHS workforce. And we have the means to use it better
It is no doubt a massive understatement to say it has certainly been a challenging few years for the people profession in the NHS. Brexit and the COVID-19 pandemic have shone a light on the workforce crisis in the health and care sector. Details on the number of vacancies in the sector seem to be reported on an almost weekly basis by think tanks, in research reports and in regular news bulletins. However, this data is often historic, is not segmented enough and doesn’t help with the day-to-day planning of health and social care delivery. In truth, we risk these updates becoming background noise. This broad data doesn’t always support effective decision-making, and many of the solutions to the crisis are not in the gift of local organisations and systems. Pay, graduate pipelines and terms and conditions of employment are determined nationally, meaning some of the geographical workforce nuances can be overlooked.
Although I was aware of the operational and service delivery data available at Trust level, I have been surprised and encouraged by how easy it has been to share that operational data at system and at regional level. For example, those coordinating the response to recent industrial action have had instant to access to, amongst other things; the number of ambulances waiting outside hospitals – updated in near real time, the average ambulance turnaround time by hospital, the percentage bed occupancy, the number of discharges that day, and the number pending, the number of calls and their categories waiting on the stack at system level. This data, shared so openly, has been a real aid to decision-making and planning. It has allowed for early interventions and where necessary, appropriate escalation.
The other aspect of planning at this time that requires some improvement is that when operational capacity is reached at individual Trust level, organisations continue to resort to moving patients around the system, rather than moving staff to patients. It seems counter-intuitive that in response to pressures on local resources, we seek to divert patients to other A and E departments, that patients get moved to beds in other facilities and that we transfer patients by ambulance from one Intensive Care Unit to another, often many miles away. Surely, it has to be safer for patients and easier for managers to safely move staff to patients (and increase capacity), rather than to move patients to where the staff are? Some of this response is about the model of employment we have where the majority of staff are contracted to individual organisations rather than within a wider system. My previous blog talked about placing more value on the contingent workforce to ensure better patient care. We need to together have a fundamental rethink about how staff can be safely and flexibly employed, contacted and deployed across systems.
How different would decision-making have been if we had access to real time workforce data at local, system and regional level in the same way we have access to operational data? How different would the conversations about local and system risks have been if we had access to real time rosters at local and at system level? Instead of reassuring conversations about coping with pressures, data on rosters in local organisations could be compared to provide assurance on actual staffing levels by shift, on visibility on whether minimum staffing levels were achieved or exceeded. Conversations that could see the prospective redeployment of staff to patients rather than patients moved to where staffing levels are perceived to be better. In other words, we can hope to start a more honest conversation using operational and workforce data to ensure meaningful, timely decisions are made to enhance patient care and experience. This approach could fundamentally change how Provider Collaboratives operate and ensure greater quality and efficiency in the long term.
This desire to use workforce data more effectively to enhance care and planning, led me to check if any systems were using real time workforce data on rosters to help with decision-making, and of course there are! A system has started sharing rostering data to show where minimum staffing levels have been met or not and where they have been exceeded, allowing decisions to be made on whether to utilise bank or agency. The same system also showcases in real time the rates being paid to agency staff, enabling organisations to maintain better grip and control over workforce spend. More details on the tools available now to organisations and systems can be found here. As is often the case in the NHS, we have pockets of great practice, and so we need to accelerate the roll out of these models and products on a wider regional scale.
This is not just about better efficiencies and greater productivity, important though they are. Transparency and sharing of data is also better for staff flexibility, allowing more clinicians to work when and where they can best contribute, ultimately demonstrating a real commitment to the value we place on the contingent workforce.
The reworking of the health and care workforce seems a daunting task, but sharing data transparently can help us better understand how we can increase employee engagement and maintain quality of care. It will still be hard, but as the playwright and poet Seamus Heaney said ‘if you have the words, there is always a chance that you’ll find the way’.
We can do this!