Health and Care Services

Towards a sustainable NHS workforce in Wales

15 November 2016

Article by Philippa Watkins, National Assembly for Wales Research Service

Darllenwch yr erthygl yma yn Gymraeg | View this post in Welsh

Image of a chain of cut-out people shapesThe sustainability of the workforce continues to be cited as the biggest challenge facing NHS Wales in the coming years. Here’s an update on some of the key issues and actions being taken.

National Assembly’s Health, Social Care and Sport Committee

The Assembly’s Health, Social Care and Sport Committee has identified ‘workforce’ as a priority area of work for the Fifth Assembly. Over summer 2016 the Committee ran a consultation and survey on the sustainability of the health and social care workforce, and agreed that workforce issues, including the potential impact of Brexit, should be considered as part of all the policy and legislative scrutiny it undertakes. Some specific pieces of work have already been prioritised, including inquiries into medical recruitment and primary care.

Workforce data

An important point, identified in responses to the Committee’s workforce consultation, is that we don’t have an accurate, comprehensive picture of the current health and social care workforce. This is undeniably a barrier to effective workforce planning. Significant data gaps exist in relation to certain groups of staff and care settings, but also not enough is known, for example, about vacancies, use of temporary staff, or the skills/competencies of staff in post.

The lack of robust workforce data is acknowledged in the previous Welsh Government’s primary care workforce plan (2015), which sets out a number of actions in this area. The primary care workforce plan also identified the need for greater clarity about the future picture of services, in order to fully understand the type of workforce required in the longer term. This is a key point; the Welsh Government-commissioned Health professional education investment review (2015) and NHS Wales workforce review (2016) both emphasised an urgent need for a clear, refreshed strategic vision for NHS Wales, based on the prudent healthcare agenda. This must inform the strategy for the workforce.

Workforce strategy

The Health Foundation’s October 2016 report The path to sustainability – Funding projections for the NHS in Wales to 2019/20 and 2030/31 also identified the development of ‘a strong workforce policy’ as one of the necessary steps towards achieving a financially sustainable NHS in Wales.

The Welsh Government has already committed to develop a 10 year workforce strategy, and originally intended to publish this by the end of 2016. In September, the Cabinet Secretary described some of the work already undertaken. The workforce strategy will not however be published until the parliamentary review into the long-term future of health and social care in Wales has concluded.

Vaughan Gething: The review represents a real opportunity to build a consensus on the priorities and long-term aims of health and social care in Wales, both of which will help further inform the direction of the future workforce.

In light of this, the 10-year plan publication date has been moved, to allow for the Parliamentary Review to conclude and provide a period of time to analyse the outcome of the review and develop the plan accordingly. (In answer to WAQ70943)

The establishment of a parliamentary review is one of the priorities outlined in the Welsh Government’s five year programme Taking Wales Forward. Terms of reference are expected to be published later this month. The review is expected to take around 12 months to report.

The Cabinet Secretary has made clear that some actions on workforce shouldn’t wait for the outcome of the parliamentary review. This includes the launch of a new medical recruitment campaign (October 2016) and a refreshed offer for GPs, as well as work to establish a single body for workforce planning, development and commissioning of education and training.

The creation of a single body was one of the most significant recommendations of the 2015 review into health professional education investment in Wales, and is intended to support a more strategic, joined-up approach to planning and training the NHS workforce. On 10 November 2016, the Cabinet Secretary announced that a new single body – Health Education Wales (HEW) would be established. HEW is expected to be operational from April 2018.

Wellbeing of staff

Stakeholders responding to the Health, Social Care and Sport Committee’s consultation and survey identified the health, wellbeing and safety of staff as a key priority for achieving a sustainable workforce.

The sickness absence rate in NHS Wales is 4.8% according to the most recent statistics (for the quarter ending June 2016. Note, sickness absence shows wide seasonal variation throughout the year with the rate lower in summer). The highest rate is among ambulance staff (6.9%), followed by healthcare assistants and support workers (6.7%). The highest sickness absence rates have consistently been seen in these two staff groups.

In the British Medical Association (BMA’s) recently-published survey of general practice, over 60% of respondents indicated that they do not have a good work-life balance. Almost three quarters reported that the health of staff within the practice had already been impacted negatively by workload. The BMA told the Health, Social Care and Sport Committee (pdf ,715kb):

We regularly hear from members that stress-related illnesses are becoming increasingly common. Burnout is a very serious threat to the sustainability of services, not to mention to individual doctors’ health. We believe that an all-Wales comprehensive occupational health service for all NHS staff is required.

The British Psychological Society (pdf, 163kb) also suggested that greater promotion of psychological health and wellbeing at work would have a positive impact on the sustainability of services.

Service integration

The Welsh Government’s programme commits to the development of integrated and sustainable health and care services. The NHS Wales workforce review published earlier this year highlighted the lack of an agreed definition of ‘integration’, and called for greater clarity from the Welsh Government about the extent of the integration being aimed for.

The workforce review found that a potential significant barrier to progressing integration between health and social care is the differing pay and terms and conditions of employment that exist between staff employed on NHS contracts, those employed by local government and those employed by the independent sector.

Outcomes are better when clinical staff worked in multi-disciplinary teams with social care staff. However, the perceived lower status of social care staff compared to healthcare staff can create significant difficulties in developing integrated systems.

This point was echoed in stakeholders’ responses to the Health, Social Care and Sport Committee’s workforce consultation, which highlighted that social care is under-valued as a profession, yet care workers will play a vital role in meeting future population needs and enabling the delivery of more care closer to home