Workforce planning in challenging times

Challenges which affect healthcare professionals are not new. Alongside the changing patient demographic profile, the shift of care into the community, emphasis on the management of chronic conditions and an ever present requirement to focus on improving the outcomes of care, we are facing unprecedented financial cuts in the NHS. There can be few professionals who are not currently facing a squeeze on their budget and many who fear losing their jobs. Headlines in the national and professional press herald huge staff cuts as pressure to deliver the savings escalate towards the end of this fiscal year and into the future. The healthcare workforce is changing too; they are also ageing alongside the rest of the population. Newly qualified healthcare workers take a different perspective to their work-life balance than those at the end of their career, and expect more from their employer in terms of investment in education and lifelong learning. The present context, therefore, is especially difficult for anyone looking into the future, to commission education to meet the need for workers for the NHS in the next three to five years. In an ideal world, there would be a balance between supply and demand. However, in a far from ideal scenario, it seems that demand for healthcare is limitless; and the supply of personnel wanting to become healthcare professionals a smaller pool, with greater demands which have to be met. In addition, the organisations, the Strategic Health Authorities in England, which currently co-ordinate the workforce planning for the NHS, are due to be abolished during 2012. In Scotland, the Health Boards submit their workforce plans to the Government, but they have to meet strict criteria – particularly if they wish to reduce the workforce. The changes must be accompanied by a risk management plan to explicitly show that risks to patient safety and quality of care have been identified and mitigated.1 Together with the increasing complexity of healthcare, there is a global shortage of nurses and other healthcare professionals. In effect, this means that unlike the tactics utilised in the past, there is no available workforce waiting in the wings to supplement our numbers. We will have to be self-sufficient to a large degree – which implies having robust strategies in place to manage the impact.

A decisive decade – mapping the future NHS workforce

In their interim report, from the forthcoming Royal College of Nursing Labour Market Review, Buchan and Seccombe2 claim that “the challenges facing nursing and the nursing workforce across the UK in 2011, are the greatest for a generation.” They say that the nursing workforce is highly vulnerable to policy change, especially with regard to the number of nurses potentially retiring and the numbers being commissioned for education. The report contains eight models of different workforce scenarios – none of which make for a peaceful night’s sleep. The report models the impact of a variety of assumptions which may affect the nursing labour market in the next few years. They have used the current headcount of 352,104 qualified registered nurses, midwives and health visitors and exclude bank and practice nurses. The modelling assumes that 85% of all newly qualified registered nurses move from education into employment in the NHS. Shockingly, figures obtained from higher education establishments show an attrition rate during education of 28%.