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Nurse workforce planning matters

Marilyn Eveleigh
Consultant Editor

Workforce planning is every nurse's business. Nurses are part of it and a product of it. You have a role in influencing the way healthcare provision is staffed and the skills needed for a safe and efficient service, says Marilyn Eveleigh

The NHS employs 1.4 million people in 300 different roles and over 50% of them are clinicians. There are strategists in some far-away place that plan how many doctors, nurses and allied health professionals, plus other non-clinical workers, will be needed to deliver the NHS. This is not just a simple replacement calculation for those who leave the service for various reasons, but it also includes new roles and professionals that are “invented” to meet the increasing demands of new services tailored to taxpayers higher expectations.

Have they planned well for the workforce we now have? Yes, we do have paramedic practitioners who have transformed the traditional ambulance service, resulting in commendable improvements in first contact and life-saving interventions. We have non-medical prescribers who provide cost-effective, highly responsive care. We have associate practitioners and healthcare assistants crucial to specialist teams being able to function effectively. Pharmacists have expanded their medicines management role and clinical skills both in acute and primary services. You may think of many more examples of the changing healthcare workforce.

Yet in the last decade, I can recall the overabundance of trained physiotherapists and GPs who were unable to secure employment after qualification. There is a shortage of midwives when the national birth rate is at an all-time high. Health visitors have seen a drop in retention and recruitment. District nurse specialist qualifications are being phased out and the success of the community matron role is still variable. Many trusts actively recruit for overseas nurses to make up their vacancies and costly reliance on agency nurses. The NHS has spent £1.9bn on agency staff.

In the new NHS white paper, Equity and Excellence: Liberating the NHS, there is a clear indication that workforce plans must be managed better so skill mix matches changing patient needs. National top-down planning is not compatible with bottom-up local GP commissioning. In future, the Department of Health will have direct involvement in the public health service workforce only. Local healthcare employers will work together to ensure the supply of “the right people with the right skills, in the right place at the right time.”

The professional bodies, such as the Nursing and Midwifery Council (NMC), will remain responsible for the quality of education, in conjunction with academic educational institutions.

There is a workforce planning consultation paper out that sets out some proposals entitled Liberating the NHS: developing the healthcare workforce.1 The proposals could affect you directly, so you may want to respond with your comments. What do you think about the following?

All healthcare providers, including private providers (such as nursing homes), independent providers (such as GPs) and the voluntary sector must be part of a local network that will co-ordinate workforce plans and training. To be commissioned, they will have to adhere to workforce numbers and training plans that assure patient safety and quality of care.Healthcare services should co-operate together at local level to ensure clinical placements are provided and shared.

The government will reduce funding to Skills for Health, the training resource. It will, however, expect employers to invest it this and other training packages.

It is risky to allow market forces to determine investment in training and development. Pharma companies and some healthcare employers may be prepared to develop skills but this may not be fair or in the taxpayers best interest. There is a need to make allocations of training funds equitable and transparent.

Should there be a levy on private healthcare organisations that use NHS publically funded trained staff?
Send your thoughts back by 31 March 2011.

Nearly every nurse will have experienced workforce pressures that have affected the responsibility of the role and the potential to respond to patient needs. It may have been one of inadequate staffing levels, insufficient clinical competencies or barriers to training and development.

In the new world of GP commissioning, I believe there will be support for developing the confidence and flexibility of clinical teams to deliver healthcare. But nurses must make themselves heard within the new commissioning consortia. Your perspective on what staffing levels, skills and training are needed to ensure patient services are safe and responsive needs to be loud and clear. You are close to the patient. You have experienced the risk and see the potential of community services. You have a responsibility to contribute this knowledge - for the sake of the future nursing workforce. Make a difference to workforce plans and make yourself heard.

Department of Health (DH). Liberating the NHS: developing the healthcare workforce. London: DH; 2010.