Post on 31-May-2020
Changing the NHS Workforce
through collaboration and partnership
Patrick MitchellRegional Director, South of England
UHMLG – Brighton
29 June 2017
Health Education England’s Purpose
"Health Education England exists for one reason only: to
support the delivery of high quality healthcare and health
improvement to the patients and public of England by
ensuring that the workforce of today and tomorrow has the
right numbers, skills, values and behaviours, at the right
time and in the right place.”
The role of HEE
3
Quality &
Education
Commissioning
Workforce
Transformation
Education
Support:
Workforce
Planning &
Intelligence
HEE, through its Four Region’s delivers its mandate to the NHS through organising delivery through four main service offers.
Supported by a range of national/regional corporate
services – finance, HR, ICT etc.
• Of HEE’s 16/17 allocation, £4.5bn (89.5%) is effectively pre-
committed to future workforce commissions either through
undergraduate clinical (e.g. nurses) or PGMDE programmes.
• £104m (2%) was used to support workforce development and
allocated according to local priorities through HEE’s regional
offices.
• In addition £35m (0.7%) was allocated to national programmes in
support FYFV Transformation programmes
• Only £72m (1.4%) is admin spend. NHIR academic funding (listed
as “other expenditure”) of £53.8m is also distributed through HEE
mechanisms (but HEE has no role in its quantum or allocation)
HEE spending 16/17
HEE Spending 16/17Undergraduate non-medical
Undergraduate medical
PGMDE
Programme
Admin
Other
The Collective Challenge
• Cost containment
• Workforce shortages
• Rising workforce costs
• Fragmented approach to the design, development and training
of our workforce.
• Alignment of workforce skills, roles and capacity to service
models
• Collaborative System Leadership
Demographics
Mind the (generational) Gap
Potential impact of ‘Brexit’
NW London
South London
NC&E London
South West
Thames
Valley
East
Midlands
Yorkshire
& the Humber
North
East
North
West
West
Midlands
Wessex
Kent, Surrey
and Sussex
East of
England
• 5% of current NHS staff EEA nationals
• Variation by role (below) and geography* (right)
• Some reductions in EEA applications to non-medical
clinical undergraduate (why? CSR vs. brexit)
• No impact on applications to medical post-graduate
training (yet)
• More pronounced potential impact for social care
*Darker regions indicate a higher proportion of EEA clinical staff
• To deliver these plans, NHS providers, CCGs, Local Authorities, and other health and
care services have come together to form 44 STP ‘footprints’.
• These footprints are of a scale that should enable the transformation required to
implement the Five Year Forward View’s vision of health, quality care, and efficiency
by 2021.
• The STP footprints will not cover all planning eventualities – there are layers of plans
that sit above and below STPs.
• HEE have established coterminous Local Workforce Action boards to support the
STP’s workforce strategy and delivery
Sustainability and
Transformation Partnerships
The 44 English Geographies
In forming their footprints, local areas will
have taken the following factors into account:
• Geography (including patient flow, travel,
and how people use services);
• Scale (the ability to deliver sustainable,
transformed, and financially sound health
and care);
• Fit with footprints of existing change
programmes and relationships;
• The financial sustainability of organisations
in an area; and
• Leadership capacity and capability to
support change.
HEE’s changing role
2013: Education and
training commissioner
• Careers service
• Workforce planning
• Commissioning
education and
training
› PGMDE
› Undergraduate
clinical
• B1-4 staff (Care
Certificate)
2020: Strategic leadership, workforce intelligence,
and market intervention
• Workforce transformation (inc. Talent for care)
• Workforce intelligence
› Supply and demand; current and future
› Working with and influencing HEIs
• Future workforce
› Including improving the attractiveness of
healthcare careers and the ‘informal’
workforce, developing apprenticeship
standard
• Quality assuring clinical placements and education
• Delivering, overseeing, and transforming PGMDE
• Leadership development and talent management
• Quality assuring clinical placements and educational programmes
• Delivery of national programmes,
• Overseeing, delivery, and development of PGMDE programmes,
• Oversight of legacy non-medical commissions,
• Role in new SLC funded non-medical market to be determined by
consultation
• Oversight and assurance of LWAB delivery
HEE’s internal Structure
• Development of Workforce Strategy/Strategies, including FYFV
transformation programmes,
• Workforce Planning, including PGME commissioning,
• Policy development, e.g. development of Nursing Associate role.
• National Programme development and delivery e.g. NME programme,
• Accountability to Parliament via the DH and ministers,
• Oversight and assurance of Regional Team delivery
National Team
Regional Teams (4)
Local Workforce Action Boards (38)
• Cover labour markets and coterminous with STP planning areas,
• Allow Local providers access to and support from from HEE analytical and
policy capabilities,
• Support for local place-based workforce planning,
• Distribution of local transformation funding (dependant on 17/18
settlement),
Everyone “does” workforce planning
Strategy
Implementation
Future
DH(Pay, Pensions, etc.)
Present
PROVIDERS(Service provision, planning and transformation)
HEE (Education, training, commissioning and market management)
NHSI (Provider support, financial
sustainability)
The best predictor of the future is
the past…
-10.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
% Increase in NHS employed staff 2004-2014
Consultants
Allied HealthProfessionsHealthcare Scientists
Ambulance staff
Total GPs
Specialty recruitment:
round 1 – acceptance and fill rates
2017 R1 2016 Comparison
Posts Accepts Fill Rate Posts Accepts Fill Rate Posts Accepts Fill Rate
ACCS Acute Med/Core Medical Training 1385 1027 74.15% 1334 1084 81.26% 51 -57 -7.11%
ACCS Anaesthesia/Core Anaesthesia 499 462 92.59% 487 483 99.18% 12 -21 -6.59%
ACCS Emergency Medicine 304 238 78.29% 309 290 93.85% -5 -52 -15.56%
Cardio-thoracic surgery 8 6 75.00% 5 5 100.00% 3 1 -25.00%
Clinical Radiology 221 221 100.00% 212 212 100.00% 9 9 0.00%
Community Sexual and Reproductive Health 4 4 100.00% 5 5 100.00% -1 -1 0.00%
Core Psychiatry Training 406 236 58.13% 417 274 65.71% -11 -38 -7.58%
Core Surgical Training 499 498 99.80% 507 505 99.61% -8 -7 0.19%
General Practice 3250 2399 73.82% 3250 2282 70.22% 0 117 3.60%
Histopathology 76 54 71.05% 74 65 87.84% 2 -11 -16.79%
Neurosurgery 25 25 100.00% 23 23 100.00% 2 2 0.00%
Obstetrics and Gynaecology 234 229 97.86% 230 228 99.13% 4 1 -1.27%
Ophthalmology 54 54 100.00% 61 61 100.00% -7 -7 0.00%
Oral and Maxillo-facial Surgery 7 7 100.00% 3 3 100.00% 4 4 0.00%
Paediatrics 377 303 80.37% 379 351 92.61% -2 -48 -12.24%
Public Health Medicine 67 67 100.00% 57 57 100.00% 10 10 0.00%
Total 7416 5830 78.61% 7353 5928 80.62% 63 -98 -2.01%
Workforce plan vs. reality - Consultants
The Future of Medical Rotas?
Consultants/GPs (CCT holders)
Non-Consultant
Non-Trainee Medics
“Training Grade” Medics
The wider workforce
Underlying supply constraints limit the number of
trainees available to deliver service and will
continue to do so in the medium/long term
• Need to attract/recruit/retain NCNT doctors?
• Use medical resource across STPs?
• Hot/Cold sites?
• Non-medically led/delivered services?
• Better, different, use of non-medical
workforce to support efficient delivery of
medical rotas? (ANPs, ACPs, Pas?)
• Enabled by holistic/multi-professional learning
environments?
• An additional 1,500 medical students;
– 2 cohorts, 2018 and 2019
– Clinical placement capacity?
– Clinical Placement funding (SIFT/Tariff)
– Overseas Students and cap?
– Point of Registration/Medical Licencing Assessment?
• Beyond 2019?
• New Schools entering the market?
• First trainees reach FY1 in 2023, CCTs 2028-2032
Medical Student Expansion
Workforce plan vs. reality – Allied Health
Professionals
Workforce plan vs. reality –
Nurses and Midwives
Nursing & Midwifery
Cumulative
Intake Intake Annual Increase
Year Size Increase v 2012/13
2012/13 20,124
2013/14 20,572 448 448
2014/15 21,769 1,197 1,645
2015/16 22,858 1,089 2,734
2016/17 23,285 427 3,161
2017/18 - est 23,285 0 3,161
Supply to 2020/21 111,769 11,149
HEE are currently training over 3,000 more nurses each year compared to
2012. 2012-2016 NHS adult nurses in post 13,751 (8.3%).
Source : NHS Improvement
Variation in staff turnover
National Transformation Programmes
FYFV priority programmes
• Urgent and Emergency
Care
• Cancer
• Mental Health
• Seven Day Services
• Maternity
“Five Pillars” approach to
workforce Strategies
• Increasing the attractiveness of
NHS Careers and improving
retention
• New Staff
• Adopting New Roles
• New Skills
• Delivering Care Differently
FYFV programme outcomes
• Improved access
• Improved outcomes
• Better patient experience
• Higher staff engagement
Given the importance of workforce to delivering on the Five Year Forward View (FYFV) priority areas HEE is supporting the
national programmes of work by producing national workforce strategies for each.
HEE will support the system to continue attract the vast majority of the educational output, look at how care pathways can
be designed to make use of a wider range of staff to support specialists in delivering care, rationalise the deployment of
staff where there are potential shortfalls, as well as how to better retain the existing staff that the NHS employs.
HEE’s local transformation offer
The HEE STAR is a web based tool, designed to inform and present
the HEE LWAB ‘offer’ to meeting the workforce requirements
described by the STP process. The tool has two functions;
• It creates a single ‘go to’ directory, for providers and systems to
access information on tools, resources and investment available to
deliver their workforce transformation plans
• Further, it provides a single, coherent framework to guide local
conversations with provider systems to better understand and
define their workforce transformation requirements
The STAR is a simple, step by step, staged approach that helps to
tackle workforce transformation in bite sized chunks, prompting
creative solutions to workforce planning, retention, skill mix and re-
design.
The STAR is in pilot phase with a small number of LWABs/STPs
across the country before being shared more widely in the Autumn.
@NHS_HealthEdEng #HEELKS
Sue Lacey BryantSenior Advisor, Knowledge for Healthcare
@SueLaceyBryant
UHMLG – Brighton
29 June 2017
How can we future proof the profession?
The Evolving
Librarian
Questions for today
• What can we draw on from the past?
• How are we positioning health librarians centre stage?
• How can we put quality at the heart of our work?
• How can we demonstrate our impact?
• What can we see on the horizon?
• How can we prepare?
H
EE
CILIP
PHE
HEIs
SCL
NIHR
NICE
NHS
England
Image credit
C12th
1879
1960s to 1980s
HEE
CILIP
PHE
HEIs
SCL
NIHR
NICE
NHS
England
Image credit
Image credit
Dibrary: National Digital Library of Korea
1990’s and 2000’s
“NHS bodies, their staff,
learners, patients and the public
use the right knowledge and
evidence, at the right time, in
the right place, enabling high
quality decision-making,
learning, research and
innovation to achieve excellent
healthcare and health
improvement.”
Knowledge for Healthcare
http://www.hee.nhs.uk/our-work/research-learning-innovation/library-knowledge-services
HEE
CILIP
PHE
SCL
NIHR
NICE
NHS
England
Making it real
HEE
CILIP
PHE
SCL
NIHR
NICE
NHS
England
Making it real
NHS Library & Knowledge Services in England
Policy
http://kfh.libraryservices.nhs.uk/nhs-lks-policy/
All NHS staff to be able to
freely access library and
knowledge services
Developing NHS librarians
and knowledge specialists
to use their expertise
Developing a coherent
networked national serviceNick Youngson - link to - http://nyphotographic.com/
CILIP
PHE
HEIs
SCL
NIHR
NICE
NHS
England
http://kfh.libraryservices.nhs.uk/knowledge-management/km-goals-tools-and-techniques/
Skills, techniques and tools to mobilise
evidence and organisational knowledge
E-Learning and
postcards
Knowledge
Management
Toolkit Synthesis and
summarising
training
CILIP
PHE
HEIs
SCL
NIHR
NICE
NHS
England
With thanks to Rachel Cooke, SASH and acknowledging her work with Chris Collison
Board self-assessment tool
CILIP
PHE
HEIs
SCL
NIHR
NHS
England
http://kfh.libraryservices.nhs.uk/patient-and-public-information/ideas-bank-2/
Supporting local networks
Cascade training
Health
Information
Week
3- 9 July 2017Ideas Bank
Supporting health and wellbeing
HEE
CILIP
PHE
HEIs
NIHR
NICE
NHS
England
How can we put quality at the heart?
Teaching Excellence Framework
How to articulate the Library’s
contribution to quality taking
into account:
• Student satisfaction?
• Retention rates of students?
• Employment outcomes?
HEE
CILIP
PHE
HEIs
NIHR
NICE
NHS
England
How can we demonstrate our impact?
1. Organisations are more effective in mobilising evidence and
internally generated knowledge
2. Patients, carers and the public are empowered to use
information to make health and well-being choices
3. Improved consistency and increased productivity and
efficiency of healthcare library & knowledge services
4. Enhanced quality of healthcare library and knowledge
services
5. Partnership working is the norm in delivering knowledge to
healthcare
6. Increased capability, confidence and capacity of library and
knowledge services workforce
@NHS_HealthEdEng #HEELKS #aMilliondecisions
Making a positive impact
£500,000 saved: clinical librarian crucial
to success of Nursing Supplies Group
University Hospitals of Morecambe Bay
NHS Foundation Trust
Rapid response to clinical supply problem
relative efficacy of two agents –MRSA
Wirral University Teaching Hospital NHS
Foundation Trust
http://kfh.libraryservices.nhs.uk/value-and-impact-toolkit/kfh-impact-tools/impact-case-studies/
CILIP
PHE
HEIs
SCL
NIHR
NICE
NHS
England
http://kfh.libraryservices.nhs.uk/value-and-impact-toolkit/
Quality and Impact Tools
Value and Impact
ToolkitHigh Profile Health
Libraries Toolkit
Metrics Guidance
http://www.thebluediamondgallery.com/a/advocacy.html
What can we see on the horizon?
HEE
CILIP
PHE
HEIs
SCL
NIHR
NICE
NHS
EnglandSix key developments in
technology:
• Big Data
• Digital Scholarship Technologies
• Library Services Platforms
• Online Identity
• Artificial Intelligence
• Internet of Things
NMC Library Edition 2017 Developments in
Technology for Academic and Research Libraries
https://www.nmc.org/publication/nmc-horizon-report-2017-library-edition/
Looking to the future
HEE
CILIP
PHE
HEIs
NIHR
NICE
Top Strategic Predictions for 2017 and
Beyond: Surviving the Storm Winds of
Digital Disruption
Horizon scanning
What's next in digital technologies
and how can we help?
HEE Blue Sky
Event
Will a robot take our jobs?
http://www.bbc.co.uk/news/technology-34066941
… It is All about the people
John Gill 1970’s
Victoria Treadway with Dr Girendra Sadera and medical colleagues at
Wirral University Teaching Hospital NHS Foundation Trust. Image
copyright Wirral University Teaching Hospital.
2016c. 1970
John Gill, District Librarian, Poole Hospital Library, 1970
CILIP
PHE
HEIs
SCL
NIHR
NHS
England
What do we need?
2017 Training Needs Analysis
Resources for role redesign
Demonstrating impact
to critical appraisal;
information for patients
to emerging technologies.
HEE
CILIP
PHE
HEIs
SCL
NIHR
NICE
NHS
England
http://kfh.libraryservices.nhs.uk/learning-zone/
Learning and development
Leadership DevelopmentLearning Zone
Talent Management Toolkit
“Tomorrow
belongs only to
the people who
prepare for it
today.”
Malcolm X
By Ed Ford, World Telegram staff photographer - Library of Congress.
New York World-Telegram & Sun Collection. http://hdl.loc.gov/loc.pnp/cph.3c12133, Public Domain,
https://commons.wikimedia.org/w/index.php?curid=1304014
QuestionsPatrick.mitchell@hee.nhs.uk
Sue.Lacey-Bryant@hee.nhs.uk