Against the backdrop of a growing demand for healthcare and shrinking healthcare budgets, staff shortages are widespread within health systems across all disciplines. Despite being the largest employer in the UK, with over 1.2 million full-time equivalent (FTE) staff working in hospital and community services, right now the NHS workforce is struggling to cope, reporting a shortage of more than 100,000 FTE staff. It has been projected that the gap between staff needed and the number available could reach almost 250,000 by 2030. A looming shortage of doctors is cause for alarm even in normal times. Mid-pandemic, it signals catastrophe.
With chronic understaffing comes a plethora of consequences, most notably for patient care, with life-threatening diseases at risk of late diagnosis, when treatments are less effective, more expensive and result in unnecessary emergency admissions. To meet the rising demand for healthcare workers, providers have turned increasingly to agency staff, which not only brings greater financial costs, but has been directly linked to poor patient experiences, as well as that of staff, for whom there are also significant impacts on health and wellbeing.
Back in 2016, Simon Stevens, chief executive of NHS England, announced a major drive to improve the health and wellbeing of NHS staff, yet in 2019 40.3% of NHS staff in England stated that they had felt unwell as a result of work stressors, with understaffing being key. This proportion has been steadily increasing since 2016, when 36.8% said the same. As a result, NHS sickness absence rates are 27% higher than the UK public sector average, and 46% higher than the average for all sectors.
If substantial staff shortages continue, we could see staff absences and patient waiting lists continue to grow, potentially undermining the future sustainability of healthcare services. The problem has been on the horizon for some time, but action has been slow. Here, I will reflect on two solutions that have been widely discussed to date.
Education and training
The training of new staff is an obvious route to growing the workforce that the NHS requires. The NHS Long Term Plan acknowledges that university places for entry into nursing and medicine are continuously oversubscribed, and thus commits to expanding education and training places, including funding for 50% more nursing placements from 2020. However, this requires significant financial investment, and national funding for education and training in this area has fallen in recent years.
Another option would be to tap into the existing talent within the healthcare support workforce, by offering flexible or part-time routes, which enable existing support staff to train and progress into nursing roles while they continue to work, to help attract career changers or appeal to those who did not have the opportunity to study through a traditional university route. Despite the range of targets and measures to improve the supply of staff, including increased funding for clinical placements during training, more apprenticeships and online degrees, the training pipeline is repeatedly failing to deliver the right number of staff in the right places.
However, as I’m sure you will recognize, this is not a quick fix, with first year students being at least three years away from emerging into currently understaffed frontline positions. There’s also an understanding that the ability to support clinical placements and provide high quality training is particularly challenging when services are already under severe pressure. It is clear that when healthcare demand rises considerably and rapidly like we have seen, and continue to see, throughout the pandemic, the supply of trained staff available to fill hospitals’ full-time posts cannot easily respond at the same pace.
A workforce redesign and technology adoption
Alongside a call for six million additional nurses globally by 2030, the World Health Organization has suggested that their roles should be expanded to take on some activities traditionally undertaken by senior staff. Certainly, in both the UK and internationally, there is a shift away from “doctor-driven” to team-based ways of working within primary care. Many have argued that giving nurses greater clinical responsibility to safely undertake advanced diagnostic roles is the best way to develop the capacity of the health service workforce.
Equipping nurses with the right resources to be able to, for example, confidently recommend a diagnosis to patients during triage, will not only increase operational efficiency but also encourage staff retention by demonstrating clear routes to career progression, avoiding further gaps forming in the workforce. Under this model, patients will also see benefits in the form of optimized referral pathways, with frontline nurses better equipped to refer patients to the most appropriate clinical pathway, thereby speeding up their journey through the healthcare system. Furthermore, this will use doctors’ time more efficiently and effectively, reducing unnecessary contact with non-urgent, simpler cases.
Rapid advances in medical technology and devices are supporting this transition to an expanded multidisciplinary team and are likely to have great impact across the healthcare workforce (Figure 1). Digital tools and platforms, such as symptom checkers, as well as the increased use of artificial intelligence to make sense of the overwhelming amount of data created, brings the promise to deliver healthcare on a far more rational, efficient and tailored basis. For example, telemedicine can reduce the amount of time nurses and other care providers need to spend with their patients, freeing their time for those who need to be monitored by a healthcare professional at all hours of the day.
Figure 1: Top 10 digital healthcare technologies and their projected impact on the NHS workforce from 2020 to 2040 (From the Topol Review). Arrow heat map represents the perceived magnitude of impact on current models of care and, by inference, on the proportion of workforce affected: white = <20%, light blue = 20%, dark blue = 50%, black = >=80%.
Without a doubt, the staff working in the NHS are its greatest asset and are key to delivering high-quality patient care. This has been exemplified more than ever throughout the pandemic, with staff demonstrating remarkable resilience and commitment, despite being consistently asked to do more with less resource.
To this issue there are no easy answers or quick wins. But I believe the most effective way to address the projected gap between supply and demand is to make much greater use of an expanded multidisciplinary team, by leveraging the rapid advances in medical technology to empower existing frontline staff with greater clinical responsibility.
One thing is certain, if we are to effectively tackle the next global health crisis, we must act now.
Dr Lorin Gresser is CEO and Co-Founder, Dem Dx.