Prescription for a new way to work - NHS

Edward Fennell looks at moves to solve workforce problems and build better career paths in the health industry.

JUSTICE and health are the areas of most concern to today’s electorate. Both are pushing forward with a reform agenda. The NHS has to find more effective ways of making better use of its limited resources.



Under proposed changes, staff will have extended roles and become more flexible. But for the system to work it must be based on defined standards of performance that people can show they have achieved.

The justice service, especially the police force, is being measured against national occupational standards. Skills for Justice is developing performance standards while encouraging through foundation degrees, the understanding a modern justice system needs.

THE human factor of having enough people with the right skills deployed to best effect is critical to the long-term viability of the NHS and the rest of the health sector. But there are concerns about whether the current system is sustainable.

John Roger, chief executive of Skills for Health, whose remit covers everyone from doctors to porters, says: “At the end of the 1980s the demographic time-bomb posed a big threat to the NHS. We overcame it by attracting women-returners, retention initiatives and overseas recruitment. With competition for workers across all sectors, we are running out of options over the next three years. We have to restructure the way we operate. ‘More of the same’ will not work.”

The sector skills council intends a radical rethink of how the health sector can maximise the use of the skills of its whole workforce. “Historically, we have had a system whereby the patient has followed the services provided by healthcare professionals. Now we are looking at a different model. We want a more flexible system which moulds itself to patient needs.”

This means moving from the strict demarcation lines drawn around each profession. Roger says: “Instead we need a multi-professional approach centred on patient needs. Skills and competences developed in one setting need to be recognised and transferable.”

As an example he cites the scenario of a minor accident in which an elderly person sprains her ankle. Currently, the ambulance crew would take the victim to A&E; where she would probably spend up to four or five hours before being sent home after relatively minor treatment.

In the future, by contrast, the paramedics on the ambulance, trained and qualified as emergency care practitioners, should be able to administer the care themselves and take the person home immediately if they are satisfied that there are no complications.

This kind of streamlined process would save time for the individual and avoid clogging up the A&E; department, freeing the hospital staff to focus on more serious injuries. Similarly, pharmacists might be better placed than at present to form part of a “whole system approach” to delivery of diabetes patient care.

For these changes to happen, national competences need to be defined and agreed while staff need to be trained and assessed so that everyone, including patients, have confidence in the new way of working.

Defining a “national competence framework” is the key to the future. Partnership is essential and professional bodies and royal colleges have worked with Skills for Health on the development of a wide range of competences (covering care areas ranging from coronary heart disease to public health).

It is intended that the new nine-level career framework managed by Skills for Health will encourage flexibility and progression. It should mean that individuals can have a more extended role and step up to new functions as they arise.

Looking ahead, Roger says that he is aware that technical advance is moving at such a pace to defy any rigid planning. “The only thing we can say confidently is that the one thing we need in the future is not what we have now.”

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