Doctor's message to NHS England: 'What the hell are you doing about creating the workforce?’
In the post-Lansley NHS, if it's not about money, it's about staff - or rather about the lack of money and staff. Two issues that do not on their own often make headlines, but can certainly cause them.
Last month (February 17 & 19) Marlborough News Online published the results of a three part special investigation into the NHS' recruitment gaps (see links below.) Coincidentally, on February 23 a new 'high level risk' was noted by Wiltshire's Clinical Commissioning Group's (CCG).
There was a red level risk that: "Lack of staff across the health and social care system due to difficulties in recruitment, national staff shortages and competitive local market, will result in the system being unable to cope with demand for services and provide safe and high quality care both now and in the future."
And this week workforce shortages dominated a considerable part of Wiltshire Clinical Commissioning Group's (CCG) March board meeting.
Debbie Fielding, the CCG's Accountable Officer or CEO, said the path of transformational change they had set out on "...requires recruitment on a large scale. We know the workforce is going to be our most difficult area. It needs to be our top priority for the next year."
Dr Simon Burrell, who leads the CCG's North & East Wiltshire grouping (which includes Marlborough), underlined Ms Fielding's anxieties: "We've got a plan and it's the right plan...making the investment count is very difficult. My message to NHS England - and please minute this - is 'What the hell are you doing about creating the workforce?' "
The CCG Board's 'Registered Nurse Member' called for some lateral thinking: "We need different models of delivery. It isn't just about nurses - it can't be."
By chance the board also heard a specific example of the impact of staff shortages - an impact felt by patients and the CCG's bottom line. Two senior executives of the Avon and Wiltshire Partnership (AWP), which is contracted by the CCG to provide mental health services for Wiltshire, explained the challenges they faced both in recruiting staff and in retaining staff.
Too many people have been moved to beds for treatment outside the area because AWP has had to close beds due to their tight finances and staff shortages. This, they said, was "terrible" for patients and families. And financially it has meant, said the CCG's director of finances, Simon Truelove, that "We've taken quite a significant hit".
AWP has got the number of Wiltshire patients treated outside the area down to five. But warned it is a volatile figure. And staffing is the real problem.
"It is difficult to locate mental health nurses for Wiltshire." They have had a recruitment drive and have been to Ireland where there is a surplus of trained mental health nurses.
They are forging links with training colleges and universities - a longer-term solution. But this is a long-term problem as AWP faces a looming retirement bulge: "There's a rather ageing workforce in Wiltshire." In one specialty AWP could not even get the right staff from their best and most expensive agency.
They were heard sympathetically. But then, after one of the AWP executives said they had to be careful not to 'poach' staff and 'destabilise' another part of the care sector, a lay member of the board said to AWP: "You better break out of the loop and think of something else."
With the increasingly horizontal organisation of the Lansley designed NHS, It is very easy for commissioners who do not have to find and employ clinical staff to simply imagine there is a way to find enough trained staff.
As Marlborough News Online asked - very politely - last month, when they were designing their plans, had commissioners just hoped staff could be found by their contracted providers and just expected them to appear in Wiltshire? Perhaps a safer approach would be to find out what staff levels could be available and tailor plans and job specifications to fit. Is top down or bottom up the better approach?
Marlborough News Online's 'recruitment gap' reports can be found here: the shortage of nurses - the government's extra health visitors pledge - and the workforce statstics game.