June 2019

Securing a skilled and sustainable workforce for the future

The NHS must transform the way it works to meet the ambitions of the Long Term Plan

We have known for some time that the NHS must change in fundamental ways if it is to continue to deliver healthcare services to an ageing and increasingly demanding population. Now, with the publication of the Long Term Plan, we have a clearer idea of the scale of the challenge.

How this relates to the workforce, already struggling with shortage of supply, will become clearer still when the People Plan is published later this year. Already we have a good indication from the recently published Interim People Plan, which highlights urgent actions including tackling the nursing shortage and improving the leadership culture.

At PwC, we have been looking into these issues for some time and developing ways to help tackle them. We highlight some examples in this publication.

Shortages are perhaps the obvious and most headline-grabbing challenge, and the Interim People Plan prioritises the shortage of nurses as the area needing most urgent action. This is closely related to the problem of retention, and making the NHS a better employer will be vital in tackling this.

While the workforce needs to grow, it must also have the right skills – in many cases there may be new roles, resulting from new technology and other innovation, requiring a different skill mix. These changes can make the workforce more productive, ensuring better care for patients and saving costs. On top of all this comes workforce planning, which has become an increasing challenge in a world of flexible working and the gig economy.

It’s clear that the necessary transformation is not going to be easy. There is a lot to be done to ensure the NHS meets the workforce challenges it faces now and over the coming decade. I hope the ideas in this publication will be helpful in that task.

Mike Farrar Chair, Public Sector Health Board

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How can the NHS deliver the aims of the Long Term Plan and interim People Plan?

The Interim NHS People Plan makes it clear that the health service must switch its focus so it is firmly on people – both workforce and patients. This will involve putting workforce planning at the centre of planning processes because the NHS can only transform its services by transforming the way it works.

This interim plan paves the way for a fully costed five-year People Plan but the NHS Long Term Plan (LTP) has already set out the need for ambitious changes to meet a growing demand for health services against a backdrop of staff shortages.

Although the response to the LTP has been generally positive, professional bodies and think tanks have expressed concern about how this vision can be delivered when one in every 11 posts is vacant.

Now the interim People Plan has spelt out what needs to be done:

• Make the NHS the best place to work.

• Improve the leadership culture.

• Prioritise urgent action on nursing shortages.

• Develop a workforce to deliver 21st century care.

• Develop a new operating model for workforce.

• Take immediate action in 2019/20 while the full five-year plan is developed.

The challenge now facing NHS leaders is how best to press ahead with the urgency required. Technology and training will play key roles, but managing costs will remain vital.

Workforce shortages, particularly in the medical and nursing fields, have a significant impact on the ability to deliver sustainable services in the short term and to plan and grow services in the medium to long term.

Workforce planning is currently short term, fragmented and not adequately linked with safety, operational and financial planning.

The NHS needs to develop its leadership and staff training and development now and for the future, in order to create a more diverse, inclusive and motivated workforce.

To meet the growing demand for health services, workforce productivity will have to improve, and technology will play a key role in this.

With workforce as the NHS’s biggest expenditure, managing costs (including high agency costs) more effectively will be fundamental to making it sustainable in the long term.

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Meeting the workforce challenges

The workforce challenges facing the NHS may seem daunting, but the ambitious changes being put forward in the Long Term Plan offer exciting opportunities for innovation.

At PwC, we already have extensive expertise around driving improvements and efficiencies within the NHS workforce, including leadership development and productivity in the health provider sector.

We are constantly exploring new ways to tackle the workforce issues in the NHS and to support the transformation which will be needed. So, we have developed a range of digital tools and capabilities that address the evolving needs of the health sector. Here are some examples.

What’s the issue?More people are embracing the ‘gig economy’ – working flexibly to suit their lifestyles and other commitments. This leaves health sector organisations facing agency costs and the administrative burden of juggling a bank of temporary and flexible workers – a challenge complicated further by compliance requirements and changing regulations.

How can we help?Our mobile-enabled Flexible workforce hub gives organisations the ability to establish an effective and compliant process for managing flexible workers and tracking engagements. You can save costs by directly engaging with workers instead of through an agency; get real-time reporting and audit trail; monitor budgets and spend at any time; remain compliant with IR35 legislation by linking to Companies House; collaborate across trusts; and stay on top of all legal, pensions, employment tax, HR and other advisory services. At the same time, it enables workers to: submit timesheets from any device at any time; track payments; and have 24-hour access to all their information.

Where we’ve done itWe worked with three London trusts to move them across to our direct engagement model, and they are now involving almost 100% of their flexible workforce. We developed weekly reports for each trust, giving them absolute visibility over spend and with real-time updates. The trusts use these reports to inform decisions, reduce agency spend and set budgets as a collaborative group. The easy mobile access has meant they can oversee everything from any location and any device, and workers can submit their time ‘on the go’ and access payment information anytime, anywhere.

Flexible workforce hub

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Smart credentials platform Strategic workforce planning tool

What’s the issue?Our development of the Flexible workforce hub showed that there can still be a lot of administration involved in the checks around agency workers – to confirm basic questions like who they are, whether they have the right qualifications, and whether they have the right to work.

How can we help?We have developed a Smart Credential platform by harnessing blockchain technology to issue staff with digital versions of their certifications, which are then kept in virtual wallets, where they are secure and tamper-proof, and can be shared and verified in real time. This reduces employers’ screening costs and gives owners complete control over sharing their credentials digitally.

Where we’ve done itWe worked with Institute of Chartered Accountants of Scotland (ICAS) to trial the Smart Credential platform for our staff who have qualified with the Institute over the past two years.

This first project has shown the potential for other fields where credentials are earned and updated – such as health professionals, as well as pilots or safety engineers.

What’s the issue?Organisations of all kinds face a challenge in effectively planning and delivering their future workforce and in maximising the efficiency, effectiveness, productivity and sustainability of their current workforce. This will be especially true within the NHS in the coming years as it strives to deliver the ambitious vision in the Long Term Plan.

How can we help?We have developed a Strategic workforce planning tool, which enables organisations to plan and deliver a future workforce as well as maximising the efficiency, effectiveness, productivity and sustainability of the current workforce. The tool is agile, highly interactive and can be quickly configured to your specific needs. It has a simple modular structure, based on: workforce demand; workforce gap; workforce supply; and workforce plan. Its flexibility means it can easily include additional modules.

Where we’ve done itWe are working with a major transport organisation to introduce the tool for its workforce of around 1,000 FTE. Gathering data from several systems, it will enable the organisation to be far more efficient and effective in its strategic workforce planning, with reliable forecasts for workforce demand and supply, and identifying gaps. Before handing over the tool, ready for use, we provide all the necessary training.

£480mSpent by the NHS on agency staff in 2017/18

54.7% of FY2 doctors in 2017 did not pursue further training

How we can help We understand healthcare, we understand people, and we understand the pressures now facing you, as a leader in the NHS , to play your part in delivering the Long Term Plan.

Our expertise can identify, design and deliver the best solutions for the unprecedented workforce challenges facing the NHS in the coming years.

We have already developed technology which can help transform the healthcare workforce. As part of a global network, we draw upon knowledge and experience from around the world, adapting and refining as needed, to ensure it helps you achieve your goals.

In all cases, we focus on delivering solutions that make a real difference to costs and patient outcomes.

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Mike Farrar Chair, Public Sector Health Board

Tel: +44 (0)2078 044019

Our team

Kalee Talvitie-Brown Health Industries Partner

Tel: +44 (0)2072 124372

Iain Alexander Health Industries Partner

Tel: +44 (0)7739 874619

This content is for general information purposes only, and should not be used as a substitute for consultation with professional advisors.

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