Why AHP Workforce Planning reminds me of watching the latest episode of The Walking Dead
Part way through the Covid-19 pandemic, I started watching The Walking Dead TV series again. I'd lost interest several years previously due to the repetitive nature of most of the episodes. But I suddenly yearned for something familiar, and the story of a virus turning busy streets into ghost towns had obvious parallels with the real world at the time.
As fans will know, the series focuses on the survivors of a mysterious near-apocalyptic event that turned many people into zombies. Entertaining enough, you might think, but by series seven the formula was becoming a little too familiar. Pretty much every episode resulted in a major cast member walking into an abandoned supermarket, house or factory – insert building of choice HERE – that’s been ransacked and is poorly illuminated.
The central hero and a more peripheral cast member – (spoiler alert: soon-to-be-victim) – creep forward together in near silence until one of them accidentally knocks an object over with a crash, at which point a zombie pops up and the less important cast member is consigned to a gory death.
Watching the standard zombie attack scene unfold for the umpteenth time, I was suddenly struck by the parallels to workforce planning for allied health professionals (AHPs).
At a provider or system level, any discussion about how to address healthcare staffing (AHPs very much included, although you wouldn’t know it from the media debate, which predictably only focus on shortages of doctors and nurses) is invariably constrained by what’s deliverable rather than what is required. So, instead of the rather obvious ‘let’s recruit more registered staff’ (answer: we can’t as there aren’t any), we instead reanimate the same few ideas again and again… seemingly for seven or more series.
Ideas such as
1 Upskilling healthcare support workers to alleviate pressures on registered staff
Fine to do, but there comes a point at which you begin diluting the registered workforce. Non-registered staff actually deliver the majority of patient contact, so perhaps registered staff have always been the support workforce in reality. Quite how we can continue to ‘upskill’ our hard-pressed colleagues to deliver ever more tasks is questionable. Plus, increasingly staffing the NHS with this lower paid staff group would appear to contradict the NHS’s ‘anchor institution’ status, whereby offering decent salaries is a benefit providers convey to their local population.
2 International recruitment
Again, another fine idea and one that is entirely welcome in that it further diversifies the NHS workforce, which is something we all benefit from. Yet aside from the obvious ethical issues of removing registered staff from countries who may feel they need them, it’s also not cheap. Like most ‘quick fixes’ this is an expensive option with little guarantee of success. Hoping a workforce that is transient, by its very definition, commits long-term to the NHS is hopeful at best. At worst these individuals are being asked to enter a depleted workforce to plug gaps, with little in the way of cultural or professional support at hand. NHS leaders will do what they can to provide this support, but with no budget, operational pressures rising daily, and legacy NHS staff hard pushed to provide much in the way of peer support it’s a tough environment for international recruits to fit into.
Add into this mix the recent fall in the value of the pound, which means international recruits who send some of their salary home to their families will see this worth about the same as a bag of Haribos, and, finally, a Brexit infused marinade of immigration defensiveness preventing the easy employment of our EU friends, all means that international recruitment is as much a problem as it is a solution.
With the arrival of the next soon-to-be-victim (read: health secretary) promising ‘radical’ reform and yet another report highlighting the precipitous position healthcare staffing is in, I was reminded of the The Walking Dead scene in which (spoiler alert!) Rick Grimes is forced to choose between taking a baseball bat to his friend’s head or a knife to his own son’s hand
Digital opportunities are numerous, and AHPs are at the forefront of recognising the potential benefits offered by an effective digital deployment. However, ‘digital’ is too often seen to be a solution in itself. For example, the rush to digitise processes, paperwork and assessments has simply resulted in a labyrinthine system of drop-down menus, electronic trails, and screens. I mean what can go wrong with having (at the last count) 40 different electronic patient record providers available?
As most people already know, digitising a process or service without improving it simply results in a poor e-process or e-service. Unless you have the time to train staff to use a digital system fully, and it delivers improvements to the work ‘as done’ and has not been modelled on some artificial version of the task, then it hinders more than helps. And this all requires adequate workforce capacity to embed the digitisation successfully, trying to implement ‘digital’ as a solution to the workforce crisis is a backwards reimagining of what’s needed.
4 Role re-evaluation and maximising clinical ‘productivity'
The thinking goes something like this: ‘We don’t have enough GPs, so let’s get a physiotherapist in to see all the musculoskeletal patients.’ Again, superficially not a bad idea, but it immediately falters because we do not have enough physiotherapists either. And it can make things worse for secondary care as AHPs (understandably) are tempted to move out of rehabilitative-focused services into the diagnostic world of primary care.
Secondary care is not immune to this thinking either though, as efforts are made to shuffle the clinical deck of workforce cards to see what combination of staff can fulfil ward-based or community ‘tasks’, with ultimate decisions based more on what’s available rather than what’s optimal. Which takes us full circle to the upskilling of healthcare support workers, as this staff group is just that little bit easier to recruit into roles. In all of this we seem to have lost sight of the intrinsic value of ‘care’ as a complex necessity, and healthcare delivery now focuses on what resource is available to deliver ‘X’ task with no additional investment.
Recently, with the arrival of the next soon-to-be-victim (read: health secretary) promising ‘radical’ reform and the release of yet another report highlighting the precipitous position healthcare staffing is in, I was reminded of the infamous scene in The Walking Dead in which (spoiler alert!) Rick Grimes is forced to choose between taking a baseball bat to his friend’s head or a knife to his own son’s hand. Neither are exactly what’s needed and it’s unclear how either will help the overall situation, but what else is there to do in this post-pandemic world when they are all the tools you have?
Chris Tuckett is a director of AHPs with an NHS trust
Twitter: @HealthPhysioAuthor: Chris Tuckett