The long awaited Topol Review was published yesterday. The review, commissioned by the Secretary of State for Health last May, looks at how the NHS must upskill in order to be prepared for a digital future. California based Dr Eric Topol has duly delivered an insightful state of the union, looking at where the NHS must focus its energies to create a workforce ready to handle what the next generation of healthcare provision looks like.
Yet whilst alluding to the changing nature of work in its pages, the report skips over a critical problem facing the future of the NHS: how do we upskill and create a modern workforce if we cannot stem the tide of clinicians leaving the NHS altogether?
The NHS is in the midst of a staffing crisis. 2018 saw the number of junior doctors continuing on to specialist training following their foundation years drop below 50% for the first time, and it’s predicted that the NHS could be short of 350,000 staff by 2030. Whilst we heartily welcome any and all efforts to ensure our clinicians can thrive in a digitally-led health service, we must first address some of the fundamental challenges which are contributing to endemic staffing woes.
As the Topol review points out,
“the entry of millennials into the workforce has already resulted in changing expectations around work-life balance, flexible careers, rewards and incentives, relationships with employers and the use of technology.”
This is fundamental. We cannot expect the NHS to retain a workforce and foster development amongst it’s ranks if it can’t offer them the kind of employment they are looking for. Whilst their peers are flexing their hours, logging on from home, or enjoying the perks of co-working, millennial medics are being left frustrated by the strictures of life on the NHS payroll.
The report makes no mention of how the institution should look to address these structural issues. It does recognise that “the NHS needs to attract new talent and shape new career pathways”, but unless we can create a workforce that reflects modern day aspirations, the need to attract new talent will never diminish.
As the rest of the economy marches slowly towards a new reality of flexible, balanced working, the NHS has remained static. Indeed, in some respects it has gone backwards; just look at the increasingly proscriptive route for foundation training, or the hardline dichotomy between full-time and temporary work. The lack of flexibility in our system is driving modern medics away. Without this, the aforementioned new career pathways will fail to materialise.
The review points out that “within 20 years, 90% of all jobs in the NHS will require some element of digital skills. Staff will need to be able to navigate a data-rich healthcare environment.” For any other major sector in the UK, this statement might seem out of date. But the NHS is playing catch-up when it comes to modernising its organisational approach, despite the myriad advances and innovations happening in the wider healthcare sphere.
Pivoting the approach of an organisation the size of the NHS is a mammoth task. But one that we must invest all our energies into. We must think about the type of employer the NHS needs to be if it wants to retain clinicians, empower staff, and reduce its crippling agency spend.
A more flexible approach to training is needed, alongside new options for staff who want to work less hours, or perhaps split their time across different departments or employers. Reducing the admin burden associated with booking shifts or sourcing bank work can smooth the way, as well as helping Trusts move away from expensive locum agencies. And a new approach to rotas and annual leave regulations would reduce much of the frustration felt by doctors and nurses who simply want to book a holiday. Much of the tech which can enable this already exists; innovations which could introduce relatively simple structural changes that would make a massive difference to the overall reality of life in the NHS.
As we look to a creating a workforce fit for the digital future, we must not neglect the need to create an environment fit for a modern workforce.