This meeting was held under the Chatham House Rules, hence neither the identity nor the affiliation of the speaker(s) nor that of any other participant can be revealed.
I was delighted to attend the discussion at Reform, an independent non-party think tank focused on public service delivery, on workforce planning. A group of 20 senior administrators, policy advisors and senior clinicians were invited to this roundtable discussion.
As a junior doctor, my interest was personal. Is there a light at the end of the training tunnel? We are all familiar with the anxiety and uncertainty facing junior doctors applying for specialty training and I was keen to find out how the current changes to healthcare service delivery model will affect doctors at the frontline.
The roundtable discussion commenced with the interesting fact that in the next 20 years, the number of people in England who are 65 and over is predicted to rise by 51% and the demands on our health and social care system will be very different. The key challenges brought up by this demographic shift were discussed in great detail. The term ‘horizon scanning’ was introduced. It was acknowledged that short-term cost-cutting does not and has not worked, hence the need to focus on long-term thinking; looking into probable futures in 15-20 years’ time. Although it is not possible to predict the impact of a potentially groundbreaking technology or life-saving drugs on workforce or the population, it is possible to postulate future healthcare needs with the Centre of Workforce Intelligence’s Horizon scanning system.
In order to meet the healthcare needs of the future, two main streams of solutions were identified. First was the less attractive and unpopular change in payment model, i.e. reviewing the range of services available free at point of delivery on the NHS. Second stream was to improve workforce motivation and efficiency. It was agreed that the second stream should be the focus at present to address the challenges highlighted.
Following on from that, the five habits to improve productivity in healthcare workforce were discussed. This was based on research performed by KPMG, titled ValueWalks. The detailed report is due to be published in autumn this year; an abbreviated version is available here
http://www.kpmg.com/UK/en/IssuesAndInsights/ArticlesPublications/Documents/PDF/Market%20Sector/Healthcare/preface-value-walks-june-2012.pdf
One of the habits outlined was mandatory training for clinicians in service re-design and business innovation. It was emphasised that clinical leadership and engagement is essential for re-modelling care. The common practice of successful healthcare teams around the world was to look at the precise aspects of care and to continuously improve each micro-process. In order for this practice to be adopted, staff had to be empowered. This, in turn, improves efficiency.
There was also discussion about the shift of healthcare delivery from hospital-based care to community-based care and doctor-led to nurse-led care. Although one of the driving forces is cost, this model has been noted to be successful in other countries. It was felt that task shifting and blurring the boundaries of healthcare workforce was another way to maximise the efficiency of the current staff.
There were several radical and thought-provoking ideas brought up during the discussion. Although there was consensus regarding the real and present challenges faced by the NHS, there was no panacea for this issue. Each professional group (providers, analysts and clinicians) had different ideas of how to rectify this issue. One of the guests described the current situation as a ‘perfect storm’, which was the perfect opportunity for us all to get back to the drawing board and innovate a solution to heal our NHS.
I came away from the meeting with several thoughts. However, most importantly, I felt that it is crucial for junior doctors to be acutely aware of the changing shape of healthcare. It must be emphasised that clinical leadership and interest in service design and delivery are important, yet often over-looked areas of professional development. The traditional role of doctoring and hospital-based care structure are changing and we should use this as an opportunity to re-align ourselves to fit into this brave new world of healthcare of the future.
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