Tackling NHS waiting lists through effective workforce management 

Tim Powlson and Sue Johnson Gregory, Entec Si, discuss how a new approach to workforce management could help reduce NHS waiting lists

With the number of people waiting for non-urgent operations recently rising to 6.1 million people, urgent action is needed to tackle workforce and capacity issues within NHS trusts. So, how can they optimise their workforce to ensure the right levels for patient service delivery and keep workers happy, while keeping costs under control?

Supporting the NHS COVID-19 response

While the NHS was already facing workforce and capacity challenges prior to the pandemic, these issues have been exacerbated by the events of the last two years. Following the coronavirus outbreak, the healthcare sector initially received a boost in resources as people rallied to support the NHS’ COVID-19 response, for example, by returning from retirement or volunteering to support the vaccination programme rollout. However, this extra support has diminished as people return to their pre-pandemic lives.

While the relaxation of pandemic-related restrictions across the UK means that many areas of life are getting back to some kind of normality, this is not the case for NHS trusts. In fact, the buildup of two years’ worth of stress and strain means that workforce wellbeing in some areas has reached crisis point. Steps also need to be urgently taken to tackle the growing backlog of non-emergency care, with the health of many patients having further declined as a result of longer than normal waiting times.

Capacity issues leave healthcare workforce in “firefighting mode”

Despite the urgent need for positive transformation to healthcare sector staffing, capacity issues mean that workers are constantly in firefighting mode, and the impact of this cannot be underestimated. This makes it difficult for them to devote the time and resources required to take a step back and identify where change is needed most. The coronavirus crisis also shone a spotlight on the pressures facing NHS workers. The challenges now facing the sector also risks reducing the desirability of a healthcare career choice, something which is needed to secure new talent.

It is therefore important to find ways of making the most of the existing workforce in order to boost capacity within NHS trusts. This involves developing a clear understanding of what the current workforce capacity situation is for each of the various specialties within a Trust and then comparing it to the service requirement. The requirement will be influenced by many factors; national specialty guidelines, volumes of patients, local geography and the patient demographics all play a part. The comparison of workforce capacity to demand will highlight pain points and quantify the scarcity of resources.

Modelling – as part of a job planning process – enables clinicians to articulate the requirement and to test out different workforce solution scenarios. Quickly testing solutions helps to keep a clear focus on the needs of patients and workforce, whilst balancing benefits and costs.

For example, by looking at the availability of consultants over the week and weekend could help determine whether additional people are required or whether they are just needed at a weekend. This could help balance the costs of recruiting new staff and ensure the right mix of weekday and weekend doctors. Other important aspects to consider are the location of staff and how consultants’ caseloads vary depending on their specialty.

For example, anaesthetists generally provide a service to other specialties – like surgeons – while a diabetes consultant will be delivering a greater proportion of their direct clinical care in a community setting, educating and supporting patients to manage conditions.

NHS trusts need to avoid single points of failure

NHS trusts also need to avoid single points of failure within the workforce, for example, specialist advice being unavailable due to an individual becoming ill. Taking steps to improve management processes is often key to this.

Currently, common practice is for all staff calling in sick to phone a single ward manager, who would then be responsible for filling staffing gaps. An improvement to this process could be to free up the ward manager’s capacity for handling immediate patient issues by creating a central team for handling longer-term sickness absences. By developing a process orientated rather than people orientated culture, this will reduce single points of failure.

When driving forward transformation, it’s vital to recognise that change is extremely personal and can affect members of staff in different ways. Rather than simply presenting people with new processes and procedures, it’s important to engage with workers to find out more about their personal challenges and work with them to develop a solution. This includes finding ways of working with people that are convenient and aren’t overly disruptive to their day-to-day, already pressurised work. For example, a 30-minute video call between clinics may be more realistic than trying to meet consultants in-person for an hour-long meeting during their working day.

The backlog of routine operations is a key issue in the NHS

Close collaboration with finance teams is also key to unlocking additional capacity within NHS trusts, while keeping costs under control. Often, trusts have highly complex financial structures and processes, which may not be widely understood by those delivering patient care. To combat this, steps should be taken to encourage finance teams and clinicians to work together and share knowledge to realise long-term efficiencies.

Allowing the backlog of routine operations facing the NHS to grow could have significant implications, both for patients and workforce wellbeing. It has never been more important to find ways of freeing up capacity and driving more value from the healthcare sector’s existing resources.

By adopting a people-focused approach to delivering change, avoiding single points of failure and improving understanding of both workforce experience and finances across the sector, trusts can reduce strain on staff and improve patient care over the coming years.