ANALYSIS
• Standards aimed at improving people management, including improved systems for line management and HR, defined by strong commitments and action on equality, diversity, and inclusion • Standards for what “ good ” looks like for anti-racism and anti-discrimination • Measures to protect NHS staff from unwanted sexual behaviour, violence, and aggression • Systems for managing problematic and transgressive behaviours, conduct, sexual misconduct, and poor practice, supported by a comprehensive review of the legal frameworks relevant to employment in the NHS • A revised pay review process • A programme of investment to improve physical infrastructure • The funding, investment, incentives, and enforcement methods to ensure the success of the framework, including board accountabilities where appropriate. Government, NHS England and their equivalents in the devolved nations should prioritise funding and support improvement in administrative infrastructure, operational functioning, and work system design. This should use high quality systems co-design, human factors principles, and pilot innovation and change before scaling up. Improve workforce planning — Government and system stakeholders should collaboratively develop a comprehensive programme of consultation and evaluation on workforce design and planning, including: • New roles and how they can best be configured, with due consideration to the design of work systems and the right set of roles for providing high quality patient care • Effects of scientific development and technological change, including artificial intelligence, for how work is done and how the workforce needs to be configured and supported • Recruitment and professional development of staff in “ non-clinical ” roles An independent review should be commissioned by the government by the end of 2024 to identify how to improve the quality of training pathways in the NHS, with a particular focus on improving experience and conditions and financial support, including options such as student loan forgiveness and other rewards and incentives. Finally, system stakeholders should implement in full the recommendations of the parliamentary committee on clinical academics, including those on the role of research in the NHS. Some of these recommendations can be managed at organisational level. Others will need to be led from the top of government and the NHS centre, as they require dealing with some of the structural challenges and behaviours outside any individual organisation. Much stronger leadership and accountability for people and their development at all levels, from Whitehall downwards, is now needed for workforce stewardship. Recommendations • Make workforce stewardship a key priority • Improve workplace conditions through a collaboratively designed framework of standards, design, and investment • Improve workforce planning through a comprehensive consultation and evaluation on workforce design and planning, an independent
Of further major concern is that the clinical academic workforce — vital to the research, educational, and training enterprises of the NHS — is in major difficulty. A recent House of Lords Science and Technology Committee noted, 48 with alarm, the shortage of clinical academics and its consequences, including the long term future of clinical research and trials. Identifying financial disincentives as a key problem, the committee made several important recommendations. The NHS workforce plan did recognise the need for a more cohesive approach to clinical academic pathways, but delivering on this aspiration will require following the parliamentary committee ’ s recommendations more comprehensively and making corresponding investments. Doctors are not, of course, the only group affected by issues in professional development and career progression. Some staff groups — including clinical and non-clinical support staff and administrative staff — remain neglected in terms of investment and opportunities for training and development, 49 and a much more transparent, fair, standardised, and comprehensive approach is needed to meet their needs. Conclusions and recommendations The future of the NHS depends on the people who work in it. A bold vision (box 1) is now needed to make stewardship of the NHS workforce a top priority. Quite apart from the ethical imperative to look after the NHS workforce, secure their satisfaction and pride in their work, and assure their wellbeing, there are strong arguments that doing so will improve efficiency, productivity, and patient experience and outcomes. As the largest workforce in Europe (1.7 million people), investing in the staff of the NHS is also a sound investment in population health. Box 1: A vision for the future NHS workforce • NHS workforce stewardship is regarded as a key priority and important responsibility at all levels • Staff are respected for their rich diversity and feel valued and proud to work in the NHS • Roles and competencies are appropriately configured, with sufficient people in those roles to deliver high quality, safe care • Working environments support all staff to thrive • NHS careers in all roles are seen as attractive and interesting, are capable of enabling progression, and are suitably financially rewarded • Regulation is designed and functions well to protect patients and secure the confidence of staff • Career pathways are well designed, supported, and resourced, offering a positive experience in all roles We make three specific recommendations to achieve this vision. Workforce stewardship — Workforce stewardship should be recognised as a key priority and responsibility requiring active planning, design, investment, and evaluation through all levels of the system from a policy level through to employers. Improve workplace conditions — NHS England and their equivalents in the devolved nations should introduce a collaboratively designed national framework for NHS employers to improve working environments for all NHS staff, including pay and conditions. It should set out: • Minimum standards for the workplace, including on matters such as transport, availability of food, rota scheduling, rotation systems, and pay cycles
the bmj | BMJ 2024;384:e079474 | doi: 10.1136/bmj-2024-079474
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