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Training and developments needs for the war on attrition

Hicom : 20 April, 2015  (Technical Article)
The healthcare industry in the UK is facing a battle for meeting the right staffing levels as it suffers from both attrition and a lack of sufficient talent
Training and developments needs for the war on attrition

The ‘war for talent’ may be one of the business world’s most well-worn clichés but it’s a challenge faced by all industries – and healthcare is no different. Workforce planning is one of NHS England’s hottest potatoes. The need to ensure that the current and future workforce has the right numbers, skills, behaviours and values to improve patient care is the highest priority. Despite the best efforts of Health Education England (HEE), in partnership with the thirteen Local Education Training Boards (LETBs), the NHS in England still suffers from a shortage of healthcare staff. As pressure on NHS resources intensifies, the need to develop a pipeline of qualified professionals ready to step into the breach grows ever more important.

The training and development of doctors and clinicians remains an important objective – and the systems and programmes designed to support monitoring and maintaining capacity in the system are well-established. However, in the equally critical area of healthcare support professionals such as nurses, midwives and allied healthcare professionals (AHPs), the means of charting progress in the education and development of learners seeking a career in healthcare is much more difficult. HEE has outlined clear projections for the numbers of ‘commissioned programmes’ to satisfy local NHS needs – but if LETBs maintain their current approach to data management, the accurate measurement of outcomes against those needs may prove challenging.

Attrition rates of healthcare learners on courses remain high, but common limitations in LETBs’ ability to identify and address contributory factors could be contributing to a significant waste of NHS resources. Moreover, the lack of data around the development of healthcare learners makes long-term workforce planning yet more difficult. What the process requires is the development of a better, end-to-end understanding of healthcare learners on higher education programmes to ensure the NHS, patients and taxpayers get value for money from HEE commissioned programmes.

The NHS currently employs over 600,000 healthcare professionals to assist clinicians in all healthcare settings. Attracting, recruiting and retaining good support professionals is vital to the delivery of a sustainable workforce, and education plays a crucial part in developing and nurturing staff. The belief in education is reflected by activity on the ground. Estimates suggest that over 100,000 professionals are active ‘learners’ in part-time higher education programmes funded by HEE via individual LETBs. The figure is an estimate, however, because datasets monitoring undergraduate learners are poor.

Systems to support data management in this area are largely ineffective with many workforce executives using paper, spreadsheets or out-dated databases that operate in silos and do not connect with other stakeholders across the education life-cycle.  Without access to accurate and up-to-date information it is impossible to monitor learner output into healthcare careers.

Primarily, sub-optimal data control means that LETBs have no means of identifying the volume of learners that drop out or fail to complete higher education programmes. Attrition rates are a major concern. HEE’s first Workforce Plan for England (2014/15) places great emphasis on the importance of reducing attrition rates, and includes estimations of attrition rates in healthcare learner programmes for the past eight years. These estimations – ‘inferred attrition rates’ – underline the lack of data in the system.

Happily, the rates appear to be falling. For example, on the three-year adult nursing programme, final output from the 2009/10 intake revealed a 27% attrition rate by 2012/13, whereas the inferred attrition for the 2011/12 intake fell to 19% this financial year. However, according to HEE, drop-out rates in this and other areas remain ‘unacceptable’.

The lack of metrics goes beyond attrition. Most LETBs are also unable to chart the career steps of those that do successfully qualify; are graduates remaining in NHS employment, changing career direction or taking their qualifications overseas? With no means of tracking people as they move through the system, developing strategies to respond to staff shortages is challenging. As a result, although HEE trains, for example, enough nurses to meet NHS requirements, it is often forced to deploy nurses from overseas when resourcing gaps appear. This is most likely because there is insufficient visibility of what is happening at ground level to identify and resolve problems.

Equally, LETBs often have limited knowledge of the higher education institutes from whom they procure services. These institutes consume a high level of funding yet LETBs typically have a narrow understanding of the nature, and more importantly, learning outcomes from individual educational programmes. These outcomes, along with the ability to demonstrate resource optimisation and sound financial management, have a major impact on LETBs securing future HEE funding – as such, the inability to provide transparent and robust data could have serious repercussions. More collaborative engagement with education providers could contribute to driving down attrition rates and improving the learning experience.

The combination of being unable to provide accurate measurements of attrition rates, learners’ career progression and educational outcomes significantly compromises LETBs’ ability to prove ROI and makes long-term workforce planning difficult. Moreover, whilst the oversupply of qualified healthcare professionals can lead to costly and inefficient services, undersupply can leave patients vulnerable to gaps in care. Certainly, the gaps in data are clearly evident.

HEE’s Workforce Plan for England warns that longstanding gaps and weaknesses in data need to be urgently addressed: “We currently have incomplete data with regard to how many healthcare professionals are employed within the community, social care and independent sectors. An inadequate understanding of what the current supply is makes it harder to decide just how much additional supply is actually needed.” The problem reverberates across all non-medical healthcare professionals in the NHS.

To ensure HEE gets a higher quality return on its investments – and commissions staff in sufficient numbers with the right skills – LETBs should consider developing their informatics infrastructures to give them greater visibility of progress across commissioned programmes. The introduction of integrated technology can connect stakeholders from all parties – learners, Trusts, LETBs and Higher Education Institutes – and empower LETBs with robust, accurate data to optimize resources, secure HEE funding and improve workforce planning. At present, LETBs have major objectives to drive improvement in this area, and are working hard to make progress. However, they are let down by technology that is not fit for purpose and that forces them to make strategic decisions without the reassurance of quality data.

The effective deployment of simple technology can help stakeholders capture the right data to support those decisions and bring greater visibility and transparency to workforce planning. Moreover, it can give LETBs better control of financial management to secure value for money, improve standards in learning and drive down attrition rates.

The NHS, like all employers, is fighting for talent. But to ensure an affordable and equitable NHS today and a sustainable health service tomorrow, winning the fight against attrition is going to be essential. That battle starts with securing, maintaining and optimizing accurate business intelligence – and technology is the very best weapon.

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