A fundamental aspect of the PBC is a focus on providing better conditions and opportunities for staff, to retain and attract the workforce needed. One of the UHB’s biggest challenges has been workforce shortages and over-reliance, and cost of, temporary staff. This affects our staff and services in the following ways:
- Quality of care: Over reliance on temporary staff (locum and agency) leads to an inability to provide the highest quality of care. Not because of the ability of individuals in those roles, but due to unfamiliarity with local guidance, procedures and policies and familiarity with other team members. This can affect safety, timeliness of care, efficiency, and the ability to provide patient-centred care. It also reduces our capacity to achieve service development and creates difficulties in staff development, retention, and recruitment.
- Poorer trainee or student experience: Locum and agency staff are generally less involved in teaching and this leads to poorer trainee or student experience. Poorer student or trainee ratings make it difficult for us to increase trainee numbers and risks student/trainee posts being removed by HEIW (which has happened locally). Trainees and students are the lifeblood of our future workforce, therefore losing trainees means reduced opportunity to build our future workforce. In addition, the highest calibre consultants, senior nurses, therapists, pharmacists, and other healthcare professionals want to work in an educational environment that involves training, so lack of trainee opportunities has a negative effect on recruitment overall.
- Increased training burden on permanent staff: Another issue with high locum, bank and agency use is that the training burden on permanent staff increases. Our experience aligns with research, which has found that locums enable healthcare organisations to maintain appropriate staffing levels and flexibility, but they also gave rise to concerns about continuity of care, patient safety, team function and cost.
- Difficulties for individuals to develop specialist areas of expertise: Our thinly spread specialist workforce means that it is generally more difficult for individuals to develop specialist areas of expertise as they all need to be generalist. This means that access to specialist expertise locally for the population and for consultant members of staff is reduced. This can lead to either a lower standard of care, or more specialist advice being required from distant specialists in other providers. A thinly spread specialist workforce also leads to less peer support; less ability to be involved in educational and research activity; and less time to be involved in service development leadership activity, including both developing the specialist service within the University Health Board but also in developing its integration with community services. These points relate as much to senior/specialist therapies, diagnostic and nursing workforce as they do to the specialist medical workforce.
- Impacts on research: Activity in research is associated with higher quality of care, and innovation is required for continuous improvement. Locum, bank and agency staff rarely contribute meaningfully to research or innovation activity, and permanent staff who are either thinly spread across sites or working alongside temporary staff often have little time to involve themselves meaningfully in research or innovation activity.
- Impacts on investment and care: Our ability to invest in additional resources, higher value activities and better technology, all of which has the potential to significantly improve our services, is reduced. More importantly, it also means that our care and treatment is more costly, less joined-up and results in more variable outcomes for patients. This lack of continuity also has the potential to impact on the safety and quality of the health care services we provide. None of this is what we want for people living in our local communities.
- Impacts on individuals: Workforce pressures also take their toll on our individual members of staff. Trying to provide health care services with insufficient staff, and relying on a temporary workforce, is stressful and impacts moral.
Each of these issues is individually impactful, however together they influence our whole health system.