Role redesign in the National Health Service: The effects on midwives' work and professional boundaries

yesThis article examines the effects of role redesign on the work and professional boundaries of midwives employed in the National Health Service. It outlines midwives' views and experiences of attempts to change their skills and professional boundaries and, using the concept of closure, considers the implications for the midwifery profession. The findings show that role redesign is changing midwives' work and that the traditional emotional, social and caring skills associated with a midwife are being undermined by the growth in technical work. Importantly, midwives attempts to use closure have met with limited success and aspects of their work which they enjoy are being delegated to maternity support workers, while midwives' roles expand to include work traditionally performed by doctors. Midwives' concerns about the implications of work redesign for maternity care and their professional boundaries reflect the uncertainty surrounding the profession about the future role and skills of a midwife

Recruitment and retention of the health and social care digital workforce: A rapid review

YesThe recruitment and retention of a digital health and social care workforce in the United Kingdom (UK) is challenging for several reasons that include the shortages of these employees in the National Health Service (NHS) and social care and the high demand for digital skills from other sectors (HEE, 2021a; NHS Providers, 2017). Brown (2022:7) notes that ‘high staff turnover rates, chronic recruitment and retention issues, and low morale are increasingly identified as major challenges for those working in social care’. Liu et al., (2019:5) in their report ‘NHS Informatics workforce in England: Phase 1 Project Report’ estimated that the size of the NHS informatics workforce in 2019 was between 40,640 Full Time Equivalents (FTEs) to 53,936 FTEs based on electronic staff records. However, significant shortages in digital and information technology staff in health and social care were identified that pose a challenge. This rapid review examines the strategies used to recruit and retain the health and social care digital workforce and potential solutions to issues raised

Planning the Radiology Workforce for Cancer Diagnostics

YesThe publication of the Delivery plan for tackling the COVID-10 backlog of elective care (NHSE/I, 2022:5) contained a number of ambitions, including that, by March 2024, 75% of patients who have been urgently referred by their GP for suspected cancer are diagnosed or have had cancer ruled out within 28 days. By March 2025, waits of longer than a year for elective care should be eliminated and 95% of patients needing a diagnostic test should receive it within six weeks. The report acknowledged the need to grow the workforce to achieve these ambitions and ensure a timely cancer diagnosis, while also proposing the use of digital technology and data systems to free up capacity. To assist West Yorkshire National Health Service (NHS) organisations to meet these ambitions, this report presents the findings of a ‘deep dive’ that focuses on the role of radiology in meeting the ambitions of providing timely cancer diagnosis. Aims 1. To understand current and projected demand for radiology expertise in cancer diagnosis in West Yorkshire. 2. To understand the current and projected radiology workforce in West Yorkshire and determine the gap between the projected radiology workforce and the required radiology workforce. 3. To identify possible solutions to assist in providing the radiology workforce required for West Yorkshire and explore their acceptability and potential impact. Methods A range of sources of data and methods were utilised. We examined publicly available quantitative data concerning cancer waiting times and diagnostic waiting times and activity and used this to forecast future cancer waiting times and diagnostic waiting times and activity. We examined data from Health Education England (HEE) regarding radiologists’ and radiographers’ workforce profile data for West Yorkshire, the number of radiologists completing training, and the number of radiographers graduating, and data submitted by West Yorkshire Trusts to HEE regarding their plans for growing their radiology and radiographer workforce. Interviews (N=15) conducted with radiology service managers, university academics and key strategic and operational stakeholders delivering radiology services were used to understand the current and future issues around strategic workforce planning, workforce changes and transformation, workforce roles and skills, training and education and service changes. A rapid review of the literature examining the impacts of artificial intelligence (AI) on the workload of radiology services was also undertaken. To put this work in context, we also reviewed relevant policy documents and reports. Alongside this, we consulted with the Yorkshire Imaging Collaborative (YIC) and the West Yorkshire Cancer Alliance (WYCA) and attended a series of workshops run by the Yorkshire Imaging Collaborative. Results Overall, the findings show that demand for radiology services is increasing and that both cancer waiting times and the waiting times for diagnostic tests increased, with a concurrent downward trend in activity that, if all else stays the same, is forecast to continue up to 2025. The cancer waiting times data indicate that patients were waiting longer and that their needs were not being met. Moreover, 3 the proportion of people treated within accepted cancer waiting times decreased both nationally and within the West Yorkshire region from 2013. This was exacerbated by COVID-19 which caused a further decrease nationally and for the West Yorkshire region. National data for waiting times for all diagnostic tests show a significant decline between 2006 and 2008, with a decrease in median waiting times from just under 6.0 weeks to approximately 2.0 weeks. Overall, waiting times remained stable until late 2020 when they started to rise with the longest median waiting times at just over 8.0 weeks in mid-2020. The total number of people waiting for radiology tests nationally is decreasing and is predicted to continue to do so, while in West Yorkshire the number of people waiting for radiology tests decreased until 2020 but has since been on an upward trend which is predicted to continue. Nationally, the total number of radiology tests is on an upward trend that is predicted to continue, while in West Yorkshire activity has been decreasing since well before COVID-19 and is predicted to continue to do so. Data examining the current and future workforce showed that the national figures for the total radiology and radiography workforce are small relative to other health professional groups. In West Yorkshire, 265 radiologists and 926 radiographers were employed, and staff turnover was generally low. Trusts’ forecasts for the number of radiologists and radiographers they believe they need suggest a 16% increase in the number of radiologists in post between March 2022 and March 2027 and a 25% increase in the number of radiographers in post. The numbers of radiographers and radiologists being trained in West Yorkshire suggest that this is feasible. Interview data identified a number of main themes and associated issues: delivering diagnostic cancer targets, strategic workforce planning, workforce roles and skills, service transformation, recruitment and retention, universities, artificial intelligence, collaboration, and international recruitment. Across all themes, some reoccurring issues were identified: a lack of staff, increased demands, a lack of capacity in terms of space and staff, a lack of strategic workforce planning with a focus on operational or financial plans. Respondents proposed potential solutions to some of the issues raised that included: new ways of working, upskilling, developing current and emerging roles, Community Diagnostic Centres (CDCs), greater collaboration between NHS Trusts, universities, CDCs, imaging academies and networks and the private sector, and the international recruitment of radiologists and radiographers to address workforce gaps. The rapid review findings helped to identify a number of potential benefits of use of AI in radiology, including contributing to improved workflow efficacy and efficiency of radiology services. However, this is dependent on the nature of the work and the AI function. As a result of faster AI reading, radiologists may be able to focus more on high-risk, complex reading tasks. AI can support automation of image segmentation and classification and aid the diagnostic confidence of less experienced radiologists. Respondents’ views on AI were mixed. There was acknowledgement that AI was already used to support radiology service delivery and both the benefits and problems associated were identified. The implications of AI for radiologists’ and radiographers’ roles were discussed in terms of changing work, AI being used to support or in some cases substitute radiologists and radiographers, and the need for the radiology workforce to adapt to the technological change whilst maintaining a caring servic

A scoping review: Strategic workforce planning in health and social care

YesAim This aim of this scoping review was to undertake a detailed review of the pertinent literature examining strategic workforce planning in the health and social care sectors. The scoping review was tasked to address the following three questions: 1. How is strategic health and social care workforce planning currently undertaken? 2. What models, methods, and tools are available for supporting strategic health and social care workforce planning? 3. What are the most effective methods for strategic health and social care workforce planning? Methods The scoping review utilised the five-stage scoping review framework proposed by Arksey and O’Malley (2005). This includes identifying the research question; identifying relevant studies; study selection; charting the data and collating, summarizing, and reporting the results. The search included a range of databases and key search terms included “workforce” OR “human resource*” OR “personnel” OR “staff*”. Relevant documents were selected through initially screening titles and abstracts, followed by full text screening of potentially relevant documents. Results The search returned 6105 unique references. Based on title and abstract screening, 654 were identified as potentially relevant. Screening of full texts resulted in 115 items of literature being included in the synthesis. Both national and international literature covers strategic workforce planning, with all continents represented, but with a preponderance from high income nations. The emphasis in the literature is mainly on the healthcare workforce, with few items on social care. Medical and dental workforces are the predominate groups covered in the literature, although nursing and midwifery are also discussed. Other health and social care workers are less represented. A variety of categories of workforce planning methods are noted in the literature that range from determining the workforce using supply and demand, practitioner to population ratios, needs based approach, the utilisation of methods such as horizon scanning, modelling, and scenario planning, together with mathematical and statistical modelling. Several of the articles and websites include specific workforce planning models that are nationally and internationally recognised, e.g., the workload indicators of staffing needs (WISN), Star model and the Six Step Methodology. These models provide a series of steps to help with workforce planning and tend to take a more strategic view of the process. Some of the literature considers patient safety and quality in relation to safe staffing numbers and patient acuity. The health and social care policies reviewed include broad actions to address workforce planning, staff shortages or future service developments and advocate a mixture of developing new roles, different ways of working, flexibility, greater integrated working and enhanced used of digital technology. However, the policies generally do not include workforce models or guidance about how to achieve these measures. Overall, there is an absence in the literature of studies that evaluate what are the most effective methods for strategic health and social care planning. Recommendations The literature suggests the need for the implementation of a strategic approach to workforce planning, utilising a needs-based approach, including horizon scanning and scenarios. This could involve adoption of a recognised workforce planning model that incorporates the strategic elements required for workforce planning and a ‘one workforce’ approach across health and social care

Strategic workforce planning in health and social care - an international perspective: A scoping review

YesEffective strategic workforce planning for integrated and co-ordinated health and social care is essential if future services are to be resourced such that skill mix, clinical practice and productivity meet population health and social care needs in timely, safe and accessible ways globally. This review presents international literature to illustrate how strategic workforce planning in health and social care has been undertaken around the world with examples of planning frameworks, models and modelling approaches. The databases Business Source Premier, CINAHL, Embase, Health Management Information Consortium, Medline and Scopus were searched for full texts, from 2005 to 2022, detailing empirical research, models or methodologies to explain how strategic workforce planning (with at least one-year horizon) in health and/or social care has been undertaken, yielding ultimately 101 included references. The supply/demand of differentiated medical workforce was discussed in 25 references. Nursing and midwifery were characterised as undifferentiated labour, requiring urgent growth to meet demand. Unregistered workers were poorly represented as was the social care workforce. One reference considered planning for heath and social care workers. Workforce modelling was illustrated in 66 references with predilection for quantifiable projections. Increasingly needs-based approaches were called for to better consider demography and epidemiological impacts. This review’s findings advocate for whole-system needs-based approaches that consider the ecology of co-produced health and social care workforce.Claire Sutton and Julie Prowse are seconded (from February 2022 to March 2023) to the Workforce Observatory, the University of Bradford, West Yorkshire. Their research posts at the Workforce Observatory are funded by Health Education England

Women take care and men take charge’: The case of leadership and gender in the Public and Commercial Services Union

This article presents the findings of a case study that aimed to understand the specific leadership styles that are valued by women and men lay representatives in the Public and Commercial Services (PCS) union and to determine the gendered implications for increasing women’s leadership and representation in trade unions. Survey responses from PCS lay representatives (reps) show the majority of women and men agreed that the leadership style they value, and makes a good union leader, is post-heroic (communal) leadership. This approach is associated with leadership characteristics such as being helpful, sensitive, and kind and are generally practised by women. This contrasts with male union leaders who are associated with a traditional, heroic (agentic) leadership style characterised by confidence, self-reliance, and decisiveness. Although some differences exist that highlight gender issues, both women and men lay reps have positive attitudes towards increasing women’s representation and participation in union leadership

Flexible working and work-life balance: Midwives’ experiences and views

This article presents midwives’ views and experiences of flexible working and work–life balance. Both flexible working and work–life balance are important contemporary agendas within midwifery and can have both positive and negative consequences for midwives. Full-time midwives and those without caring commitments feel disadvantaged by flexible working and work–life balance policies as they have to fit when they work around part-time midwives and are increasingly expected to cover extra work. They feel their work–life balance is marginalized and this is fuelling discontent and resentment among midwives and leading to divisions between full- and part-time staff that reinforce flexibility stigma. Although flexible working and work–life balance are important for recruiting and retaining midwives they are part of the ongoing tensions and challenges for midwives and the midwifery profession

Leading Change- A TUC Programme to Facilitate Leadership Development for Full-Time Senior Union officials: An Inter-Union Approach

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