Written evidence submitted by the Independent Healthcare Providers Network (RTR0063)

About IHPN - The Independent Healthcare Providers Network (IHPN) represents independent healthcare providers of both NHS and privately funded clinical services, from acute, diagnostic, clinical home healthcare, primary and community services. 

Summary 

IHPN’s members currently employ or contract over 150,000 people in England. Among respondents to IHPN’s 2021 Industry Barometer publication, the most comprehensive annual survey of independent healthcare organisations, 84% of independent providers view workforce challenges as the top priority for their organisation. Their feedback tells a common story heard across the health sector – that of too few experienced clinicians, and significant difficulties recruiting to more specialist roles. Retention too is highlighted as a challenge, with work-life balance a significant factor for many.

Our members are already planning for how they can mitigate these challenges. Two-thirds of our members report that they are actively planning on how to use their own apprenticeships, training and development programmes to tackle workforce challenges. Nine out of ten members are expecting to increase training for clinical staff over the next five years.

Given the scale of the challenge facing the entire sector, however, it is clear that no one organisation – and not even one as far-reaching as the NHS – can address it on its own. A sector-wide, collaborative approach is needed. This should, in all likelihood, be backed up through strong workforce provisions within legislation that give a clear mandate for regular workforce planning that contains both a short and long-term outlook on requirements across the whole healthcare system.

In any scenario, it is clear that the independent healthcare sector will have a significant role to play. The independent health sector has already been expanding its endeavours in this area, including through nursing associates and apprenticeships schemes, as well as clinical placements for other professionals such as physiotherapists, radiographers and Doctors in Training (DiT) support. Since the onset of the pandemic, more than 4,200 NHS junior doctors have already undertaken their training in independent facilities and our aim is for this to increase further this year, with IHPN continuing to work both with Health Education England and our members to further extend these activities.

Below, we comment on three key issues that we believe a comprehensive workforce planning exercise should be required to cover.

Independent Sector Workforce Initiatives

Independent healthcare providers are working across a range of areas to help develop, train and retain the clinical health workforce.

In surgical training, in 2020 IHPN, NHS England-Improvement, Health Education England (HEE) and the Confederation of Postgraduate Schools of Surgery (CoPSS), announced a new agreement  to increase the opportunities medical trainees have to train in elective surgery or diagnostic activities taking place in the independent sector.

Over 4,200 surgical trainees have already benefitted from the opportunity to spend time in independent sector environments and we believe that this provides an example of what can be achieved in other clinical specialties in the future.

In terms of accessing new talent, IHPN member HCA Healthcare UK last year partnered with the independent charity Talent Beyond Boundaries, to open international employment and migration pathways and welcomed thirty forcibly displaced healthcare professionals to fill talent gaps at the organisation.

IHPN are working with Talent Beyond Boundaries to extend the scheme further within the independent healthcare sector, including through a number of pilots to recruit refugee and displaced physiotherapists and radiographers.

Independent sector healthcare providers have also invested heavily in measures to create a positive working culture – essential when it comes to workforce retention. IHPN member Connect Health, for example, have introduced a system of “Job Crafting”, which won an award at the CIPD People Management awards in 2020. The system allows individuals to control and shape their role and enables them to tailor it make it more meaningful to them. This could be as simple as pledging not to access emails for the first 30 minutes of their day, or it could be to have walking meetings or to host external events. The scheme has had noticeable impact on staff happiness and wellbeing.

Similarly, One Medical Group have introduced a wellbeing retreat as part of their Health and Wellbeing Strategy, giving staff members the chance to focus physical health, healthy eating and developing resilience. This is followed up with one-on-one health checks to further promote wellbeing and provide employees with any support they need. Again, IHPN believes that sharing best practice in terms of employee wellbeing across the health system can serve as an important factor in creating a more robust workforce.

International Recruitment

The international workforce is absolutely vital to the continued functioning of the health workforce. Current immigration policies are broadly supportive of recruiting registered health professionals from overseas, however the impact of Brexit has significantly complicated this process. It is unclear what the long-term impacts will be in terms of attracting health workers to the UK.

It has been estimated that that up to 160,000 EEA workers who arrived in the UK over the last three years would not have been eligible to live and work here had the new immigration rules been in place. Though the proportion of potential health sector employees impacted will likely be lower than for other sectors, further analysis of recruitment over the next few years will be essential to monitor progress against recruitment targets.

In addition, restrictions on movement introduced to help manage the Covid-19 pandemic will have paused and disrupted many migration plans, and it is likely that these will continue in the short term, even with international travel now restored.

Finally, it will of utmost importance to both independent providers and the NHS that both the mutual recognition of professional qualifications and registration requirements are carefully managed following the end of the post-Brexit transition period, and reviewed on an ongoing basis to ensure that they remain fit for purpose.

Training

Alongside robust international recruitment, it is necessary to increase the number of health professionals who are trained in the UK. As discussed above, IHPN members have already reflected the importance of increasing apprenticeships and widening access to other training and clinical placement opportunities. We are aware from our colleagues at the NHS Confederation that their members frequently report difficulties both in terms of ability and capacity of the service to support an increase in placements and supervision in clinical roles that require a large amount of supervision and assessment within the workplace.

It is difficult for health organisations to strike a balance between providing excellent patient care and having sufficient capacity to support meaningful and high-quality learning in the workplace, and so therefore it is important that infrastructure and support for training reflect this. There will be a critical role for the independent sector in this, particularly specialties – ophthalmology, for example – where independent providers deliver the majority of some activities on behalf of the NHS.

Shared workforce mapping is particularly important with regards training, given the key role independent providers play in delivering NHS care. A key element here is ensuring that best practice and innovation can be efficiently and effectively shared across the whole healthcare system to ensure that the training offer is as robust and comprehensive as possible.

Systems Working

Ongoing health system reforms are seeking to place a greater emphasis than ever before on integration across local regions for health and care. For this to achieve its desired goals – and particularly with regards to training, recruitment and workforce retention – then it is vital that a “whole systems” approach is taken. This could mean, for example, ensuring that the training offer from independent providers is viewed as much a part of clinical career pathway as a standard NHS junior doctor rotation placement, or even – capacity permitting – including an independent provider placement as a standard rotation for junior doctors.

It’s therefore important that new NHS Integrated Care Systems (ICSs) are as open and inclusive as possible, and include all local providers in their area (regardless of ownership type). This will help ensure that any workforce initiatives are successfully implemented across local systems, with the most effective use of all available staffing resource.

January 2022