Written evidence submitted by The Digital Healthcare Council (RTR0093)
About the Digital Healthcare Council
1) The Digital Healthcare Council works to inform the development of policy and regulation.
2) We represent digital providers that span the breadth of health and social care, either delivering care directly to patients or by working in partnership with others. Many of our members work in primary care delivering online and remote consultations. Some provide whole practice GP services through a digital first model; some work in partnership with traditional NHS GP practices; and others offer specific services that sit alongside general practice, such as prevention and screening services, and online pharmacies with prescribing capabilities.
3) We believe that digital healthcare can transform the quality of patient care and experience of care.
Response to specific terms of reference of the inquiry
4) Our response focuses on the aspects of the terms of reference of the inquiry where we have particular expertise, rather than covering all areas under discussion. Specifically, our response focuses on four, often overlooked, areas:
a) The additional capacity that can be achieved through remote working, for example by additional improved rates of retention, encouraging staff to return after career breaks and optimising the number of hours that staff work.
b) The importance of training staff to work in an increasingly digitised health and social care system.
c) Opportunities to increase workforce capacity and effectiveness through innovative employment and engagement models.
d) Ensuring workforce are fit, qualified and safe to carry out their duties.
The principal factors driving staff to leave the health and social care sectors and what could be done to address them
5) While we are fully supportive of wider initiatives to recruit and train more staff, we would highlight that far more can be done to encourage the workforce who have already been trained not to leave their professions.
6) NHS Digital publishes monthly workforce data[1] that includes information about why people leave their NHS roles. In recent pre-pandemic years, around 10% of staff explicitly stated work-life balance as the main reason for leaving. When we consider other factors which also suggest a need for more flexibility such as caring for adult or child dependents, this figure rises to around 25% of all leavers.
7) We note that the figures published by NHS Digital show a reduction in the number of people leaving due to work-life balance issues since the pandemic began. It is reasonable to expect that after the immediate pressure of the pandemic has eased, we will see a rise in people leaving for those reasons in years to come, further exacerbating pressures on the service.
8) While many of these people will leave the service for the long-term, a sizeable proportion could be retained in some form by offering remote working. As well as directly benefiting from hours that would otherwise be lost, this would retain highly skilled staff in whom significant training investment has already been made.
9) We know from DHC members who regularly survey their workforce that the flexibility of remote working is a key factor in attracting staff. Not only does remote working play a significant role in retaining staff who might otherwise leave the service altogether, many are likely to work more hours than they would if limited to face-to-face. This is because the flexibility that remote working permits, allows shifts to be taken up that would simply be impractical to balance with other personal life commitments if a physical presence were required.
10) Considering just GPs, data from DHC members show increased flexibility when working remotely allows 90% of GPs to work more hours overall, adding up to 25% more hours per week per GP. If 26% of our current 45,600 GPs were to work remotely through a fully supported digital service, this would create the capacity equivalent to an additional 6,000 GPs.
What should be in the next iteration of the NHS People Plan, and a people plan for the social care sector, to address the recruitment, training and retention of staff
11) The NHS data strategy has highlighted the importance of improving digital skills across health and social care. Given that the role of digital is only going to grow, and digital maturity across health and social care is generally behind the rest of society, albeit with notable and honourable exceptions, we believe it is crucial to reiterate the development of digital skills as part of any training plan.
12) As staff move roles within health and social care it is important to ensure all staff are fit, qualified and safe to carry out their duties. There is an important role for digital solutions here, but we would caution against a single one-size fits all approach as it is impossible to predict every future scenario. Rather, we should encourage a range of solutions to support the flow of workforce information so that individual staff retain control of how their information is used, but in a form that can be easily shared between systems that allows important information to be communicated, such as assurance around vaccination status, credentials, qualifications, safeguarding measures etc.
Specific roles, and/or geographical locations, where recruitment and retention are a particular problem and what could be done to address this
13) The pandemic has demonstrated how a significant proportion of care can be delivered through remote channels. Patients’ enthusiasm for remote care when delivered effectively, as demonstrated by the significant number of people who have chosen to change their providers in favour of digital first organisations, shows that we can make significant contributions to address geographic workforce pressures by making high quality remote provision available to all.
14) To be clear, we recognise there will always be a role for face-to-face provision, and it is particularly important to ensure continuity of provision. Here again we are only just beginning to scratch the surface of what we could achieve. More effective triaging and channelling of patients to the most appropriate healthcare professionals to deliver care would reduce pressures on workforce in specific geographic locations. We therefore need to incentivise change across the system to tackle these issues more effectively and to support more digital-first solutions to allow develop services in under-pressure areas that can immediately benefit from additional support provided remotely working hand-in-glove with local provision.
To what extent are the contractual and employment models used in the health and social care sectors fit for the purpose of attracting, training, and retaining the right numbers of staff with the right skills?
15) Most of the public policy discussion around workforce begins with an assumption that existing contractual, employment and delivery models are set in stone. However, potentially transformative innovations such as personal care budgets could be used to change the nature of a significant proportion of social care provision. For example, DHC members are already providing assured digital workforce exchanges to match individuals who need social care support while living in the community with individual social care providers.
16) The benefits to the individuals who receive care through these new approaches are overwhelming: more responsive, personalised support that often allows them to live at home and avoid moving to much more intensive residential provision, safe in the knowledge that the staff who support them are appropriately qualified and credentialled. The staff who provide the services benefit from significantly greater flexibility and autonomy. Taxpayers benefit from a much more cost-effective solution that avoids extremely expensive long-term residential care.
17) Unfortunately, while the policy mechanism to facilitate widespread adoption of such approaches, e.g., personal budgets, is already available, there is considerable variation in take up across local authorities. We believe that greater widespread awareness and more systematic support of such initiatives could make a profound material reduction in the looming cost of social care while improving many people’s lives. The workforce implications of such developments are likely to be a reduction in the number of social care staff likely to be employed on standard contracts, and an increase in the number and range of contractual models from self-employment through to social enterprises, facilitated and assured through digitally enabled platforms.
For further information, please contact:
Graham Kendall
Director
The Digital Healthcare Council
Jan 2022
