Growing your own staff key to workforce change.

More money and more staff are not the solutions to creating a more sustainable health workforce. A process of cultural change, where the existing staff are used more effectively and upskilled appropriately, is what is needed.

This was the message at last month's "Workforce action: ready for the future" conference in Wellington by its keynote speaker Jim Buchan. Buchan is professor at Queen Margaret University in Edinburgh, a former human resources adviser at the World Health Organisation and a recent adviser to the parliamentary inquiry into National Health Service (NHS) workforce planning in the United Kingdom. His presentation to the conference, a joint Ministry of Health and District Health Boards New Zealand initiative, was one of over 100 presentations, workshops and symposia, looking at the health workforce and its future.

Health workforce terms like skill mix/staff mix could cover a number of different approaches and mean quite different things, depending on the country and context, Buchan warned. "There are greater and lesser degrees of commonality in the use of these terms internationally. We must understand what people are saying before we start making comparisons. There is no single, optimal mix, no simple common truth here. There is also very little evidence about what works and what doesn't."

Good research evidence on its own would not change the world: "We don't have a huge evidence base in health and never will have. There is good research out there, but it's not perfect, not complete. We cannot wait to get our evidence complete, so we need to make the best use of what evidence we have now."

Using the example of recent NHS changes in England, Buchan outlined the challenges facing health services wanting to work differently and more effectively. Over the last seven years, there had been huge investment in the NHS (around seven percent per annum), resulting in a 20 percent increase in staff numbers, increased investment in training, in international recruitment and in support for nurses wanting to return to the workforce. This funding was now trailing off.

"The numbers in training are now going down and international recruitment is down. Retention rates must be improved but there is no clear understanding about how best to do this. Health planners and managers must now look at new roles, skill mix and productivity in a more fiscally tight environment."

In Buchan's opinion, the boom years were a distraction from achieving positive change. "When you put 80 percent of your effort into recruiting more staff, you have little energy left to look at how to improve your skill mix or find new ways of working. The NHS grew its workforce too fast--the exercise was disastrous in terms of workforce planning. There is also no evidence that all that extra investment has brought lasting benefits for patients. You can increase staff numbers, but the more important question is whether those extra staff are the right staff in the fight place with the right skills. Learning to work differently is all about changing attitudes, team practice and management capacity."

There was no 'quick fix' to workforce change, said Buchan. For it to be sustainable, staff must be involved, with a good communication strategy in place. To improve services, a process of cultural and incremental change was needed, with costs and benefits considered together. "The top down approach to change is not sustainable, as programmes will wither if they are not rooted locally."

In contrast to the experience in the NHS in England, services in Scotland had developed very differently, he said. Not nearly as much money had been invested in staff, but there had been a greater commitment to workforce change. "Growing your own and keeping your own health workforce is vital. Tap into the international pool if necessary, but don't rely on the workforce from other countries. This is not sustainable in the long term," Buchan concluded.