Having the right people in the right place at the right time lies at the heart of workforce planning. But how does that work when the NHS is faced with a pandemic? Karen Mackenzie, Assistant Programme Advisor with Healthcare Improvement Scotland’s Healthcare Staffing Programme, tells us how colleagues in one territorial boards have coped – and how the experience of COVID-19 can help shape future workforce planning ahead of legislation due to be enacted next year.
The COVID-19 pandemic has been transformative for all of us. Many of us have found ourselves in situations we’d never imagined, doing things we’d never dreamed of. Nowhere is this truer than in the NHS, where staff who may not have worked on the frontline for years have suddenly found themselves volunteering to be front and centre when it comes to tackling COVID – and helping to prevent its spread.
When I started my new role as an Assistant Programme Advisor with the Healthcare Staffing Programme (HSP) in August 2020, our team had started to re-group after being redeployed to work in the first phase of the pandemic. It was an exciting time to join my nursing and midwifery colleagues as they worked to support territorial boards with remobilisation and recovery. Reconnecting with our NHS colleagues to learn from the challenges they faced was going to inform our objectives for the year ahead. But then the second phase of the pandemic descended on us and it was once again “all hands on deck”. Health and care services were faced with the parallel demands of COVID-19 care and the urgent roll out of the vaccination programme. Having heard about these challenges from frontline colleagues, I volunteered to provide enhanced support to vaccination programme staffing with NHS Western Isles.
All hands on deck
My clinical background is as an Allied Health Professional (AHP), but even with my knowledge of workload and workforce planning, I was anxious about whether I would be able to offer the right level of support to nursing colleagues given the pressures of vaccination targets.
Working with clinical staff, senior nurses, Public Health Scotland colleagues, clinic schedule coordinators, health intelligence colleagues and the local Quality Improvement coordinator, I began to learn about the landscape in which we were having to plan vaccinations. Something that immediately jumped out at me was the multiprofessional nature of the vaccination staffing effort, and the importance of professional judgement and clinical voice when staffing new services. I saw so many AHPs, from paramedics and podiatrists to dietitians and speech and language therapists, working to support the vaccination effort while also trying to maintain their own services.
Nationally, the pandemic response has highlighted how staffing affects healthcare quality and staff wellbeing across health and social care. In keeping with the principles of the Health and Care Staffing (Scotland) Act 2019, and ahead of its enactment, NHS Boards have to have systems in place to ensure professional advice has been provided at the right level in relation to staffing. Where decisions are made contrary to such advice, associated risks should be identified, recorded and any required mitigation put in place.
With this principle in mind, I worked with my vaccination programme colleagues to map out the current vaccination clinic process, highlighting key staffing risks to allow us to prioritise staffing and workload improvements. For example, observing workflow at vaccination clinics and joining the morning safety huddle helped me to understand the key staffing issues that were impacting patient safety and staff wellbeing. The mapping process helped to identify simple changes to rostering processes that helped to improve the skill mix and effective use of staff during their allocated shift times. Overall the changes were well received by the vaccination staff on the ground as they felt more engaged in staffing discussions and their concerns about patient safety and staff wellbeing were heard. The increased governance and flexibility gave the staff more ownership of their workload and helped to make the best use of their time. Importantly, the changes also protected rest break times and safe working hours to maintain staff wellbeing.
What we can learn
My experience and that of many of my colleagues is that the pandemic has demonstrated that multi-professional collaboration and improvement are possible in the most challenging of circumstances. However, as we move towards what is, hopefully, the beginning of the end, it has also highlighted the need for AHPs to have a consistent way to capture their workloads and to use reliable workload information to plan their services and workforce. This is where my team at Healthcare Improvement Scotland comes in. We support the upskilling of a range of professions in workload measurement to help ensure that their services are safely staffed for high quality care. Now we want to use the learning from COVID-19 to help AHPs prepare for the delayed enactment of the Health and Care Staffing (Scotland) Act 2019. We want to help AHPs understand the importance of knowing their available workforce and identifying gaps in their required workforce, and to explore practical, low data burden solutions to workload and workforce measurement.
Taking a closer look at staffing beyond the nursing and midwifery workforce helps to put health and social Care services in a stronger position for the new legislation, ensuring that services are “safe to start” each day. It also helps them prepare, post-COVID, for whatever happens next.
Karen Mackenzie is an Assistant Programme Advisor with Healthcare Improvement Scotland’s Healthcare Staffing Programme.