Advance Clinical Practice needs NHS support staff development

One of the things I am spending an increasing amount of my time thinking about and talking to people about, is the ‘business case’ for investing more in the clinical supportive and assistive workforce. Whilst there is a ‘justice’ case to be made here, there is a strong return on investment case as well (if you are interested in the full case see here). In fact, other than the lack of capacity and funding to do things like cover backfill for support staff to join apprenticeships or map jobs against competency frameworks or look at task allocations in teams, I struggle to think of any good reason or downside not to develop the support workforce. Indeed, there is a cost to not developing them; a cost the NHS has, frankly, been incurring since it was first established.

 Just two examples of the sort of costs the NHS incurs by not investing enough in its support staff -

 Firstly, registered staff are busy, often far too busy. Yet alongside them unregistered staff are too often underutilised. The following quote is from radiography but could apply to any service-

 “…few trusts benefit from the full opportunities of support workers to increase capacity…[they] are under utilised even when the rest of the team are extremely busy” The Radiology GIRFT Programme National Specialty Report (Halliday et al, 2020)

Research suggests up to 25% of tasks performed by registered staff could be safely delegated to appropriately trained and supervised support staff. This is over nine hours of registered staff’s time freed up a week. More appropriate and modern job design means more rewarding work for everyone and better care for patients (and, research suggests, less missed care). There is much talk about NHS productivity, but this seems a pretty impressive gain and one that, in many areas, can be easily achieved.

The second cost is linked to the above. There is rightly support for the further development of Advance Clinical Practice (ACP) across occupations. One of the barriers to its extension is a lack of capacity. I was recently talking to a service head in the north of England who had successfully made a case for employing more support staff. How did they do it? In part, by making a link to ACP. To free up capacity higher up the grading structure, there was need for more capacity and better utilisation below. They made the link, but the tendency of NHS workforce planning to operate in silos means examples of such thinking are rare.

 The healthcare clinical workforce is one workforce, some of whom are registered and some of whom are not. Only by looking at the workforce holistically will the NHS begin to address its long-standing workforce challenges. It can no longer afford not too (if it ever could).