by
Professor Marcus Longley
| May 03, 2023
In late March, in partnership with the Welsh Government, we held our sixth annual seminar exploring recent healthcare regulatory policy developments in Wales and across the UK. Delegates from across the sector joined us and together we discussed the current issues and challenges which are influencing Welsh Government policy.
As noted in the opening remarks by the Welsh Government’s Chief Nursing Officer Gillian Knight, there is a clear commitment from the Welsh Government and those in the sector to work towards shared goals of maintaining staff and patient safety despite some differing approaches across the UK. There is also a firm commitment to provide the NHS and care sector with the skilled workforce it needs.
There needs to be close collaboration underpinning a UK-wide commitment to considering issues of regulation. Differences in professional regulation do exist for a variety of reasons; nonetheless, equitable and balanced regulation is crucial, particularly as we move towards a multidisciplinary way of working which creates new challenges for workforce planning.
Ensuring our workforce can deliver safe and quality care
In our first session, we asked the question: ‘What skills do the health and care workforce need and what do services need from regulators to provide safe and quality care?’
We heard from a range of speakers from the General Medical Council Wales, Health Education & Improvement Wales, Social Care Wales and Cardiff & Vale University Health Board. All agreed that legislative reform is now essential to ensure regulation can be effective and support multi-disciplinary team working. As the health and social care system continues to evolve in Wales, regulators must continue to learn, adapt and collaborate with others – and regulation must be seen as a fundamental element of the strategy, not something separate.
Initially, discussions focused on the critical need for reform for the medical profession, amplified by the growing dependence on international medical graduates (IMG). While work is ongoing to improve Equality, Diversity and Inclusion outcomes for doctors, there is still a disproportionate number of IMG and ethnically-diverse doctors being referred for fitness to practise investigations.
More broadly across the healthcare system, stress and burnout issues are a significant challenge. It was observed that workforce data could be better used to support the system, including identifying areas with high burnout rates and addressing staffing shortages which lead to poorer quality of patient care. Lack of education and training opportunities can also exacerbate workforce pressures.
So what can be done to support the workforce? All agreed that prioritising staff wellbeing was essential, so that they can provide the best possible care to patients. Promoting an inclusive and fair working environment and addressing systemic issues through a learning culture will lead to improved outcomes.
And it’s crucial for professionals to have access to ongoing CPD and leadership support so that they can adapt to new ways of working and new models of care, such as providing more care closer to home. Graduates must be supported via agile curricula to ensure they have the right skills for a modern working environment. Regulators also play an important role in supporting professionals: in taking risks, developing new skills and working across boundaries.
When discussing how to embed compassionate leadership in healthcare, the speakers all agreed that regulators should not only talk about it, but also ‘live it’ and set examples for others to follow to ensure a more cohesive and effective system.
At the same time, it is important that regulators do not diverge too much under their new legislation following reform as this may well cause more fragmentation and confusion.
Ensuring public needs are met and their voices are heard
In the second session, we asked the question: ‘What do the public need from the workforce and how can their voices be heard effectively?’
We heard from the representative from LLAIS, a new independent statutory body set up by the Welsh Government, which will replace the Board of Community Health Councils. Their vision is to give the people of Wales more say in the planning and delivery of their health and social care services – locally, regionally and nationally. LLAIS will do this by engaging with community representatives and groups via evidence-based approaches, sharing with the NHS, local authorities, and other decision-makers to ensure that people's views and experiences directly contribute to, and improve, health and social care services.
LLAIS will work in partnership with NHS bodies and local authorities to promote their activities and make arrangements to co-operate in the exercise of functions, including sharing information when asked. It wants to foster clear communication and ensure the empowerment of patients, and its success will be measured by how well it works with the NHS and local authorities. The hope for the future is that, through LLAIS, patients’ voices will be better heard, and mutual communication between the health and social care sector, and the public, improved.
Providing support for a post-pandemic recovery
In the final session, we heard from speakers from Aneurin Bevan Health Board, Royal College of Nursing Wales as well as Unite the union, who discussed what support the workforce needs to help them deliver a post-pandemic recovery.
A series of surveys totalling over 16,000 individual respondents by Aneurin Bevan Health Board found that nearly 60% of their staff reported suffering from fatigue; 61% reported to be struggling to cope with the pressure of increased service demands; and 55% felt pressurised due to staff shortages. On average staff absences due to anxiety and depression account for at least 31% of total absences, an increase of just over 2% from 2022, and 11% since before the pandemic. Data also indicated that nearly a quarter of staff were unsure if current working levels in response to increased demand were sustainable. Most staff who leave do so in their first five years of employment; many of them report feeling undervalued, and unable to settle in environments with high numbers of temporary or agency staff.
Despite these obvious challenges, the Board was focused on staff retention and has increased staff engagement activities, the established Employee Well-being Service has been invested in, and is placing a strong focus on leadership development and healthy working culture. Post-Covid, there has been a change of approach to staff entry points and ensuring training for internal development and progression is in place.
In the discussion, it was recognised that career progression for healthcare professionals is important; there is a need for more career pathway planning, career progression rewards and dealing with middle management bureaucracy that can push staff towards agency roles. If we worked towards a goal of having at least 80% of staff in substantive positions, the current over-reliance on agencies would reduce. Contingency plans in the short, medium, and long term are needed, so that the profession can be improved, and practitioners can receive the support and recognition they deserve.
Closing thoughts and common threads
All our speakers called for a more compassionate and meaningful collaboration within the healthcare system and agreed that effective communication and partnership-building are essential to address the challenges we face and to deliver better outcomes for patients and healthcare professionals alike. Collaboration with system regulators is needed, and regulators should work with each other, and with employers, to break down the perceived professional barriers which can get in the way of creating the roles that are needed.
As always with these seminars, it was great to hear a wide variety of different views from various parts of the health and social care system. It is still quite rare for service providers and patient and staff representatives to talk directly with regulators about shared issues. It was really useful, too, to think about the specific circumstances and ambitions of Wales in this context.
There could be no doubt at all about the scale of the challenges facing health and social care. Equally, the energy, enthusiasm and creativity around a shared purpose was really powerful. The Professional Standards Authority is committed to support action it can on the back on the recommendations we made on workforce in our Safer care for all report. Let’s hope it bears fruit soon.