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Health Education England (HEE) Chair Sir David Behan has had a long and distinguished career in health and social care spanning four decades – a service recognised with a knighthood in 2017.
He became chair of the organisation in December 2018 and has since made his ideas and vision for the future of the NHS clear, namely that we must prepare today for tomorrow’s world.
Healthcare Leader sat down with Sir David in his office at the Georgian terrace HEE headquarters in central London. He explained how he believes technology, along with new training and working structures, will enable the NHS to respond to ever-increasing demands.
There are currently 100,000 NHS vacancies across all health professions. Why is this and what role does HEE play in addressing the shortage?
I don’t think there is any one reason why there are that many vacancies. We’ve got more people working in the NHS this year than we’ve had in previous years. The investment we’ve made in the NHS over the years has not kept pace with the number of people in the population and the demand.
We’ve got a strategy which looks at recruiting new staff to come into the workforce and addresses how we support current staff.
We’ve got very high turnover rates in some places alongside high vacancy rates. So that provides instability. We know from the [2019 NHS staff] survey that not everybody feels valued. There’s still too much bullying and harassment. The People Plan will begin to put a premium on creating a culture in the NHS where people do feel valued and appreciated so that we can retain people.
The interim People Plan notes that NHS workers ‘want to have more flexible careers and a better work/life balance’. How do you square this with the current shortage of workers and increasing demands?
We do need more staff to come into the NHS, but we also need to think differently. We need to think about the attitudes to work and career younger people are bringing into the workforce.
I’m a baby boomer. I have two sons who are millennials. I think they work as hard as I do and did. I think they care as much as I do and did. But I think the emotional and psychological contract with work is a very different one today.
I think they’ve put a premium on flexibility in work. They want to be able to balance work and life much more than my generation expected and required. Who they work with, their immediate colleagues, is really important to them and if they don’t like it, they won’t put up with it. They’ll move on and do other things. And they want the flexibility of work.
So, I think, one of our challenges is how can we create a much more flexible and agile working environment for people to work in so their degree of satisfaction can be greater.
You have previously spoken about technology, science and the fourth educational revolution. How will all this impact the NHS and what do you have to do to ensure it is prepared for these advancements?
Science and technology change the tools that are available. I’m thinking very much about wearable devices for people who’ve got diabetes, for instance. The job of supporting and caring for people with diabetes changes and therefore we need to ensure the education and training system is preparing people to undertake some of those tasks as well.
Another example is that imaging is now more reliable at diagnosing certain conditions. What the machine won’t do is have that conversation about what this means for a patient’s treatment. So, I think one of the challenges we’ve got is about how that science and technology is going to work alongside human beings.
However, there are some tasks like incontinence care for very old people with dementia who might need assistance with nutrition and personal hygiene and I can’t say a machine is going to do that.
My generation had to learn this stuff as the technology became available. I think that young people going into university now have not had to learn it because it’s always been with them. The school system now teaches about coding in computing classes. It was not available to previous generations. So I think that will work its way through.
Would you need to outsource for technology and IT jobs or would you employ people in the NHS to do this?
I see a future where there will be more analysts and bioinformaticians and people with engineering backgrounds employed by the NHS. As we get an increase in machines that provide basic diagnostic services, there will be a premium on people who can keep those machines running and some of that might be outsourced, but some of it might be through employment as well.
I can see the balance of the workforce beginning to change as that science and technology comes through. I think there’s a good side to that. I don’t think that’s about taking away jobs, I think it’s about different types of jobs being created.
I see a future where young people who have real skills in maths or computing, for instance, who perhaps might not have seen the NHS as a future employer will begin to see this.
So, I think some of the careers work here at HEE is not just thinking about where our future nurses are going to come from, but where some of our future analysts are going to come from.
Do you think the health secretary will follow through on his promise to deliver the 6,000 additional GPs the Conservative party promised in its election manifesto?
We think that’s achievable. We’ve got more people in training for general practice than we’ve ever had before. So yes, this is a stretch, but we’ve got plans in place. And the good thing is there’s still a desire for people to come into the healthcare profession.
The GP contract talks about physiotherapists, social prescribers and clinical pharmacists working in general practice. They can all undertake tasks that were undertaken by general practitioners. That is not about diluting general practice.
So, it’s not just thinking about GP numbers, it’s thinking about the 26,000 allied health professionals, clinical pharmacists, physiotherapists and occupational therapists who will make a contribution to keep predominantly older people healthy and safe in the community, alongside GPs.
What do you say to the criticism that pharmacy apprenticeships, nursing associates and similar new career paths are a cheap way to fill shortages?
One of the things that made me smile over Christmas was somebody reciting a letter a doctor had sent into the Times – saying these new things called stethoscopes will never catch on. Change can be uncertain and it can be threatening. I think we need to listen to the concerns that are there. I don’t think this is about diluting professions.
I was at Cambridge University Hospital for an award ceremony for nurses with around 15 to 20 people getting their award that day. They were all facilitated into becoming registered nurses by following the apprenticeship route.
I don’t think they would have applied to go to university to do an undergraduate degree in the traditional way because the majority of them were mature students.
One of the people I spoke to was a 50-year-old woman with a family. And I also spoke to the only man that was in that cohort as well, who had another career until that day and wanted a change to do something more meaningful.
Alongside that, there were five people who had done an Open University degree and three different groups of people doing foundation degrees, setting them on the training path to do the nursing degrees.
So, I think we need flexibility of routes into professions alongside the traditional training path. We can’t carry on what we’ve been doing over the past 70 years as we go into the future when we know we’ve got a global shortage of healthcare workers.
How is the health education system changing to accommodate technological advances and new working structures?
As I’ve gone around the universities, what I’ve seen is virtual reality, simulation and assisted reality being used to train doctors, nurses and dentists.
Previously they would have gone into a lecture and learned from a textbook. It’s changing the way people can learn. I feel more confident, as a citizen, knowing that people have practised using virtual reality in a simulation rather than practising on me. If these were airline pilots, they would spend hours and hours in a simulator before being allowed to fly an aeroplane.’
I was speaking to a GP trainer, who reflected that her medical education was about retaining facts. She compared this with her job when she was a GP and said her main function was to solve problems.
Many of the facts she needed to retain weren’t relevant to the way she needed to work and if she needed to access some information, she would look it up.
We need people who the public can have confidence in terms of their knowledge, skill and ability to be safe practitioners. But we also need to think about how we can get some professionals into the workforce more quickly than is currently the case.