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Macmillan Cancer Support recently welcomed the opportunity to respond to the draft health and social care workforce strategy

Health Education and Improvement Wales (HEIW) is the recently created special authority, within the Welsh NHS, that has a leading role in the education, training, deployment and shaping of the healthcare workforce in Wales. Alongside Social Care Wales, HEIW developed the draft strategy following an extensive programme of engagement with individuals and organisations across the health and social care sector.

Their thinking and approach has been shaped by both the Parliamentary Review of Health and Social Care in Wales, and the Welsh Government’s response “A Healthier Wales”. Those documents set the context; the vision, aims and ambition in which the draft workforce strategy has been produced. It is a context in which the status quo is not an option, and not sustainable.

The strategy is built around 7 emergent themes:

  • Valuing & Retaining our Workforce: Creating a stable workforce that feels valued, reflected by reward and recognition including opportunities for development.
  • Seamless Working: Multi-professional and multi-agency working, to deliver excellent services to support new person centred models.
  • Digital: Developing capability to optimise the way we work, and the way we learn.
  • Attraction & Recruitment: Establishing health and social care as a reputable brand and the sector of choice for our future workforce.
  • Education & Learning: Ensuring a competent, capable and confident workforce who are supported to meet current and future health and social care needs, and advance their careers.
  • Leadership: Developing compassionate leadership with a focus on quality improvement.
  • Workforce Shape: Ensuring a flexible and sustainable workforce in sufficient numbers to meet needs.

The strategy will be built around each theme, its context, themes, priorities, and activity over the course of the next decade.

“It is of the highest importance that any future strategy aimed at developing and enhancing the health and social care workforce is fully costed and sets realistic milestones for achieving the level of change required.”

Macmillan Cancer Support

The workforce strategy is an overdue, critical development, a significant piece of the transformational puzzle needed if the people of Wales are going to have the integrated health and social care of the future.

While we’ve broadly welcomed the strategy, there are areas where we would like to see improvement and further development between the draft and the final workforce strategy.

First, person-centred care. The draft strategy references the importance of person-centred care under the pillar of ‘seamless working’. While we welcome this clear commitment set out by HEIW, achieving person-centred care should be a core ambition clearly stated in each strand of the workforce strategy. It should be every part of the system’s responsibility to improve person-centred care, and would better reflect the vision and ambition of “A Healthier Wales”.

Second, the involvement of local authorities. Essential to the integration of health and social care, their separate funding and governance arrangements could – potentially – present a complicating factor to this strategy. The recognition of their importance is an important practical step to overcoming these hurdles, another approach is to understand and learn from Macmillan’s experience of piloting new, integrated ways of delivering holistic, integrated cancer care in Scotland.

‘Improving the Cancer Journey’, known as ICJ. The programme, originally piloted in Glasgow, offers people with cancer time with a link worker to talk about their support needs. The link worker role provides an interface between health and social care, but importantly reduces the burden on the clinical workforce by managing the individual’s wider holistic needs.

In Wales, we are piloting and testing ways of seamlessly joining together health and social care. Projects such as ‘Right by You’ in Pembrokeshire and ICJ in Powys are mapping services, developing meaningful working relationships with local authorities, and testing new approaches to delivering support in the community. At the same time they’re improving the standards of holistic care and freeing up essential clinical time.

We want to see these projects develop and provide an important evidence base towards how we link together parts of the health and social care system in the future, and commend them to HEIW.

Third, Macmillan recognises the importance of digital technology in the delivery of care, and that it should not become an end in itself. Technology has the potential to enable person-centred care, but done incorrectly risks dehumanising people needing care and embedding inequalities.

We would welcome consideration towards creating ‘digital champions’ across different professional teams to drive adoption of new approaches. We also hope an integrated approach will be taken towards adopting new technology, keeping professionals as a key part of the design and delivery process of any new products.

Fourth, there is a UK-wide recruitment crisis impacting on almost every part of the health and care workforce, with health professionals leaving careers early due to being overworked or taking early retirement due to the lack of flexible working arrangements. The public perception of a career in health and care is also not set in the most positive of light. It will be essential for the NHS, Welsh Government and their partners to consistently raise the profile of a career in health and care and make Wales an attractive proposition for non-UK nationals.

A continued focus and development of Train.Work.Live and other campaigns to improve the reputation of both health and care professions in Wales is welcome, and Macmillan would also welcome concerted efforts to boost the profile and reputation of health and care roles to young people and people considering a career change.

Fifth, Macmillan welcomes the recognition of the current continuing professional development (CPD) challenges facing the workforce in Wales. In our evidence gathered from professionals across the United Kingdom, we have seen challenges in accessing CPD due to a lack of available protected time.

In a UK-wide poll conducted by Macmillan, 60% of CNS’ felt workload was the biggest factor in preventing access to CPD over the last 12 months. In Wales CNS’ also felt a lack of locally available courses and support from a line manager were prohibitive to accessing CPD. We support the Wales Cancer Alliance’s call to tackle succession planning and review the Cancer CNS career path to ensure that it is made more attractive as an incentive for new nurses looking to join the workforce, and that opportunities for career progression and entry into specialisms are promoted to current nurses, with time made available to enable them to have the relevant training.

Finally, as far as the workforce “shape” is concerned we drew attention to the Macmillan Cancer Workforce Census we carried out and published in 2018. In it we identified critical gaps in the current cancer nursing and support worker provision. The census’ findings provide clear evidence for focusing on critical shortage areas within the cancer care workforce, to drive a more consistent approach to workforce planning across Wales.

“The census examined the age of the cancer workforce and critically identified some short and medium term issues that will require corrective action to mitigate against:
• 74% of Breast CNS’ were aged 50 and over.
• 45% of the specialist palliative care workforce were aged 50 and over
• 50% of brain and gynaecological CNS’ were aged 50 and over.”

Macmillan Cancer Support

The changing face of cancer, and the pressures facing the workforce is changing the nature of cancer care in Wales. We call on HEIW to commission research, if necessary in partnership with other stakeholders, to examine these issues and better understand what the workforce of the future will look like. Clear career pathways for specialist cancer nursing roles would be welcome as they underpin and support the delivery of high quality person-centred cancer care in Wales.

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