Biomedical subjects
Publications and source records attributed to James Buchan.
Foundation trusts will in theory have greater freedoms over pay, non-pay rewards and recruitment, although details are still unclear. Foundations are likely to differ in their use of these powers, partly because of desire and partly because of practical limits. Taking advantage of new powers for short-term gain, at the expense of other trusts, will have negative effects if not part of a wider development of HR practice.
The government's proposal to produce a holistic pay system for the NHS has been limited by the separate settlement for consultants. The new system must balance management needs for local flexibility and unions' desire to sustain national pay. The introduction of foundation hospitals and overseas clinical teams will have implications for the implementation of the new pay system.
Overseas nurses account for 40 per cent of all new registrations in the UK and this may be rising to 50 per cent. This upward trend is likely to continue. International recruitment is to be part of the NHS's long-term strategy and is becoming the focus of increasing policy attention. The international labour market will become tighter: the US needs to recruit an extra million nurses of its own.
This paper discusses the reasons for skill mix among health workers being important for health systems. It examines the evidence base (identifying its limitations), summarizes the main findings from a literature review, and highlights the evidence on skill mix that is available to inform health system managers, health professionals, health policy-makers and other stakeholders. Many published studies are merely descriptive accounts or have methodological weaknesses. With few exceptions, the published analytical studies were undertaken in the USA, and the findings may not be relevant to other health systems. The results from even the most rigorous of studies cannot necessarily be applied to a different setting. This reflects the basis on which skill mix should be examined--identifying the care needs of a specific patient population and using these to determine the required skills of staff. It is therefore not possible to prescribe in detail a "universal" ideal mix of health personnel. With these limitations in mind, the paper examines two main areas in which investigating current evidence can make a significant contribution to a better understanding of skill mix. For the mix of nursing staff, the evidence suggests that increased use of less qualified staff will not be effective in all situations, although in some cases increased use of care assistants has led to greater organizational effectiveness. Evidence on the doctor-nurse overlap indicates that there is unrealized scope in many systems for extending the use of nursing staff. The effectiveness of different skill mixes across other groups of health workers and professions, and the associated issue of developing new roles remain relatively unexplored.
US research suggests that magnet hospitals have better outcomes than other Institutions Key to magnet organisations are participative management style, strong professional development and flexible working practices. The magnet concept appears to be an effective way of tackling nurse shortages.
The government's plans for the NHS will not be achieved simply through meeting its targets for staffing. More attention should be given to retention and a fairer pay system. The introduction of new roles and skill mix will be the biggest test of the human resources agenda. Success is more likely to come from developing the roles of current health professionals than from introducing new types of workers.
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Canada is not alone in having to face up to significant human resource (HR) challenges as it debates how healthcare should be managed and delivered in the 21st century. The United Kingdom is having to deal with many similar issues related to demographic change, skills shortages and the drive to "modernize" public services. This commentary highlights some of the main dimensions of HR-related change in the U.K. National Health Service (NHS) to counterpoint the main messages in the lead paper. The primary focus is on examining the key HR aspects of achieving sustained improvement in staffing levels, mix and motivation.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.