ABSTRACT
This chapter brings the story of support worker development in the NHS up to date. Support workers continue to face barriers to their full deployment and development that include a plethora of job titles, inconsistent job design and task allocation, a lack of standard entry-requirements and post-employment learning requirements, ill-defined career progression pathways including into pre-registration grades, limited autonomy and unsupportive workplace cultures. Despite gaining satisfaction from their work, support workers can feel frustrated that they cannot contribute more to service deliver or progress their careers. This has a negative effect on their health and wellbeing. It also means that support workers are underutilised by the NHS. Whilst evidence of the impact of support workers on service delivery is limited (due to the paucity of research), there is evidence of the benefits they can deliver which include: increases in capacity reducing the workload of registered staff, greater continuity of care, improved service outcomes such as reduced incidence of pressure sores, lower waiting lists and reduced turnover. There is no conclusive evidence that skill mix impacts on safe staffing although this is a complex area. Poor workforce planning, along with employer discretion in how support workers are employed, are two significant reasons support staff experience the problems they do. Workforce planning is a long-standing weakness of the NHS due to the complexity of services, the lag in training some staff and challenges in estimating future demand. Support staff have rarely explicitly featured in workforce plans. The publication of The NHS Long Term Plan (NHS England, 2019a) heralded a series of significant reforms in the NHS, including to the workforce, such as the creation of a more prominent role for local Integrated Care Systems that bring together health and social care along with other partners to address population health needs. Alongside these NHS reforms are wider changes to the organisation and delivery of vocational, education and training including a bigger role for employers to determining skill plans in localities and reforms to colleges.
Possible reasons for the status of the NHS support workforce are considered, including an investigation of whether the support workforce in the NHS constitutes a secondary labour market. Understanding the reasons for issues, will assist anyone concerned with the development of the support workforce and enable them to enhance their contribution in a safe and effective way. These issues are not ‘Wicked Problems’ because they are well defined and there are solutions to them, but rather represent a ‘meta-problem’ – a problem of problems. Approaches to dealing with meta-problems are discussed including Discovery Methodology.
