A blog in a blog …

Roy Lilley writing in NHSManagers.net blog today with his views on workforce – what do you think?



There’s something else for us to worry about.  People to do the job…


Healthcare begins and ends with workforce.  There’s not enough people ready, in the pipeline or even willing to come and commit to a career in healthcare.  Not just in England, world-wide.


In 2013, we knew, to reach a global threshold of 34.5 skilled health professionals per 10,000 population, approximately 7.2 million more midwives, nurses and doctors were needed – the shortfall is predicted to rise to 12.9 million by 2035.


A global crisis.  Not enough skills to go around.  Here, we are cleverly closing the doors to immigrant doctors and any idea we can be self sufficient, in the foreseeable, is frankly, potty.


We train our workforce a mile deep and an inch wide, reinforced by Royal Colleges, affinity groups and associations, each of whom exist in their professional silos, to perpetuate their models.


With the urgent need to integrate services we have to ask; have we got the right workforce?  We have skills, talent and vocation aplenty but are we using them, training them for the future?  

The direction of travel is clear; we need a workforce that is comfortable being part of a multi-sectoral future. 


A workforce that is trained a mile wide and an inch deep.  A workforce that knows enough to know when it doesn’t know enough and brings in the experts.  Core skills, plus.


Specialists have deep skills, narrow scope, are peer-recognised and know little outside their domain.  


Generalists have shallow skills, broad scope, are accessible and deployed quickly but lack enough skills.


Time for something different.  Not a new kid on the bloc. It’s an idea borrowed from the IT industry, first coined by Gartner, a US research consultancy, originally from Stamford, USA.  


It’s time for the ‘versatilist’. 




“Versatilists are able to apply a depth of skill to a progressively widening scope of situations and experiences, equally at ease with technical issues as with business strategy.”


A versatilist has deep skills, a wide scope of roles, a broad experience and is recognised by peer-groups in other domains.  Have a look atthis graphic.


In our terms think of a community service; we need workers skilled in, say, twelve areas.


A versatilist would score highly for competency in, say, three areas.  A medium score in 5 and an introductory level in perhaps four.


Match this to, say, a patient who is frail and elderly with multiple needs where, to meet the total needs, we, conventionally, would deploy a number of specialists.  


The versatilist; competencies in nursing, prescribing and tissue viability, lesser skills in social care, benefits structures and entitlements, chiropody, occupational and physiotherapy, hairdressing and an understanding of the law and power of attorney. 


Complex patients require complex care and versatilists, for most practical purposes, would be able to respond to the whole care needs.


Training based on a clinical platform+ would benefit patients but it also has another motive.


We spend the majority of the budget on staff.  A return on investment is seldom mentioned.  Partly because we back-off collecting individual performance data, hence no value is placed on training or enhancing skills and investment becomes a low priority.


Matching skills with the needs of the job means people are better equipped, the job easier and the outcomes more assured. 


Where complex needs are met with a fragmented workforce, the inevitable service breakdowns, at the interfaces of handover, disrupt the flow and create the potential for frustration and failure.


No good for the recipients and no good for the staff.  


As patients become more complex our response is either traditional… greater specialism and more interfaces, or a versatile workforce with broader skills with fewer interfaces.


It’s the difference between a workforce and a workforce that is strategic. 


 Contact Roy – please use this e-address


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