The greatest running cost of the NHS is its workforce. The authors show how this aspect of the NHS can too easily be neglected in the policy process, or discussed only in the context of concerns for costs of the NHS payroll. The NHS nationally and locally relies heavily upon weak data relating to the deployment of its workforce. This can be to the detriment of what should be a key policy concern: the effectiveness of the NHS’s most significant asset.
Even the smallest failures in staffing levels or payroll accuracy have a significant impact on clinical effectiveness and the costs of the NHS, given the overall size of the workforce. The debate about staff-patient ratios is somewhat academic in the absence of a robust system for planning, monitoring, and recording staff numbers. In achieving the ambition of high-quality patient care minutes count and systems that cannot provide such accuracy undermine this ambition. Unannounced inspections of NHS hospitals have revealed discrepancies between staff rosters and ward reality. Safe staffing is more than just a number on a roster.
In this paper we try to identify some of the potential clinical and financial benefits from more robust workforce data, and the barriers that limit progress towards the adoption of digital technology for the closely linked tasks of rostering, payment, and quality assurance. Issues of leadership lie at the heart of NHS reluctance to address some of its cumbersome, costly and dangerous workforce systems.