Yes, obviously, that's our intention, because you cannot provide a quality, safe, clinical service without the right level of skill and the right number of people. The evidence is really clear on that. I and my colleagues in the royal college spent a very interesting summer going through all the integrated medium-term plan and public board papers of the health boards in Wales, which is a very instructive experience. And I think one of the things that we have struggled with and has caused us great frustration is that, very often, you will see the description of what services can be provided, or more importantly in a way, the description of what services intend to be provided in five or 10 years—'Well, we’ve got staffing issues, this is what we can do' or 'Because of the staffing issues, this is what we can do', 'We have to do this because of staffing issues.' You very often see in the board papers, very starkly—and this is obviously the board; it’s the most senior level possible. You very often see, ‘We haven’t got enough nurses to fulfil this Act’ or ‘Well, there’s no possible way we could do that.’ The workforce situation is very often presented as a fait accompli—it's just one of those things that we all have to negotiate around. I think what we're trying to do with the suggested amendment—we're trying to lift the level of strategic discourse about workforce. Yes, you clearly do have a problem, in that you can't currently provide this service because you don't have the people. Now, let's work backwards. Let's say, 'What are the ideal clinical services we'd like to provide? What would be the ideal workforce? Right, how can we work backwards to try and obtain that?'
There's very little, if any, discussion, even in IMTPs or workforce discussions at board level, of strategy. In fact, I would go as far as to say there's probably no discussion of strategy. There is very little discussion of activities. So, you often see recruitment activities include attendance at fairs and advertisements on Facebook. Those are activities—it's not a strategy, and it's certainly not something I would be expecting to see just as a quick bullet point as the solution to something as fundamental as this crisis. There certainly is almost no discussion at all of retention strategies, yet we can't keep putting people into the system when they're actually leaving. You can see that very specifically with the nursing profession around burn-out. Some health boards, laudably, have said, 'Perhaps we should pay more attention to exit interviews.' Yes, that would be great. We need that kind of thing going on consistently and at a national level. We know what the major reasons are for nurses leaving and working for agencies—they want control of their hours—yet it's too impossible to change the rota system, except it isn't.
So, it really is quite important that we have these strategic national discussions, and that the attention of the senior people at board level is focused on these kinds of big workforce-planning questions, so that they're not just answering the question, 'What can we provide with what we've got?', but they're answering the question of, 'What do we need and how can we work nationally to obtain that?'
In fairness, I think we see with the creation of HEIW and we see with the creation of the workforce strategy that's out for consultation—we can see the Welsh Government is trying to move in that direction, and we really welcome that. And that's why we feel that this opportunity for a legislative amendment would really focus minds. To be clear, our intention in this amendment is that, in terms of fulfilling that obligation—it can be fulfilled in the way that is set out here, around the statements and around demonstrating active participation in that kind of workforce planning. So, our suggestion is for a high-level strategic start to the process.