NHS England

With existing clinical staff engaged in the fight against COVID-19, NHS England (NHSE) needed to create a new type of workforce that was agile and sustainable. Without enough vaccinators, the roll-out would be severely constrained and people would have to wait longer than necessary to receive their jabs. So, we assembled expertise in human capital, healthcare workforce planning, change management and operational performance to develop a flexible workforce comprised of unregistered and volunteer vaccinators.

Our team identified an opportunity to create the role of unregistered vaccinators to support registered clinical staff with volunteers who weren’t clinically registered. The changes made by the joint team meant that by the end of March 2021, the vaccine workforce had grown to over 149,000 people in England to support the delivery of 1.7 million vaccines per week.

Key successes

• Assembling and growing an agile workforce that could be scaled up or down to meet demand. This workforce was delivering 1.7 million vaccines per week by March 2021
• Recruiting more than 20,000 volunteer vaccinators who delivered more than 2.5 million volunteer hours during the programme
• Applying data and analytics expertise to provide intelligence six weeks in advance to help define workforce requirements
• Supporting over 50 delivery sites around the country to identify best training practice and applying it across the workforce
• The work was highly commended in the Workforce & Wellbeing category at the HSJ Partnership Awards.

Scoping a flexible vaccine workforce

Due to the scale of the challenge, a change in legislation allowed the vaccination process to be split into component parts. This enabled the programme to identify tasks that could be performed by unregistered staff under the newly introduced national protocol. Importantly, this also enabled the recruitment of a wider diversity of skills, as people such as retired doctors to pilots became vaccinators. This meant the preparation and delivery of the COVID-19 vaccine was completed by appropriately trained and competent vaccinators. Redeploying a wider range of NHS staff and volunteers to deliver different parts of the vaccination process dramatically increased the workforce available to support vaccine delivery.

Designing the vaccine workforce

To realise this solution, our team needed to undertake a national recruitment campaign and put in place contracts to support the recruitment of 18,500 vaccinators and 30,000 volunteer vaccinators. These volunteers would support NHSE through St John Ambulance (a charity that provides first-aid volunteers) where their volunteers have delivered over 1 million volunteer hours. These volunteers went on to deliver 2.5 million hours of support over the coming months. The role of this new workforce was to complement the clinical teams being recruited locally.

Our training experts then supported Public Health England with the roll-out of training. The training was designed to ensure patient safety, and that registered and unregistered NHS staff, and volunteers, all had the skills needed to deliver the vaccine.

Much of this work took place through the summer in 2020. As autumn approached, the team stepped up engagement with local integrated care systems (ICS) to establish the robust relationships needed to mobilise the workforce as soon as a vaccine was approved. We created frameworks and toolkits which included process maps describing how the workforce would be deployed, and support systems to design and recruit their workforce to reduce variation in training standards and ensure safety.

Mobilising the vaccine workforce

Following approval of the first vaccine at the beginning of December 2020, the planning phase shifted quickly to mobilisation. Local GP practices played a key role in administering the first jabs to their patients, with other delivery models coming on stream fast. By the first week in January 2021, over 130 fully staffed mass vaccination centres were up and running across the country.

The workforce model our team created determined how the workforce would be used. Together with NHSE, we developed an agile operating model to mobilise the workforce across the system. This meant each ICS had a named lead employer responsible for the workforce planning, recruitment, onboarding, training, deployment and retainment of paid and volunteer workforce across all delivery models. With our guidance, lead employers successfully onboarded more than 70,000 people to support the vaccination programme through local recruitment to staff schools, pop-up vaccination sites and other vaccination sites. With more than 1,000 full-time employees (FTE) per week being deployed across the network, this broke down the traditional constraints of moving the workforce pre-pandemic across primary and secondary care. The team also visited over 50 delivery sites around the country to identify best practice and apply it across the roll-out workforce.

Over the coming months, the capacity at each centre scaled up and down according to the supply of vaccines available. Data tools provided advance intelligence on workforce requirements and availability over a six-week period. Our experts formed part of special teams providing intense support to clear any bottlenecks identified as a result.

As the vaccination programme continued through the summer, new cohorts were invited to attend on a rolling basis. At the same time, the economy underwent a tentative re-opening, with many volunteers returning to their pre-pandemic ‘day jobs’. However, 15,000 volunteer staff have since remained and taken on a permanent role within NHSE. The new agile workforce model developed by our team enabled the programme to adapt to the constant shift in supply and demand for people to support the roll-out.

Continually evolving the new workforce model

As a result, when the Omicron variant arrived at the end of 2021, NHSE had the structures needed to enable the urgent expansion of the workforce. Our team supported the relaunch of the national recruitment campaign, which attracted more than 100,000 additional volunteers, including civil servants, St John Ambulance and members of the Royal Voluntary Service – a UK charity built on local volunteering.

The solution we had designed proved flexible and robust so that workforce never became a constraint on vaccine delivery. By the end of March 2021, the vaccine workforce had grown to more than 149,000 people in England and was administering 1.7million vaccines a week.

The expanded workforce successfully delivered almost seven million booster doses a week in the final weeks of 2021 and many more during the first months of 2022. As well as saving thousands of lives, the speed of the vaccine roll-out also enabled the country to avoid the social and economic impact of a fresh lockdown.

A workforce for the future

The impact of our thinking on workforce design was ground-breaking. Our experts quickly reimagined the future health workforce, bringing fresh ideas to solve a challenge that had led to one in ten NHSE vacancies being unfilled when the pandemic began.

The new workforce model designed by our team uses the entirety of the NHSE workforce in an agile and sustainable way. Registered and unregistered staff now collaborate to deliver health services more efficiently, with registered staff carrying out key clinical tasks or supervising volunteers to do so, therefore expanding the overall resource. New contracts enable NHSE to deploy staff where they are most needed. One of the greatest successes of the programme is through a retention programme, where we have helped more than 15,000 people from the vaccination workforce start careers in NHSE. This larger, more flexible workforce will be invaluable in tackling waiting lists that built up during the pandemic and in providing high-quality health services to a growing population into the future.