Human Resources for Health 2030 and the regulatory agenda

It is a decade since Human Resources for Health was placed centre stage in the 57 countries with the greatest shortages (World Health Organization 2006). The majority of the countries carried a disproportionate percentage of the world's disease burden, yet had, per head of population, the fewest numbers of health workers. The majority of these countries were located in sub-Saharan Africa and problems such as HIV, malaria, tuberculosis and maternal and infant mortality provided incredible challenges to those health workers that did exist. When additional factors such as conflict, insufficient resources, poor working conditions and inadequate salaries are factored in, the outward migration of highly skilled individuals to greener pastures made things even worse for those that remained. Whilst the global economic crisis slowed the exodus of out-migration the real problems failed to be addressed. In reality, issues such as the total number and distribution of health workers was inadequate to meet health systems needs and the working and living environments did not have sufficient attraction to retain staff. By concentrating on only the 57 countries with the biggest problem this failed to put pressure on those other countries to play their full part. In a global economy, focusing on only one part of an interconnected system is folly. At best the shortage is shifted around and can, in reality, be likened to reorganising deck chairs on the Titanic while the iceberg looms large. This time a global perspective has been taken. Every country has a role to play. The Human Resources for Health (HRH) 2030 strategy is different (World Health Organization 2016). It requires every nation to look at its human resources for health needs. It recognises that to address these issues we all need to work together. This strategy has been developed through a series of consultative stages and the production of a number of key informant papers. This process has increased engagement and as a result it is hoped that decision makers will be able to act promptly and, ideally, in concert on the objectives that have been set. These objectives are challenging and will require synergistic efforts if real progress is to be made. When one critically examines the HRH strategy from a regulatory lens we contend that there is a lot of regulatory work to be done. We need radically to reform our regulatory model. A model that was born in the industrial age is of no use in a digital society. The challenges are great, but we suggest we can, through the use of evidence, transform not only the regulatory model of our profession but set the direction for all professions. If we are to reform regulation we need to think beyond what is comfortable and known. We must identify not only today's opportunities but also those that will position us for the future. We no longer live in a world where we can look to the past for solutions. We need to create a new paradigm that is ready and able to address a dynamic, complex and global environment. We have passed way beyond the industrial age where our current regulatory model was born. We need to develop and implement a regulatory system fit for the digital world that we now live in. With that in mind let us share our reflections on the regulatory agenda that we see emerging from the new Human Resources for Health Strategy. Benton (2016) at the recent Government Chief Nurse and Midwifery Officers Meeting in Geneva, Switzerland presented an analysis (Figure 1) of the likely regulatory consequences of the new Human Resources for Health strategy. Each of the four objectives specified in the WHO (2016) strategy are detailed in Figure 1 and the potential regulatory consequences specified. To achieve Objective 1 we contend that the new regulatory model will require the generation and use of research to optimise the scope of practice that will incorporate and address the innovative use of technology. We recognise that this will have an impact on education and assessment models and these will need to underpin and reflect team based care that will enable the delivery of contemporary practice. We also believe, in relation to Objective 2, that regulation cannot be seen in isolation but must give full consideration to its wider impact. Such an approach will require a strong performance based culture where the consequences of new regulatory requirements are fully assessed prior to implementation. This will enable the minimisation of controls and bureaucracy whilst optimising safety. In short, the ambitions of Bartle and Vass (2005) that were revisited, albeit independently, by the Professional Standards Authority (2015) in their publication on right touch regulation will facilitate the delivery of a model of regulation fit for purpose. Objective 3 is focused around capacity development and with the radical and dynamic change agenda required over the next 15 years will require careful attention to the changing role of regulatory leadership. Changing legislative frameworks that address system-wide risk will take time and require a coordinated approach. Regulators will need high level policy and political competencies. Nurses in general have limited expertise in this area and accordingly this agenda provides an opportunity for regulatory and other nurse leaders to collaborate and indeed learn together (Benton et al. 2016). Finally, Objective 4, can only be addressed if regulators fully appreciate the role that their data can play in securing real time workforce planning. Efficiencies through the creation of secure, primary source equivalent digital repositories of the individuals professional educational and credentialing record will help to reduce bureaucracy and delays when the person is seeking to move from one jurisdiction to another. This will also offer the opportunity to deliver dynamic public protection that fully addresses continuing competence. With changing population demographics and the consequent reduction in the population support ratio any future workforce model will need to consider both health and social care needs (Benton 2011). The new global Human Resources for Health strategy provides opportunities for regulators and nurses in all nations to modernise the current industrial regulatory model towards one fit for the digital age. This will require new thinking, research, coordinated action and investment. We contend that a new regulatory model will be central to the achievement of the HRH 2030 vision. This vision should be embraced by our profession so as to create roles that optimise access to contemporary quality services that are available to all citizens. This paper has not been supported by any funding or grant source.