Agile working, poly-skilling and advanced practice roles: A discourse analysis of strategic planning in England and implications for perioperative care.

Abstract

Efforts to help the NHS recover from the global pandemic have included the establishment of new Surgical Hubs to ramp up elective surgical activity since 2022, a new 10-year Workforce Plan released in 2023, a review of the state of the NHS by Lord Darzi in 2024, and a new Budget for government spending soon after. Implicit in all measures to improve surgical activity in the United Kingdom is the need for transformation in the workforce. England's 42 Local Integrated Care Systems were established in 2022 and launched strategy documents to set a direction of travel, including on workforce. In this article, the strategies for NHS workforce transformation in England were subjected to a critical discourse enquiry to explore dominant and emergent 'speech communities', and to detect any emphasis on perioperative care. Findings revealed an advocative nature in the texts, a common ideology around workforce ('one team, one workforce', expressing optimism, togetherness and partnership) and the legitimisation of training for agile working, poly-skilling and advanced practice roles, as specific ways over the challenges it currently faces. In conclusion, perioperative care workforce transformation can deploy these sub-strategies, and further work is needed to explore the feasibility and effectiveness of specific interventions designed to deliver them.