As the NHS nears its seventieth anniversary, the time is ripe for a workforce rescue plan. Staffing worries, even more than funding pressures, are the biggest cause of concern for NHS trust leaders. There are not enough trained health workers in the UK to meet today’s needs, let alone those of the future.
Demands on hospitals, mental health and community trusts and ambulance services are growing. More patients need treatment. Increasingly, they require complex care, with specialist expertise. This is not just about numbers. We need a clinical workforce that is skilled and equipped to work in new ways to deal with the changing needs of the population it serves.
Staffing worries, even more than funding pressures, are the biggest cause of concern for NHS trust leaders.
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Workforce challenges
That means improving the supply of people coming in to work for the NHS, and doing more to develop and motivate them so they want to stay. These problems are not new but the scale of the workforce challenge has reached a tipping point which threatens the future sustainability of the NHS.
Ministers rightly point out that the NHS in England has more clinical staff than ever before but numbers have not kept pace with rising demand. The official "shortfall rate" for nurses and midwives across England is close to ten per cent - in some places significantly higher. Part of this is down to the recognition, after the events at Mid-Staffordshire, of the importance of safe staffing levels. Yet for successive years during the coalition the number of nurse training recruits fell.
These problems are not new but the scale of the workforce challenge has reached a tipping point.
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Far from being a problem just for hospitals, there are major nursing shortages in mental health and community trusts. Between 2009 – 2016 the number of district nurses employed by the NHS in England fell by more than 40%. Just as the health service tries to accelerate plans for more treatment closer to home, in key parts of the workforce it is going backwards.
There are also worrying gaps in the supply of doctors. Even as the NHS gears up for what may prove to be its toughest winter yet, we see worrying shortfalls in A&E consultants. The health service is rightly committed to putting mental health on an equal footing with physical health. But many trusts are struggling to fill psychiatry posts. And we do not have enough GPs.
Even as the NHS gears up for what may prove to be its toughest winter yet, we see worrying shortfalls in A and E consultants.
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Staff retention a key part of the problem
A key part of the problem is retention. Since 2010/11 there has been a worrying rise in “leaver rates” among nurses, midwives, ambulance staff and scientific technical staff. Many blame the pressures of workload, low staffing levels and disillusionment with the quality of care. Seventy per cent of NHS staff stay on for extra hours. Well over a third say they have felt unwell in the past year because of work related stress.
Add in cuts to real basic pay, year after year, and it is hardly surprising that some are looking to other opportunities and careers outside the public sector. We need a strategy to end pay restraint in the NHS.
There is also a worrying demographic challenge. Almost one in three qualified nurses, midwives and health visitors is aged 50 or older. One in five GPs is at least 55. We have to give them reasons to stay.
Add in cuts to real basic pay, year after year, and it is hardly surprising that some are looking to other opportunities and careers outside the public sector.
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NHS trusts have made important strides in engaging with their workforce. Staff ratings on being able to report concerns, feeling trusted to do their jobs, and being able to suggest improvements are encouraging. But there are still cultural problems - for example around discrimination and bullying – which must be addressed locally and nationally.
The NHS can no longer be sure that overseas recruits will step in to fill workforce gaps. In the early 2000s many trusts looked beyond Europe to meet nursing shortages. More recently, as tougher immigration and language rules took hold, a growing proportion came from the EU – though not enough to plug the gap.
Brexit uncertainties
Now we have all the uncertainty surrounding Brexit. We need urgent clarity on the status of current EU nationals working in the health and care systems. And we must recognise that for the foreseeable future NHS trusts will need support to recruit and retain staff from overseas. The government says it will improve the home-grown supply, but that will clearly take time.
We need a coordinated, realistic long-term strategy to ensure that frontline organisations have the right number of staff with the right skills in the right place to deliver high quality care.
Director of policy and strategy
These problems have developed in plain sight. But leadership on this has been muddled or trumped by worries over funding. Responsibility for NHS workforce strategy is disjointed. We need a coordinated, realistic long-term strategy to ensure that frontline organisations have the right number of staff with the right skills in the right place to deliver high quality care.
We must act now. This year's long-delayed workforce plan - to be published soon by Health Education England - could be a good place to start. But what we need is a more fundamental approach – with a clear vision of how the NHS must develop its workforce to meet these challenges, and a commitment to make it happen.
This article was first published by the New Statesman on 22 August 2017.
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