The largest ever survey of NHS trust chairs and chief executives has revealed rising concern over the growing NHS “workforce gap”.

Only one in four trust leaders (27%) are confident they have the right staff numbers, quality and skill mix to deliver high quality healthcare for patients and service users. Fewer still (22%) are confident about having the right staffing levels in six months’ time. These findings show that, for many trust leaders, worries over staffing are becoming even greater and more urgent than those over funding.

Only one in four trust leaders are confident they have the right staff numbers, quality and skill mix to deliver high quality healthcare for patients and service users

172 chairs and chief executives from 136 hospital, mental heath, community and ambulance trusts responded to the survey – well over half of all England’s 238 NHS trusts. The survey forms the centrepiece of a comprehensive assessment from NHS Providers of the challenges trusts face and how they are responding, including successes which give grounds for optimism but are rarely celebrated.

The state of the NHS provider sector gives examples of where trusts are improving the quality of care and increasing productivity – despite having to work at full stretch due to severe financial constraints and rapidly growing demand.

The report demonstrates that, despite rising challenges, trusts deliver when they have an achievable task and are given appropriate support and funding, including:

• Successfully treating a record number of patients: 5% more emergency hospitals admissions, 8% more A&E attendances and 4% more ambulance calls in September 2016 compared to September 2015 for all NHS trusts and foundation trusts.
• On track to reduce last year’s record £2.45 billion deficit to -£669 million, cut agency spending by a quarter and realise £3.2 billion cost improvement gains this year - this is £346 million (12%) more than last year.
• Addressing staff shortages by increasing recruitment from overseas, developing and piloting new roles like the nursing associate role, and using technology to roster staff more effectively and meet staff requests to work more flexibly.
• Leading NHS transformation by developing new care models that integrate hospital, GP and community and social care into a single service that offers better care closer to home; and leading nearly half of the 44 Sustainability and Transformation Plans (STPs).

However, the survey also reveals a range of growing concerns over how services for patients and service users can be sustained at current levels:

• In the face of much higher demand than predicted and, despite their best efforts, trusts are missing nearly all of their key performance targets. Fewer than one in three (30%) trust chairs and chief executives expect performance against these targets to improve over the next six months.
• Trust leaders share the CQC’s concern that whilst there is much good care being delivered, there is clear evidence of service quality starting to deteriorate. Only 10% of trust chairs and chief executives are “confident” or “very confident” they can maintain the level and quality of services over the next six months within the resources available.
• While there is good progress to deliver the short term plan to eliminate provider deficits, trust leaders share the NAO’s concern that there is no sustainable plan to cope with the sharply lower NHS funding increases of the next four years. Almost half (49%) of chairs and chief executives think their trusts’ financial position will deteriorate in the next six months.
• Trusts are struggling to meet a series of workforce challenges including shortages in key specialties and rising pressure on staff. More than half (55%) of chairs and chief executives say they are “worried” or “very worried” about whether their trust has the right numbers, quality and mix of staff to deliver high quality healthcare. Most expect this to deteriorate over the next six months.
• Comments on workforce included: “This concerns me more than the money”, “There are simply not enough high quality clinical staff in the country to cover some specialties”, and “Brexit has caused drying up of recruitment from the rest of Europe”.
• While trusts are leading NHS transformation, government and arms length body assumptions on how quickly the required changes can be delivered and the financial benefits that will result are far too optimistic. Fewer than one in 10 trust chairs and chief executives are confident their local area is transforming quickly enough to provide sustainable care and financial balance.

NHS Providers chief executive, Chris Hopson, said:

“NHS trusts tell us they are facing the biggest challenge in a generation.

“Thanks to hard work at the frontline a huge amount is being delivered. Record numbers of patients are being treated. All three key financial priorities are on track - financial deficits are being cut; cost improvement gains are increasing; and spending on agency staff is being reduced. At the same time, trusts are leading the much needed transformation of the NHS. When the task is reasonable and support and funding are forthcoming, trusts will deliver.

We need greater honesty and realism about what can be delivered for the funding and staff capacity that is available

“But we need to listen carefully to frontline leaders when they say that the NHS is now running a much higher level of risk.

“Demand is rising much faster than anyone predicted. Trusts are having to cope with the fallout from a social care system that has reached a tipping point and parts of general practice that are rapidly becoming overwhelmed. We are in the middle of the longest and deepest financial squeeze in NHS history with four years of much lower funding increases on the horizon and no plan on how to cope with them. We also have a series of workforce challenges we are struggling to meet.

“We need greater honesty and realism about what can be delivered for the funding and staff capacity that is available. We need a smaller set of key priorities, more support for staff, and a better relationship between trusts, the government and its arms length bodies to develop solutions to these challenges. We need to recognise that complex transformation will take time when set alongside an increasingly stretching task to deliver high quality patient care day to day.

“Above all, we need a clear plan on how to close the gap between what the NHS is being asked to deliver and the funding available.”

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