Uncertainty over international recruitment is threatening safe, high quality care for patients a major report by NHS Providers has warned.

There for us: a better future for the NHS workforce says there are no domestic “quick fixes” to the severe workforce shortages in the NHS, and that any significant reduction in the number of overseas staff in the next few years is likely to have a serious and damaging impact on services for the public.

The report criticises the slow, disjointed, response from the Department of Health and its arms-length bodies to the NHS’s growing workforce challenges. It calls for urgent steps to ease intolerable pressures on front line staff, and to develop an NHS workforce fit to meet the growing and changing needs of the population.

Our report calls for urgent steps to ease intolerable pressures on front line staff, and to develop an NHS workforce fit to meet the growing and changing needs of the population.

The report provides a comprehensive overview of where the workforce challenges are greatest, how these have developed, and what needs to be done to address them.

It includes findings from a new survey of NHS mental health, community, ambulance and hospital trusts. Chairs and chief executives from more than half (51%) of NHS trusts responded to the survey. The main findings are: 

• two thirds (66 per cent) said workforce concerns were the most pressing challenge in delivering high quality care
• the vast majority (85 per cent) said it would be important to recruit from outside the UK in the next three years
• Brexit was seen as the main barrier to recruitment outside the UK over the next three years. More than one in three (38%) mentioned this issue
• when asked for the biggest challenges to recruitment and retention at their trust, 60 per cent of trust chairs and chief executives cited work pressure and 38 per cent cited pay and reward
• an overwhelming majority (90 per cent) were doubtful that approaches taken by the Department of Health and its arms length bodies would help them to recruit and retain the staff they needed

The survey also includes powerful commentary from trust leaders (below), reinforcing many of the report’s central conclusions.

The analysis describes a growing “workforce gap” which is harming the quality of care.

“Workforce supply and retention are at the top of my risk register and are the single most important thing that prevent the application of the fundamentals of care” [chief executive, mental health trust]

The report highlights the impact this is having on workplace pressures and morale, as growing numbers of staff turn their backs on a career in the NHS.

“I have worked in the NHS for 45 years. In that time I have never seen so many staff work under so much pressure for such long periods of time.” [chief executive, acute trust]

“In some area of workforce we only have one third of the workforce in substantive posts.  In particular services people are leaving because the pressure is so great, they are unable to cope.” [chief executive, acute trust]

The report warns there are no “quick fixes” to improve the supply of UK-trained staff, yet the outlook for international recruitment is uncertain.

“Without EU and non-EU recruitment, it is going to be very difficult to adequately staff services for the next 5-10 years” [chief executive, mental health trust] 

“The current lack of progress in the Brexit negotiations is creating unhelpful uncertainty in an already challenging workforce environment.” [Chief executive, acute trust]

Trust leaders are frustrated that these workforce problems have developed over a number of years “in plain sight” and that NHS system level leadership has been unable to develop appropriate solutions:

“Sustainable staffing is the greatest challenge facing my organisation. I have no real sense that the scale of the challenge is truly understood nationally”. [chief executive, acute trust]

The report makes detailed recommendations aimed at government, the Department of Health and its arms-length bodies, regulators, and professional associations. These include:

• set out a fully funded plan to end the pay cap during this parliament
• urgently confirm the right to remain for the 60,000 EU staff working in the NHS  
• commit to a future immigration policy that allows trusts to fill posts that cannot be taken – at least for the time being - by the domestic workforce
• work with trusts to set up an international recruitment programme that they can opt into
• a clear-sighted strategy to develop the health and care workforce the country requires with skills to meet growing and changing needs
• greater clarity on the timetable to grow the domestic supply of clinical staff, and backup options should initial plans not succeed as has happened in the past
• a set of short-term stop-gap solutions to address immediate workforce shortages
• much greater coherence in workforce strategy, eliminating the current fragmented approach and developing the right national/local relationship

The report also sets out what can be done at trust level to make the NHS a great place to work. These include the importance of tackling bullying, developing new roles, improving productivity and providing greater flexibility for staff.

The chief executive of NHS Providers, Chris Hopson, said:

“The staff and skills shortages we now see reflect a fundamental failure at national level on workforce strategy. We don’t have enough staff with the right skills and we’re asking far too much of our existing staff. NHS trust leaders are telling us there are no quick fixes to improve the supply of UK-trained staff, and the outlook for international recruitment is uncertain.

The staff and skills shortages we now see reflect a fundamental failure at national level on workforce strategy.

“These problems have developed in plain sight which clearly shows the existing approach is flawed.  

“The government must deliver certainty for EU staff. It should reassure them that their commitment to the NHS is greatly valued and will continue to be welcome. It should also provide assurance on immigration policy so trusts can continue to recruit overseas while we strengthen our workforce here.

“We need a coordinated workforce strategy with clear goals in sight that match the realities of demographic pressures and new approaches to care.

“A better future for the NHS workforce is within our grasp, but we need a commitment from government and national bodies, first to recognise the gravity and urgency of the challenges we face, and then to act.”