Provider trusts recognise that to close the workforce gap they must make their organisations great places to work, develop the workforce to deliver STPs and new care models, and enhance workforce productivity. 

Yet there are also important changes needed at the national level to support trusts to recruit and retain the staff they need and close the workforce gap 

Throughout the report we have set out recommendations for key parts of the system. Here we recap what needs to happen. 

Short term (within one year) 

Provider trusts should: 

  • prioritise making their organisations great places to work, fostering positive and inclusive cultures, eliminating bullying at all levels, and delivering progress against the workforce race equality standard;

  • continue to make the most of opportunities to develop the workforce and improve workforce productivity;

The government should: 

  • take a realistic view of what is asked of the NHS and the funding they are allocated in order to alleviate the stress and pressure on NHS staff which is contributing to the workforce gap. Staff need to feel that the job is 'doable' and that they can care for patients and service users safely. We have previously backed calls for an Office of Health and Social Care Sustainability which could promote a realistic assessment of what is needed. 

  • set out a plan to deliver the promised end of pay restraint during this parliament. According to the Institute of Fiscal Studies, the cost of a 2% pay award for the NHS would be £1bn annually.51 This level of funding cannot currently be absorbed within the existing financial allocation for the NHS. Therefore this must be fully funded;

  • urgently confirm the right to remain for the 60,000 EU staff working in the NHS and provide a straightforward and inexpensive way for them to establish this right;

  • commit to a future immigration policy supporting trusts to recruit and retain staff from around the world to fill posts that cannot be filled by the domestic workforce in the short to medium-term. 

The Department of Health and the NHS national bodies should: 

  • reverse the cuts to workforce development funds distributed to trusts by Health Education England, to support staff retention and the delivery of STPs and new care models;

  • work with trusts and unions to deliver a national recruitment campaign for the NHS, promoting healthcare careers and helping to balance the negative national narrative that so often accompanies debate about the NHS;

  • work with trusts to develop an international recruitment programme that trusts can pay to opt into if they want to, rather than undertaking their own individual recruitment campaigns. The Global Health Exchange Earn, learn, and return pilot programme is a sensible place to start and could be run on an indefinite basis, positioning the NHS in England as a global centre of excellence for healthcare education;

  • work with trusts, higher education institutions, and unions, providing strategic leadership, to ensure the intended 25% increase of nursing students from 2018 is delivered and any risks to application rates or the number of places set to be offered are identified, monitored, and addressed as required. The experience of 2017 has shown we cannot assume an announced expansion of students will actually happen;

  • recognise the pressure on provider trust leaders, take a realistic view of what can be achieved, support them, and publicly value their roles;
  • continue to support provider trusts with programmes to: 

    • reduce leaver rates and improve retention rates;

    • enhance workforce productivity by reducing agency spend and implementing the workforce elements of Lord Carter’s productivity review and GIRFT;
  • publicly value frontline leaders’ roles, acknowledging the pressure they are under, take a realistic view of what can be achieved and support them to deliver it; 

  • work with provider trusts to address the leadership pipeline, building the national framework for improvement and leadership development, the aspiring chief executive programme, and the wider work of the NHS Leadership Academy;

The Nursing and Midwifery Council should:

  • continue to progress at pace its review of language requirements for the registration of non-UK nurses, maintaining patient safety and engaging with provider trusts and other stakeholders. 

The NHS national bodies, professional regulators, and professional associations should: 

  • support and enable provider trusts efforts to introduce new roles at scale and pace and develop the existing workforce to work differently, by aligning professional and institutional regulatory approaches and offering professional support. 

Medium term (within two years) 

The Department of Health and the NHS national bodies should: 

  • develop and communicate a coherent and credible strategy for the health and social care workforce, setting out what they think the future workforce needs to look like given the Five-year forward view, STPs, and new care models and what will be done, by who, and by when to at the national level to develop that workforce;

  • ensure the existing ministerial board on workforce is recognised as the forum to coordinate and own this strategy, in collaboration with provider trusts and other stakeholders. It needs to communicate effectively about its work, seek input from a wide range of opinion, be transparent about its work programme and be seen to engage effectively with provider trust leaders;

  • develop a measurable plan with timetables to grow the domestic supply of clinical staff, taking account of relevant factors such as changes to the funding of healthcare education, the apprenticeship levy and targets, the expansion of nursing, and the recent workforce plans for mental health and emergency care workforces. This plan will link to and support the strategy;

  • take action to ensure there is an agreed and publicly accessibly source of timely and accurate national-level, regional, and trust-specific data for key workforce data such as vacancy rates and leaver rates;
  • provide greater transparency of its workforce planning insight and data, for example timely publication of national and regional demand and supply forecasts for the different staff groups, together with the assumptions and any funding constraints that underpin them;

  • work with provider trusts at the sub-national level – for example, devolved, groups of STPs, or STP as appropriate – to support the delivery of locally-owned workforce strategies and plans that support service transformation through provision of timely and tailored workforce planning insight and data. 

Long term (within three to four years) 

The Department of Health and the NHS national bodies should: 

  • work with provider trusts and other stakeholders to explore the opportunities and risks of devolving elements of workforce responsibility and funding – for example medical education and training commissioning, distribution of clinical placement funding. This could be at devolved, groups of STPs, or STP level;

  • develop the capability and capacity of provider trusts to take on this greater role, building on the lessons from the original plans for local education and training boards with strong provider leadership. The return on this investment could be a more engaged, responsive, and productive workforce;

  • build and value local leadership and autonomy as crucial for the success of STPs and new care models.