Earlier this month, the Nuffield Trust, the King's Fund and the Health Foundation released a report detailing the sheer scale of staff shortages plaguing the NHS in England. The three think tanks warn that workforce challenges "now present a greater threat to health services than the funding challenges".
Trusts across the country agree with this diagnosis. In There for us, NHS Providers report on the national workforce challenge published a little over a year ago, two-thirds of trust chairs and chief executives told us that workforce is the most pressing challenge to delivering high-quality healthcare within their organisations.
Scale of the workforce challenge
Widespread consensus on the scale of the challenge is an important starting point, but action is urgently needed to protect and enhance patient care. There are currently over 40,000 nursing vacancies and an overall shortage of over 100,000 staff within NHS trusts according to quarterly data released by NHS Improvement this week. Estimates for primary care make for even bleaker reading with a survey earlier this year suggesting that up to 15% of posts within general practice may remain unfilled.
Two-thirds of trust chairs and chief executives told us that workforce is the most pressing challenge to delivering high-quality healthcare within their organisations.Policy Advisor - Workforce
The think tanks' report sought to emphasise how much worse things will be in 10-15 years if nothing changes, but progress has also been inadequate in recent years, despite the introduction of widely touted recruitment drives and employment targets. This includes the 2015 Conservative manifesto promise to add 5,000 more GPs to the service by 2020, a plan which is set to fail with the number of full-time equivalent GPs 1,400 lower than the point at which this pledge was made.
How did we get here?
Official figures released last week show that the NHS workforce has increased by 5.6% since 2010, with over 54,000 additional staff working within the service than eight years ago. This sounds like a steady gain, but the truth is it hasn't come close to matching the rise in demand for health services. In 2017, there were half a million more people aged over 75 than there were in 2010, and admissions to major A&E departments had risen by over 30% in this period. Growth in this area has not slowed since then, with hospitals now admitting almost 1,000 more patients per day into A&E than at this point last year.
The NHS has also experienced the longest and deepest funding squeeze in its history, with average annual funding increases of 1.1% between 2010 and 2015 and 2.3% since the election that year. This has hit staff directly through 1% annual pay rise caps only lifted for the first time in the best part of a decade in 2018/19. A new five-year funding settlement offering £20.5 billion of additional money – a 3.4% real terms increase per year – is undoubtedly welcome, but our Recovering lost ground analysis showed this will only help to plug the gaps providers are currently facing, leaving little to no room for transformative change within the NHS.
The government will announce its long-term plan for the NHS within the next month and there is hope that this moment will provide significant clarity over the strategic direction of the service for the coming years.
The government will announce its long-term plan for the NHS within the next month and there is hope that this moment will provide significant clarity over the strategic direction of the service for the coming years.Policy Advisor - Workforce
We will have to wait until the end of the year to find out what answers the long term plan – or any supporting workforce strategy – has for NHS staffing shortages, but there is a very real sense that action to plug the gaps and ensure appropriate staff capacity to protect patient care is needed now. At its last board meeting, NHS England said that workforce availability is "the principle internal risk" ahead of a difficult winter trusts are furiously preparing for.
A boom in healthcare education and training numbers is a must for the future, but we cannot take our eyes off the here and now. There are a number of changes national leaders can seek to implement within the next 12 months to stem the tide of healthcare professionals leaving the NHS while opening the door to new entrants.
An immigration policy based on societal, not salary value
The current salary cap of £30,000 for skilled work visas is not fit for the present or future, given the huge number of unfilled nursing (and social care) jobs that will pay below this amount, and the significant decline in EU nurses joining, and remaining in the workforce since Brexit.
Trusts desperately need additional staff which the public value greatly – nurses and doctors were once again measured as the most trusted professionals in the UK this year.Policy Advisor - Workforce
Trusts desperately need additional staff which the public value greatly – nurses and doctors were once again measured as the most trusted professionals in the UK this year – so a post-Brexit immigration policy should value the quality of patient care over income tax take.
Financial relief for UK and international-trained staff
EU employees will be given the opportunity to remain in the NHS through a 'settled status' application. Many trusts have shown a commitment to their staff by offering to pay for application fees, and while the secretary of state feels this is a "good idea", there is currently no intention for government to put forward the funding for this across the country.
An about-turn on this policy could be supported by an exemption on health surcharges for non-EU nationals working in the NHS and tax relief for consultants and managers faced with punitive pension tax charges, both of which would significant funds in the long-run by ensuring providers do not need to place a greater reliance on temporary agency staff.
Fast-tracked development of new roles
The future NHS workforce will rely on a significant expansion of staff working in new roles, whether these are physician associates, nursing associates, advanced clinical practitioners, or other positions. Trusts are eager to employ staff within these roles but frustrated that there has been little progress made to support this direction of travel.
While we expect this to be a focus on the long-term plan, the Department of Health and Social Care should seek to support and enable the regulation of staff in new roles, and consider short-term incentives for both prospective employees and trusts.
Upon his appointment to health and social care secretary in July, Matt Hancock pledged to prioritise the workforce, saying the NHS is "nothing" without its staff: "the millions of people who turn up every day to improve the lives of complete strangers."
The secretary of state's words were encouraging and we therefore look forward to seeing the action is urgently needed to ensure we have an NHS workforce fit for both the present and future.