NHS trusts are operating against the backdrop of widespread workforce shortages. At the end of June there were over 107,000 vacancies across the NHS, including nearly 42,000 nursing posts and 11,500 doctors. Comparable data is not available for the same time last year but it is clear is that overall vacancies have been rising, and recruitment and retention difficulties are likely to intensify over the winter.
Increasingly, workforce shortages across different specialisms are resulting in trusts having to resource services differently or change how or where they are provided. Endoscopy is a good example of this. In some areas of England there is a shortage of endoscopists. One trust told us that the risk to services was so critical and the potential impact in terms of diagnostic and cancer performance so serious that they have had to bring in an independent endoscopy service at a much higher cost. Other trusts have to outsource some diagnostic services and elective work because of staff shortages.
Many trusts, alone or collectively, are trying to recruit health care staff from overseas. However these costly international recruitment drives, both within and outside the EU, are not providing the numbers of staff required. A combination of the decision to leave the EU and requirements of the international English language testing system (ILETS), has resulted in a significant cut to the supply line of EU workers. However, historically the UK has always relied on international recruitment to address domestic supply problems. This is compounded by the uncertainly around Brexit which is also a concern for the provider sector as we head into winter.
Increasingly, workforce shortages across different specialisms are resulting in trusts having to resource services differently or change how or where they are provided.
Given the current labour market conditions, to manage increases in demand existing staff often go the extra mile to help provide the best care for their patients. To fill gaps in rotas many staff work additional hours, work paid overtime or extra bank shifts. Trusts also have to use agency and locum staff where they cannot fill a gap internally. All these measures come at an additional cost to the trusts compared to a permanent employee on a substantive contract.
Last winter this was absolutely clear with staff sleeping in hospitals over night or walking miles through the snow to ensure they would get to work. The goodwill and dedication of staff will no doubt shine through again this winter but this is not sustainable with high risk of burnout and increased the likelihood of sickness absence. Mindful of the need to provide a supportive workplace environment, trusts are placing a strong emphasis on helping their staff to deal with winter pressures even more effectively than last year.
Workforce challenges remain the biggest concern for trust chief executives and a priority which must be addressed in the long term plan and accompanying workforce strategy.