The workforce crisis enveloping the NHS could soon eclipse funding as the most serious problem.
There are tens of thousands of vacancies, far too few new staff are coming through; the pressure on those in post is relentless and morale is dangerously low.
The number of clinicians in the NHS has risen by 26,000 since 2012, but this has been outstripped by the creation of 62,000 more posts – including many established in the wake of the Mid Staffordshire scandal – which means vacancy rates are climbing.
The number of emergency medicine consultants has grown 32% in five years, yet demand for specialists to cope with rising A&E attendances means many hospitals are unable to fill their vacancies. Trust managers live in dread of being accused of running unsafe staffing levels, but there are 29,000 unfilled nursing posts.
The consequences of cuts have been severe. According to the National Audit Office, annual nurse training places were slashed by more than 3,000 – 19% – in the decade up to 2014-15.
The NHS has always struggled to match the supply of staff to its needs. In another effort to grip the problem, Health Education England (HEE) was set up in 2012 to oversee workforce planning. Many health service managers claim it is out of touch with the needs of hospitals and clinics, underestimates the size of the problem and lacks a sense of urgency.
HEE’s commissioning of training is driven by intelligence from local NHS organisations, but it is questionable whether modelling reflects the staff numbers or skills required to deliver new models of community-based care.
HEE’s room for manoeuvre is constrained by money and the long timescales for training staff. The first nurses in training commissioned by HEE will only graduate this year, and the benefits of work being done now to increase the number of consultants will be felt at the end of the next decade.
HEE will unveil its workforce plan in the next few weeks, but its chief executive, Ian Cumming, made clear in his NHS Confederation conference speech last Thursday that the biggest challenge is increasing retention. The arithmetic underscoring this is horribly clear – more staff are leaving the NHS each year than are joining from education and training.
The focus on retention will put the onus on trusts to solve the problem. The worst performing trust loses more than a third of its nursing staff every year, more than three times the rate of the best performers.
Retention problems are exacerbated by growing anger over public sector pay restraint. Even the health secretary, Jeremy Hunt, hinted that he would be making representations to the Treasury. But Cumming stressed that the most common reason for leaving the NHS was inflexible working arrangements.
Flexible working is a great way to retain and motivate staff, but the impact can be profound. He said the reduction in average hours worked by GPs in recent years is the equivalent of losing roughly 10% of the doctors in post.
At the conference the NHS Improvement chief executive, Jim Mackey, identified another serious problem – morale. He is concerned that the unremitting pressure on staff is undermining their resilience. If morale collapses it will hammer retention.
The near total collapse in EU nurses registering to work in UK since the Brexit vote shows the danger of relying on overseas recruits to top up staff numbers. There is a global shortage of clinical staff, with intense competition between countries to recruit and retain them. While HEE is pursuing initiatives such as training Indian nursing students, the sinking value of the pound makes working in the UK a less attractive proposition.
The government needs to stop hiding behind soundbites about more people working in the NHS than ever before and ensure there is a workforce plan that trains far more UK talent. Employers need to offer flexible employment practices that retain and motivate valuable staff and HEE needs to secure the trust and respect of local leaders.
Report courtesy of the Healthcare Professionals Network.