England’s new workforce strategy ignores the elephant in the room

It’s taken 25 years and the biggest staffing and funding crisis in the health service’s history, but at long last our civil servants have managed to produce a workforce strategy for the NHS.

The new workforce strategy for England lays bare the scale of the current crisis. There are 45,000 clinical vacancies, of which 36,000 are nurses. Learning disability services and some parts of London have vacancy rates of over 15 per cent. As the strategy acknowledges, each vacancy represents a pressure on the system – a pressure on finance, patient safety and staff wellbeing.

But the truly worrying data within the strategy relates to the current workforce dynamics in the NHS. Firstly, newly trained clinical staff are not going into the service: 17,000 nurses, midwives and allied health professionals (AHPs) went on to the professional registers between 2015 and 2017, but only 7,000 of them joined the NHS.

Meanwhile, the rate at which staff are leaving the NHS is growing. In nursing it has risen from 7.1 per cent in 2011/12 to 8.7 per cent in 2016/17. Attrition in mental health services grew from 3.1 per cent to 13.6 per cent in 2016.

Given the scale and depth of the current workforce problems in the NHS, the draft strategy’s lack of any detailed modelling for the future NHS workforce beyond 2020/21 is deeply surprising. Essentially, we have one graph which projects demand on the basis of economic growth and supply as an extrapolation of overall workforce growth between 2014 and 2017. The modelling does nothing to acknowledge:

• the underlying growth in demand for health care (although this is acknowledged elsewhere in the report)
• the growing inability of the NHS to attract newly qualified health care professionals
• the age profile of the current workforce, which we know is growing older
• the rising rates of attrition including earlier retirement.

The prospective gap of 72,000 staff by 2026/27 described by the strategy could be a significant underestimate.

Perhaps less surprising – given the loss of Health Education England’s training budget for the non-medical workforce and recent cuts to the continuing professional development (CPD) budget – but certainly disappointing, are the actions laid out in the draft strategy in response to the growing workforce crisis.

It’s all good stuff: campaigns in schools and elsewhere to promote the NHS as a place to work; advice and support for NHS providers to improve retention; some specific actions in priority areas; continuing support for return to practice; support for more flexible working including regulatory changes; and exhortations to better integrate service and workforce planning. But overall, it feels wholly inadequate compared to the scale of the workforce challenge. And I haven’t even touched on the social care workforce – covered in six pages of the 140-page report.

Of course, the report represents the beginning of a discussion. Health Education England have put the draft out for consultation. Let’s hope politicians realise that the answer to the question ‘what measures are needed to secure the staff the system needs for the future and how can actions already underway be made more effective?’ lies in more than further productivity gains.

The real answer would include NHS and social care providers redressing recent real terms falls in pay and keeping salaries on a par with the private sector. It would include radically growing the budget available for CPD. The shift to courses being funded by student loans would need to be reviewed, potentially reintroducing bursaries in high-priority disciplines or geographies. Last but not least, it would see services getting the funding they need to meet growing demand. The number one reason staff are leaving the NHS is the growing pressure they are experiencing in the workplace.

The elephant in the room, and in this strategy, is an underfunded and overstretched NHS.