NHS leaders will shortly publish a long-term plan, which will set out their ambitions for the health service in the context of the recent funding settlement. We also await the outcome from the consultation on the draft national workforce strategy published by Health Education England in December 2017, as well as the green paper on the future of social care, which should contain important detail on the equally critical and fundamentally connected issue of the social care workforce.
We believe that the workforce challenges in the NHS in England now present a greater threat to the delivery and quality of health services than the funding challenges.
This briefing sets out the reasons why the long-term plan and a supporting workforce strategy must address these urgent and mounting challenges:
- Across NHS trusts there is a shortage of more than 100,000 staff. Based on current trends, we project that the gap between staff needed and the number available could reach almost 250,000 by 2030. If the emerging trend of staff leaving the workforce early continues and the pipeline of newly trained staff and international recruits does not rise sufficiently, this number could be more than 350,000 by 2030.
- The current shortages are due to a number of factors, including the fragmentation of responsibility for workforce issues at a national level; poor workforce planning; cuts in funding for training places; restrictive immigration policies exacerbated by Brexit; and worryingly high numbers of doctors and nurses leaving their jobs early.
- Central investment in education and training has dropped from 5% of health spending in 2006/7 to 3% in 2018/19. Had the previous share of health spending been maintained, investment would be £2bn higher.
- Current workforce shortages are taking a significant toll on the health and wellbeing of staff. There is also evidence of discrimination and inequalities in pay and career progression, which must be addressed.
- If substantial staff shortages continue, they could lead to growing waiting lists, deteriorating care quality and the risk that some of the £20.5bn secured for NHS front-line services will go unspent: even if commissioners have the resources to commission additional activity, health care providers may not have the staff to deliver it.
Given these issues, the forthcoming long-term plan must be clearly linked to a strategy to address the workforce crisis. We believe the plan and a supporting workforce strategy will need to pass five key tests. Our tests require that the plan includes a funded and credible strategy to:
- address workforce shortages in the short term
- address workforce shortages in the long term
- support new ways of working
- address race and gender inequalities in pay and progression
- strengthen workforce and service planning at all levels of the system.
The long-term plan must give clear direction about where to invest the new funding to meet changing needs, address the capacity constraints and put in place or set in train the long-term changes that are needed to ensure that, in 10 years’ time, the health system delivers both high-quality care and value for money to the taxpayer. None of this can be achieved without major changes to the health care workforce. A plan that does not have these issues at its heart will simply be a wish list, not a credible path to a sustainable future.
The Health Foundation, The King's Fund and the Nuffield Trust (2018) The health care workforce in England: Make or break? Joint briefing. www.nuffieldtrust.org.uk/research/the-health-care-workforce-in-england-make-or-break