A new briefing from leading think tanks highlights the alarming risks created by shortages in the healthcare workforce which could reach up to 250,000 by 2030. So what does this mean for the aims and ambitions of the forthcoming NHS Long Term Plan?

The briefing, entitled ‘The health care workforce in England: make or break?’, draws on a new forecast of staffing gaps in the 1.2 million-strong NHS workforce to stipulate that the yet-to-be-announced plan may be unachievable from the outset. From 100,000 staff vacancies at present, it is thought that by the end of the next decade one in six health service posts could be empty.

Experts from leading health think tanks The Health Foundation, The Nuffield Trust and The King’s Fund warn that shortages could reach more than 350,000 if the NHS continues to lose staff from abroad without being able to attract others to fill the posts. According to Candace Imison, Director of Policy at the Nuffield Trust, the situation has “reached a critical juncture,” adding that “unless the NHS Long Term Plan puts in place urgent and credible measures to shore up the workforce both in the short term and in the longer term, it risks being a major failure.”

The NHS Long Term Plan will set out how the health service will change over the next ten years in response to funding boosts announced this year. However, even before the extra funding, the briefing suggests the NHS was not able to recruit effectively due to an incoherent approach to workforce policy, poor planning and restrictive immigration rules.


A need for flexible funding


In response to the briefing, Danny Mortimer, Chief Executive of NHS Employers, suggested what is needed is “more flexibility with the use of the apprenticeship levy as well as reinstating funds to support CPD and workforce development.”

According to the report, funding for education and training dropped from 5 per cent of health spending in 2006/7 to 3 per cent in 2018/19, the equivalent of a £2bn drop. Further challenges come from concerningly high levels of health staff leaving service before the age of retirement.


The five tests


The briefing sets out five tests for the NHS Long Term Plan. These tests would require a ‘funded and credible strategy’ to:

1)     Address the immediate workforce shortages. Urgent measures are needed to address shortages in certain jobs and locations, such as radically boosting international recruitment in the aftermath of Brexit and improving staff retention.

2)     Deliver a sustainable workforce over the next 10 years. This will involve expanding training places and apprenticeships and will require the government to look into financial incentives to attract more nurses.

3)     Support new ways of working across the health and social care workforce. Including making better use of the skills of some existing staff– such as a far greater role for nurses, pharmacists and physiotherapists in family doctors’ surgeries.

4)     Address inequalities in recruitment, pay and career progression. Tackling gender, race and other inequalities must be a key feature of national and local workforce strategies.

5)     Strengthen workforce and health service planning. This should involve a much more coherent and transparent approach to planning and strategy development.


In response to the report, Emma Broadbent, Director of Revalidation and Registration at NMC, said: “It’s encouraging to see that the number of nurses and midwives on our register from the UK and countries outside of the EU is increasing, and we look forward to welcoming the first qualified nursing associates in January.”

However, she also called for more to be done to “retain the highly skilled workforce we have” by investing in training and career development. This goes beyond acute trusts and applies to all corners of increasingly integrated health and care systems in England.

“We are currently short of at least 6,000 GPs in England, and if this isn’t addressed, it is our patients who will ultimately bear the brunt by not being able to see their GP when they need to,” said Professor Helen Stokes-Lampard, Chair of the Royal College of GPs.

Equally serious are the pressures and strains on the social care workforce, where there is a ‘critical interdependence,’ with health, the three organisations argue. This sector is even more reliant on ‘low-skilled’ migration, currently experiencing exacerbated levels of uncertainty due to Britain’s exit from the European Union.


What about funding?


The NHS received a crucial funding increase from the Chancellor of £20.5bn in the Autumn Budget. However, for these funds to be used effectively, a reasonable portion must be spent on workforce training and development.

Richard Murray, Director of Policy at The King’s Fund, said: “Unless the NHS long-term plan is linked to a credible strategy for recruiting and retaining staff, there is a real risk that some of the extra funding pledged by the government will go unspent and waiting lists for treatment will continue to grow.”

This is a real concern as we await further details of the NHS Long Term Plan due to be published before the end of the year.


More than just recruitment


Of course, workforce needs are not just related to numbers. It is also about ensuring staff are trained and adequately skilled to deal with patients that have increasingly complex health and care needs and an ageing population.

The briefing comes amidst drives to boost the adoption of new technologies in health and social care which take advantage of new digital capacity and innovation. However, politicians must remain aware that these advances are no substitute for a strong and capable workforce.

Recruitment, training, career development and retention of staff must all be looked at to avoid a potential crisis in the NHS and wider health system. This requires long-term planning as, unlike emergency funding, a functioning workforce cannot be delivered overnight.

“It takes 10 years to train a family doctor,” commented Professor Stokes-Lampard, reinforcing the need to take a long-term view. While trainee numbers are at the highest rate ever, this does not alleviate pressures on the system now and may still lead to pressures in the future as demands on all aspects of health are set to increase.

It is clear that these issues must be addressed in conjunction with systematic change to integrate health and social care, the delivery of prevention strategies and existing pressures in the primary and acute sectors. “The NHS is overstretched and services are being compromised by serious staff shortages,” commented Anita Charlesworth, Director of Economics at the Health Foundation.

On the current trajectory, things are set to get worse. “The NHS can’t sustain current services, let alone improve, with such a large and growing gap between the staff it needs and the people available to provide care,” she added.


What are the impacts of staff shortages?


Firstly, the quality of care delivered in all aspects of the health system will decrease. Without adequate staff to manage demands, wait times will likely increase, meaning patients will be in a worse condition by the time they are able to receive treatment and, in some cases, may not be treated in time at all. It may also mean that certain elective procedures are withdrawn to the detriment of patients.

However, the impacts are not just limited to patients. Existing staff will be placed under greater levels of pressure as they struggle to meet the needs of patients across the breadth of the system, increasing the likelihood of mistakes, burnout and decreasing standards of patient care.

Now is the time to address workforce concerns, or at the very least develop a credible strategy to do so, if the NHS Long Term Plan is to have a chance at being successful.