An employer of over one million people, and support service to many more, the NHS is very much the fabric of our society and has in the last few days set out how it will weave in what it hopes is stability by publishing its Long Term Workforce Plan.
The NHS Long Term Workforce Plan’s publication is long-awaited and comes amid bruising headlines of the sheer scale of the challenges facing the health service and Conservative Government.
High turnover rates of senior staff and high sickness rates place a significant burden on the NHS each year. The need for the workforce to grow and evolve is evidenced by the fact that there were over 112,000 vacancies across the NHS workforce in March 2023.
Given the unique challenges facing the NHS workforce and the length of time it takes to train new clinical staff (particularly new consultants and GPs), a comprehensive and long-term approach to workforce planning is needed now more than ever.
But can the plan’s vision for stability give the NHS the shot in the arm it needs?
What is the workforce plan, why is it important, and what is it proposing?
The plan is a 15-year blueprint setting out how the NHS intends to meet ongoing staffing shortages across the service. It seeks to remedy the very real and unprecedented challenges it faces, which though not exclusively caused by the pandemic, have largely been exacerbated by the challenges of the past few years.
These challenges include grappling with GP waiting times, cutting down cancer treatment waiting times, and shoring up staff retention. Indicative of the 150-page document’s importance, it’s the first time in the NHS’s 75-year history it has produced such a plan; backed by the Government promising funding to the tune of £2.4bn, on top of education and training budgets, over the next six years.
The plan is divided into three facets, train, retain, reform, with much attention given to the train element, owing to the immediate staffing challenges engulfing the NHS.
The flagship policies and targets within the workforce plan, which the Government hopes to realise by 2031, include:
- Doubling the number of medical school training places from 7,000 to 15,000 students.
- Increasing the number of GP training places by 50% to 6,000.
- Raising the number of adult nursing training places by 92%, taking the total number of places to nearly 38,000.
- Incorporating apprenticeships into the health service, seeing 22% of all clinical training coming through this route.
- Expanding dentistry training places by 40%, taking the total of places to 1,100.
There are additional commitments to train more NHS staff domestically, with a broader aim of reducing reliance on international recruitment and agency staff. Current figures show one in four members of NHS staff hail from overseas. In 15 years’ time, the Government expects that figure to drop to one in ten.
Why has it taken so long to publish?
Notwithstanding the overwhelming welcome the plan has received, to say this report is overdue would be an understatement.
In July 2022, the Health and Social Care Select Committee, then-chaired by the former Health Secretary and now-Chancellor Jeremy Hunt, rounded on the Government’s “marked reluctance to act decisively” and publish a workforce plan it had promised in Spring 2022.
In its report on Workforce: recruitment, training and retention in health and social care it called on the Government to stop photographing the problem and deal with it.
Fast forward to the plan’s unveiling, Prime Minister Rishi Sunak was keen to highlight the NHS and Government working diligently to ensure the plan was right for the needs of today, and not rushed.
Will it fix today’s problems?
If you are hoping the plan is a panacea to the problems currently pervading the NHS, then you may be disappointed.
To contend with an NHS workforce currently shy of more than 100,000 staff, the plan to recruit more staff is welcome. As the title promises, however, this is a truly long-term response, given that it takes four years to train as a nurse and seven years as a doctor.
Just as patience was key to the plan surfacing, then, a degree of patience will be needed before we see the effect of upping the annual student intake.
Moreover, increasing student numbers is all well and good, but is there the sufficient demand to fill the places?
We know that meeting the 15,000 magical medical student intake will not be a challenge given how oversubscribed medical degrees are in the UK.
Universities have expressed concern that the number of nursing students is falling, due in part to challenges presented by the cost-of-living crisis. By incorporating apprenticeship routes into the profession, the Government will hope to make NHS careers more accessible, and more reflective of current economic challenges than they once were, with more students earning and learning.
Does more staff mean a more efficient health service?
The state of the NHS is a hugely emotive political topic. Despite having the hearts and minds of the nation, the NHS has been rounded on for perceived inefficiency. Given it accounts for 20 per cent of Government spending, it is increasingly regarded as NHS Plc.
With this in mind, is a heavily funded workforce expansion profligate or prudent?
Analysis from the Health Foundation suggests there is a need to improve productivity. Despite a 10 per cent increase in NHS hospital staffing levels, NHS hospitals admitted close to 800,000 fewer patients in 2022 than in 2019.
Having witnessed winter crises unfold on our screens with ambulances queuing at hospital doors, this drop from 2019 owes to bed blocking. In many cases a patient is ready to go home from hospital, prevented from doing so as there is a lack of staff to get people through the discharge process and into a setting with safe and appropriate staffing levels to support their needs.
Therefore, raising staffing levels alone is part of the solution, but is not the silver bullet for a creaking system with a significant number of players: Hospitals, primary care, community care and social care are interconnected and all need attention.
The legacy and impact of a global health pandemic, Russia’s invasion of Ukraine, and a teetering economy has trickled down to apply sharp pressure on households, requiring Government to roll out short-term support.
The long-term workforce plan having a future focus has provided the sector with surety that there is at the very least a willingness to nurture an NHS with stability and sustainability at its heart.
Reflecting recent u-turns in Government policy, most notably scrapping plans for social care reform, the workforce plan will require the commitment and will of Sunak’s Government and subsequent Westminster administrations.
Ultimately, even if the workforce plan is not the panacea to all of problems pervading the NHS, it is a starting point for the direction and strategy that those connected to the service have long called for. For the plan to have real chances of success, it will now be crucial to secure consensus and commitment from all parties over the next 15 years.