NHS plan falls short on national staffing crisis
NHS England has published its much anticipated 10-year plan. It maps out an ambitious vision of improving healthcare. Headline announcements say that it will “save 500,000 lives” by focusing on detection and shifting money to GPs, mental health and community care. Since the plan’s release few have knocked its ambition, but there is widespread frustration that it fails to confront what experts are calling a “national emergency” in NHS staffing.
The plan acknowledges that “in the past decade workforce growth has not kept up with the increasing demands on the NHS” but also admits that the budget to expand the workforce “has yet to bet set by government”.
It answers the growing pressure on services through proposals to reorganise and treat patients in different settings away from hospitals.
- more patients are to be treated by new community-based teams, lessening the pressure on hospitals.
- new technology will be employed to reduce the 400,000 face-to-face appointments each year in outpatients and GP practices
Promises for more nursing and medical training places have been welcomed, but a string of charities and organisations have strongly criticised the lack of a funded strategy to respond to the workforce crisis.
"This plan cannot be delivered whilst trusts still have 100,000 workforce vacancies."
"This plan cannot be delivered whilst trusts still have 100,000 workforce vacancies. We need urgent action to solve what trust leaders current describe as their biggest problem.” explains Chris Hopson of NHS Providers that represents NHS hospitals.
A fundamental block to the publcation of the NHS workforce strategy could be the need for more resources. Economists analysing the government’s spending commitments have already concluded that the headline figure of £20.5bn over the next five years funding is not enough to match the projected costs.
Eight years of record underfunding has left many NHS providers with persistent debt. Last year 44% per cent of trusts overspent their budget by £1bn. Many have been forced to take out expensive loans from the Department of health. It therefore remains unclear how NHS bosses will be able respond to the targets set by government and set about recruiting the staff they need.
How big is the capacity crisis?
Across the NHS the number of staff vacancies is rising sharply suggesting that many trusts are finding it even harder to recruit. In the summer NHS England announced that 107,000 jobs were unfilled, including 35,000 nurse posts and nearly 10,000 doctor vacancies - enough to staff 10 large hospitals. A situation described as "dangerously" understaffed.
Some trusts are losing almost a third of staff each year. Managers are spending huge amounts of money “just to stand still” concluded a report by the Health Foundation
The gap between NHS staffing levels and patient demand has been growing. An analysis by the NHS Support Federation shows that over the last five years the number of outpatients has risen by 24% and emergencies are up by nearly a third and yet the number of nurses in hospitals has risen by only 4%, doctors 12% and therapists 6%.
Since 2013, the number of mental health patients accessing services across England has risen by 30%, while the number of doctors has fallen by 2% and the number of mental health nurses by 1%. The number of beds for mental health patients has slumped by 13% (2,954) across England.
GP numbers have barely risen, despite a government target to recruit 5000 more. While between 2007-14 the number of patient contacts rose by 16%.
The staffing crisis in the NHS is deepening so fast that the service could be short of 350,000 key personnel by 2030, health experts have warned. They blame, “an incoherent approach to workforce policy at a national level, poor workforce planning, restrictive immigration policies and inadequate funding for training places"
International comparisons confirm that the NHS operates with very low staffing levels.
The UK has the third-lowest number of doctors among 21 OECD nations, with just 2.8 per 1,000 people. It also has the sixth-smallest number of nurses for its population with just 7.9 per 1,000 people.
The lack of a workforce plan was identified by a Lords report into the future of the NHS over nearly two years ago. The government has promised a plan but has yet to produce it the current publication date pushed back to later in 2019.
Last year a report by the Health Foundation concluded that the NHS England planning was “not fit for purpose.”
This weakness threatens to undermine the entire NHS plan.
UNISON head of health Sara Gorton said: “Finding the NHS more staff, and holding on to those it already has, is key to the success of the government’s plan. The plan is honest about the scale of the staffing challenge. But nothing will happen without more money to attract new recruits and train existing employees. The government must act now, or its plan will fall at the first hurdle."
These two graphs from the the Health Foundation show how staffing isn't keeping pace with demand. Below the number of nurses registering from overseas, a crucial component of the NHS workforce, has fallen significantly as the uncertainty around Brexit increased.