NHS Staffing 'a Make-or-Break' Issue, Says Report

Peter Russell

March 21, 2019

Urgent action is needed to avert a staffing threat to the delivery and quality of health and social care over the next 10 years, a report by three leading think tanks concluded.

The analysis by the Health Foundation, the Nuffield Trust, and the King's Fund amounted to a warning that the long-term plan for the NHS in England to improve GP services and mental health care could falter unless deep-rooted staffing issues were addressed.

Closing the Gap

The report, Closing the Gap , followed an inquiry 3 years ago by the same institutions which warned that staffing shortages in NHS Trusts could top 250,000 unless urgent action was taken.

The latest report comes ahead of publication of an NHS workforce implementation plan, due for publication this spring, which could prove a "pivotal" moment for the health service, according to the report.

Nurses' leaders said the findings should raise "alarm" in Westminster.

However, the Government said extra funds were being ploughed into training and recruitment, including an additional pledge to improve nurse retention by at least 2% by 2025, equivalent to an extra 12,400 nurses, and to introduce new national arrangements to support NHS organisations to recruit staff from overseas.

The latest report warned that problems with staffing levels could only be addressed if budgets and polices returned to levels not seen for the past 4 to 5 years.

Also, in the lead up to Brexit, it warned that an emphasis on recruitment from abroad was needed to prevent worsening staffing shortfalls after the UK left the EU.

Doctors and Nurses

Anita Charlesworth, director of research and economics at the Health Foundation, said: "The NHS doesn't have enough nurses today and without action this problem is going to get significantly worse over the coming years. The workforce is the make or break issue for the health service and unless staffing shortages are substantially reduced the recent NHS long-term plan can only be a wish list."

The report said that without decisive action, nurse shortages would double to 70,000, and GP shortages in England would almost triple to 7000 by 2023-24.

The report's analysis of general practice found that the shortfall in the number of GPs was now so serious that it could not be filled at all. It suggested that the only way forward was to use pharmacists and other health professionals to fill any gaps.

On social care, the authors state that ministers would have to go back to the drawing board to formulate an immigration policy to attract foreign workers for England's social care system.

"NHS workforce shortages are mirrored in social care where poor pay and conditions continue to drive away staff," said Richard Murray, chief executive of the King's Fund. "Social care is heavily reliant on overseas recruitment, but the government’s post-Brexit migration proposals risk limiting this vital source of workers."

The report concluded that "having enough staff working in the NHS means that staff will not feel overstretched and will be able to provide the level of care they aspire to deliver, limiting the number of people who leave due to being disillusioned with their ability to help".

The  Closing the Gap overview urged a radical expansion of nurse training, with cost of living grants of £5200 a year, and a tripling in the number of people training as postgraduates, to help solve the impending problem.

On nursing, the report found that that even with grants and expansion of postgraduate training, bringing 5000 more students onto nursing courses each year, a staffing shortfall could persist until 2023-24.

It said policy should have a wider scope than recruitment and focus on addressing the problems caused by staff retention, particularly in "lack of work-life balance, bullying, low morale, and low pay".

Reaction to the Report

Responding to the report, the Royal College of Nursing (RCN) said it wanted to see an immediate £1 billion funding to encourage more people to train as nurses.

Dame Donna Kinnair, RCN acting chief executive, said: "The staggering numbers in this report should cause alarm in Whitehall and focus the minds of Ministers on the cash they must put on the table to close the gaps. Nursing staff are the first to admit that, despite straining every sinew, the care of their patients is too routinely compromised by these shortages.

“It’s good to see the think-tanks echoing our argument that the supply of nurses cannot be increased without very significant new funding for undergraduate and postgraduate nursing courses."

The Royal College of General Practitioners (RCGP) said it disagreed with the report authors that the problems with GP recruitment were insurmountable. Its chair, Prof Helen Stokes-Lampard, said: "We have already seen that with effective messages, campaigns and innovative thinking we can get across what a fantastic career being a GP can be with the right resources and support."

Funding a Future Health Workforce

A spokesperson for the Department of Health and Social Care said: "Across the NHS there are tens of thousands more doctors and nurses on our wards since 2010 and thanks to their dedication, thousands of patients get excellent, safe care every day.

"We're supporting our workforce by putting general practice at the forefront of our long-term plan for the NHS, in addition to funding towards up to 20,000 more staff working in GP practices – helping to free up GPs to spend more time with the patients who need them.

"We're also making funding available to increase university training places for nurses by 25%, exploring how flexible working can better support existing staff and the upcoming workforce implementation plan will set out how we can ensure the NHS has the staff it needs for future years."

Dido Harding, chair of NHS Improvement and head of the NHS workforce implementation plan, said: "Our staff are our biggest asset and so, it is vital we do more to retain, recruit and develop them across both health and social care.

"The NHS long-term plan set out our ambition to make the NHS a great place to work, to transform our workforce, and grow the number of doctors and nurses, so that we can deliver a 21st Century NHS for our rising and ageing population.

"I welcome this report which will help inform the development of our workforce implementation plan, the Interim plan for which we expect to publish in April."


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