What is the biggest problem when you think of the National Health Service? Is it the crumbling infrastructure? The long waiting lists for treatment? The inability to access a GP or an NHS dentist? The lack of integration between health and social care? For policymakers grappling with these challenges it can often feel like an impossible list of issues to address.
For many years, the number one issue healthcare leaders have identified of greatest concern is sustainable staffing. Whilst nationally, the overall number of doctors and nurses has been increasing, below the headlines, the data has been grim. There are currently 112,000 vacancies in the NHS. Senior experienced staff have been leaving and retiring early. Last year the equivalent of 75,000 staff were off sick. The bill from bank and agency staff runs into billions. The NHS staff survey reveals a third of staff have thought of leaving in the last year. Whilst nurses have resolved their pay dispute, junior doctors are going on strike for five days next month. Consultants are set to follow soon after.
The Government has had no meaningful plan to deal with all this. A workforce plan has been seriously talked about since 2017 but no proper action has been forthcoming.
So today’s plan is a significant and welcome step forward for several reasons. First it provides some overdue certainty about the future pipeline of domestic recruitment that politicians will commit to. Medical schools are significantly oversubscribed and yet the country faces staff shortages and needs to recruit more from overseas. The plan’s proposal for doubling medical places has been Labour policy since last autumn; so there is now cross party agreement to make this happen, regardless of what happens at the next election. Second the plan comes with clear funding of £2.4 billion over five years. The Treasury has always been reluctant to fund a significant expansion of the medical workforce. This approach has been shown to be a complete false economy and the arrival of Jeremy Hunt, a former Health Secretary, as Chancellor has successfully challenged it.
Third, the plan takes a longer term view which is necessary when looking at the future healthcare workforce given it takes many years to train doctors and nurses. Politicians are rightly criticised for being too short termist (this Government has a particularly short term outlook), so they should be commended for the 15 year modelling included in the plan. Fourth, the plan includes a grounded and sensible three part approach. Expanding the workforce of the future, retaining the workforce we have and reforming careers and the conditions in which staff operate by utilising new technology.
However delivering the plan could prove just as challenging as its long development. Industrial action amongst junior doctors over pay shows little sign of ending. Both the Government and the BMA appear to be in a standoff with neither side showing much sign of movement. The Prime Minister has made halving inflation his number one policy priority. But with inflation still stubbornly high, this plan does not address pay and the associated industrial disputes in any meaningful way. Pressures on services and staff in the short term are only likely to increase as a result.
The capital maintenance backlog in the NHS is now over £10 billion, dwarfing the scale of the workforce investment announced today. Putting more staff into conditions where technology does not work, buildings are not fit for purpose and data and information cannot be shared between teams is not a recipe for improving productivity and working conditions as the plan champions. Where this investment in the modernisation of the system is going to come from remains unclear.
The lack of action on social care will also hamstring the delivery of the plan. This is very much an NHS plan, and whilst there are references on the importance of joining up health and social care through new integrated health systems, the vacancies and pressures in social care – if not addressed – will be a drag on whether the NHS can operate effectively. The plan also says little on managing future health service demand through pushing ahead with new assertive action that can improve the public’s health, an area where the Government is notably inactive at present.
Politically the Government will now point to this plan as an important milestone in building back a better NHS. But thanks to the lack of action in recent years, it is starting from a very difficult position. And as a result practically delivering the ambitions within the plan remains far from certain.
The author is the Founder and Programme Director of Future Health, a thinktank specialising in healthcare.
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