Lifeline or sticking plaster? A new staffing plan for the NHS at 75

The NHS turned 75 earlier this month yet it is arguably experiencing its most challenging period in memory. With over 100,000 vacancies already, large numbers of staff are leaving the institution to work elsewhere, retire early or work as agency and locum staff. For years a workforce plan has been promised, and now the government has announced a new £2.4 billion long-term plan to recruit and maintain the workforce needed to address the complex health challenges of today and the future.

More funding for more staff might be the headlines, but does it go far enough? Is simply more investment needed or, as some commentators say, is there a need for more fundamental change if the NHS is to reach 100?

A recent report from the King’s Fund revealed that the NHS is performing “substantially less well” than the health systems of 18 comparable countries. The report finds that, while the NHS performs relatively well on some measures of efficiency and provides protection for the population from the potentially devastating effects of ill health in key areas, it falls substantially behind in many others. Underfunding, staff shortages and a poorly resourced social care sector are all impacting the provision of care.

The report’s author, Siva Anandaciva, the King’s Fund chief policy analyst, concludes “there is little evidence that one individual country or model of healthcare system performs consistently better” and that improving healthcare often comes through improving the structures already in place rather than root and branch change.

So, what might that look like for the NHS?

At the end of June, health secretary Steve Barclay set out the government’s NHS long-term workforce plan. It’s based on three core pillars:

• Train: A new £2.4bn investment to educate and train staff, with more apprenticeships, alternative routes into medicine and the creation of new roles. The plan also considers shortening the length of some medical training.

• Retain: Slowing down the rate at which staff are leaving the NHS by offering better career support, boosting flexible ways of working, and improving culture and leadership across the NHS.
• Reform: The plan suggests new ways of working that will “help build broader teams with flexible skills.” Advances in technology and treatments will, of course, be explored to help the NHS modernise and meet future requirements.

Are these proposals enough?

While there are some clear positives, many of the proposals are light on detail and fall short in several key areas.

For example, the government aims to train and recruit over 100,000 new healthcare professionals across England, but with one third of staff reporting burnout in the 2022 NHS staff survey, and recent cuts to staff support services, attracting new recruits may take more than just funding for training places. Richard Murray, chief executive of the King’s Fund, said “there is much more that can be done to make the NHS an attractive place to work and build a career.”

For healthcare communicators there are at least two major strategic challenges: to engage and energise existing and new staff; and to involve the public in embracing new and very different ways of experiencing NHS care and services. The NHS will be aiming to meaningfully engage with staff when developing plans to improve workplace culture, but the workforce is exhausted, and the mood is fractious. Indeed, the plan encourages an assessment of “the effectiveness of current methods of staff communication.” Do the proposals themselves demonstrate the listening approach they champion, however? For instance, given the significant, ongoing levels of industrial action across the health service, the report is notably quiet on pay.

It’s also argued that training more staff won’t necessarily alleviate workloads, but could see senior clinicians supervising even more students, a view upheld by the General Medical Council who report that “trainers already feel under pressure.”  So we’ll need more trainers too. But more fundamentally, it takes a long time to train clinical staff, over 12 years for a consultant. This plan was needed when promised early in this government’s life in 2010.

Finally, underinvestment in social care creates a significant bottleneck issue for the NHS. Without more capacity in social care, many patients, who need to be discharged for care elsewhere, are left occupying hospital beds. Bed blockages in hospitals result in ambulance queues at the door, unable to hand over patients and attend other calls. Given the call for more integrated ways of working, many commentators have called for “a sister plan for social care.”

The road ahead

The NHS long-term workforce plan is welcome because, to put it bluntly, it’s been a long time coming. Yet, while the government has now put pen to paper, making it a reality, and delivering on promises will be much harder. The plan will need sustained and increased capital and revenue funding for training and staff, plus facilities and equipment for them to work with and in. Technology, data analytics and more scientific and technical staff (of whom there is no mention) will be key enablers, but we’re without the details.

Given this is a ‘long-term’ plan, and NHS performance is stagnating whilst unmet demand grows, it will be a while before we see any real, substantive change promised by these proposals. Let’s hope politicians commit to the long road ahead and secure the staff and public support essential to the plan’s success.