Policy and planning for NHS workforce – ‘not fit for purpose’

CREDIT: This story was first seen in OnMedica

National policy and planning for the NHS workforce in England is not fit for purpose, OnMedica reports.

This is the conclusion of a report published by the Health Foundation. The report also found high staff turnover and instability across the NHS, and a drop in the number of trainee nurses.

Rising pressure: the NHS workforce challenge analysed trends in the NHS workforce and found increasing cause for concern, including:

  • The NHS workforce increased by two per cent in the year to April 2017, but this masks critical variations – a rise in managers and consultants but a drop in nurses (0.2% decrease in the year to April 2017) and GPs (0.7% decrease from December 2016 to end of June 2017).
  • Increasing admissions and decreasing nurse numbers risks overstretching nurses and undermining progress made in nurse numbers since the Francis report. Outside hospitals there have been declines in community nurse and health visitor numbers.
  • The government has promised 21,000 new posts in mental health by 2020, but there are reservations about whether the target is achievable, or will provide staff with the right level of skills.
  • 1,220 fewer students applying from England had started undergraduate nursing degrees this year, based on data from the end of the university clearing round. While the number of 18 and 19 year olds increased, there has been a big fall in older students.
  • The government is aiming to recruit 2,000 GPs from overseas over the next three years, but just 38 were recruited in the first six months of 2017.

Increasing workforce instability in the NHS – caused by a high turnover of staff – is costing the NHS both financially and by reducing continuity of care for patients, warns the report. It notes wides variations across the country, with the annual leaver rate at some trusts hitting 30%. At these trusts a huge amount of time, money and management effort is required on recruitment, just to maintain the same headcount, states the report.

Further consequences of the lack of coherent of workforce planning can be seen in “the muddled implementation” of the switch from bursaries to student loans for nurse training, which was intended to allow the number of student nurses to expand, the report states.

However, there has so far been a drop of 1,220 in the number of students applying from England starting undergraduate nursing courses this year – the report identifies the two biggest reasons for this as the poor implementation of the reforms, and even poorer communication from government departments.

Significantly, there has been insufficient focus on the specific needs of older applicants, who until 2017 accounted for 40% of the total number.

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Anita Charlesworth, director of research and economics at the Health Foundation, said: “There is a growing gap between rhetoric about the government’s ambitions to grow the NHS workforce, and the reality of falling numbers of nurses and GPs.

“This year has been characterised by a series of one-off announcements and initiatives, beset by unrealistic timescales and no overall strategy.

“The challenges and risks ahead for the NHS are well known, and must be met by collective action, led by the government to put in place a coherent strategy to provide a sustainable workforce for the NHS.

“With winter approaching and staffing numbers in critical areas once again declining, the NHS will be relying on the efforts of its staff to meet the inevitable rising pressures. But in the long-term, both the people working for and the people using the NHS deserve better.”

Commenting on today’s report, Janet Davies, chief executive and general secretary of Royal College of Nursing, said: “The drop in the number of nurses this year is deeply worrying, and particularly damaging when nurses are having to cope with rising numbers of patients.

“The reduction in students begs the question of how the promised expansion in nurse numbers in the future can be achieved. The drop in the number of students applying to nursing degree courses earlier this year – after ministers removed student funding – could only be dismissed if all the places were filled.  But now we learn that over a thousand fewer students began nursing degrees this autumn.

“It is shocking to learn that some parts of the NHS are losing almost a third of their entire staff every year. We know that low levels of pay and inadequate staffing are exacerbating already poor morale among nurses – the huge sums being spent on perpetual recruitment at these trusts is money that should be spent on patient care.”

However, a Department of Health spokesperson told OnMedica: “Patients can be assured that the NHS has the staff it needs to provide the best possible care — over 12,700 more doctors, 10,600 more nurses on our wards and over 5,600 fewer managers and senior managers since May 2010.

“We have a clear plan to ensure the NHS remains a rewarding and attractive place to work, including more flexible working for nurses and greater safeguards for junior doctors, alongside an historic 25% increase in undergraduate medical school and nurse training places.”

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