The NHS Long Term Plan is a 10-year strategy for transforming the NHS, but all the investment in infrastructure is meaningless unless there are trained and staff available to use it. The NHS may employ a staggering 1.3 million people, but even that’s not enough to meet the growing demands of an ageing population. The Interim NHS People Plan sets out how the health service will respond in the here and now to the challenges set out in the Long Term Plan
‘More of the same will not be enough,’ the Interim NHS People Plan begins. To be fit for today, and tomorrow, more staff doing the same won’t be enough. The new workforce planning must reflect the dynamic economic and societal circumstances it finds itself in; it must ensure staff are prepared and skilled enough to embrace the potential for technology – and the positive noises around investment in training and development must be matched with cold, hard cash. More fundamentally, the NHS must tackle some of the bureaucratic and administrative quirks – like the pension-contribution penalties that are stopping GPs from working extra shifts – to increase faith among staff.
The Interim NHS People Plan aims to ‘grow the NHS’s workforce, support and develop NHS leaders and make our NHS the best place to work.’ The plan itself is, as the name suggests, the first iteration of what will be a wider strategy for change, which uses the NHS Long Term Plan as its blueprint.
“The NHS is its people,” said Dido Harding Chair of NHS Improvement at the launch of the Interim Plan. “This plan clearly acknowledges the workforce challenges the service faces. I want frontline NHS staff to know that we have heard their concerns about the pressures they face and we are determined to address them.”
There are six key challenges identified in the plan:
- Make the NHS the best place to work: we must make the NHS an employer of excellence – valuing, supporting, developing and investing in our people.
- Improve our leadership culture: positive, compassionate and improvement-focused leadership creates the culture that delivers better care. We need to improve our leadership culture nationally and locally.
- Prioritise urgent action on nursing shortages: there are shortages across a wide range of NHS staff groups; however, the most urgent challenge is the current shortage of nurses. We need to act now to address this.
- Develop a workforce to deliver 21st century care: we will need to grow our overall workforce, but growth alone will not be enough. We need a transformed workforce with a more varied and richer skill mix, new types of roles and different ways of working, ready to exploit the opportunities offered by technology and scientific innovation to transform care and release more time for care.
- Develop a new operating model for workforce: we need to continue to work collaboratively and to be clear what needs to be done locally, regionally and nationally, with more people planning activities undertaken by local integrated care systems (ICSs).
- Take immediate action in 2019/20 while we develop a full five-year plan: we can and must take action immediately, which is why we have set out a focused set of actions for the year ahead while we continue our collaborative work to develop a costed five-year People Plan later this year.
At the launch plans were unveiled to immediately increase the number of undergraduates studying nursing at UK universities by 5,700. In order to provide a more rapid introduction to the workforce there are plans to expand the number of staff in recently created new roles, including increasing the number of nursing associates to 7,500, offering a career route from healthcare support work to registered nursing.
Acknowledging the pension challenges that are causing some GPs and nurses to turn down extra shifts, there are plans to address these issues – although, at this stage, specifics are thin. In understanding the issues staff have, there are plans to conduct a major staff engagement exercise this summer which will lead to the creation of an explicit offer to staff covering the issues they say matter to them including access to flexible working, career development and the best possible support from line managers. This, alongside other developments, will support the creation new models of multi-disciplinary working that could improve the integration of primary and secondary care.
“In the long term, the NHS needs to become more self-sufficient in training its own nurses,” said Suzie Bailey, director of leadership and organisational development at The King’s Fund, reacting to the plan. “The immediate nurse shortfall is so severe that it can only be plugged by ethically recruiting an additional 5,000 nurses a year from countries with an over-supply of healthcare workers.” This controversial practice could be made more difficult once the course of Brexit has been agreed – a situation the plan fails to tackle adequately.
At a time when the NHS is, as usual, a political football, Suzie pulls no punches about systemic and prolonged under-investment. “The plan acknowledges the damage caused by the government’s education reforms, including the abolition of student bursaries, yet offers little action to address this.”
Focusing on the significant challenges facing primary care, the focus on retaining existing, experienced GPs in the workforce was welcomed by Professor Helen Stokes-Lampard, chair of the Royal College of GPs. “Training capacity in primary care must be developed, and the funding must be provided so that hard-pressed GPs have the time, resources and suitable premises to deliver the training for the future generations of GPs and the wider team.”
A vision – like words – is cheap. What really matters is investment, a case which Professor Lampard firmly makes. “Whatever the next iteration of the plan looks like, it’s essential that the forthcoming spending review ensures there is sufficient funding to deliver it.”
Let’s hope health and social care secretary Matt Hancock is listening.
You can access the full Interim NHS People Plan here.