How do we address the greatest workforce crisis in NHS history?

The government has shown a “marked reluctance” to act decisively as the NHS and the social care sector face the greatest workforce crisis in its history, according to a damning new report from health and social care select committee.

The report published today (Monday) said there is currently a shortage of 12,000 hospital doctors and over 50,000 nurses, but no credible strategy to address it.

It states that refusal to do proper workforce planning also risks the government’s principal aim for the NHS, which is to tackle the Covid backlog.

Without transparency on projected workforce numbers, the committee said that there can be little confidence amongst the public, and little confidence amongst the NHS and social care workforces, that the government has got a firm grip on the crisis in which it finds itself.

The result is that many of the exhausted workforce are considering leaving€”and if they do, pressure will increase still further on their colleagues.

Workforce shortages are a long-standing problem

For years, health organisations have begged the government to pay heed to the ‘tsunami’ about to hit the NHS as the gap grows between the demands on services and the staff and resources available to provide care.

These problems have been further exacerbated by the Covid-19 pandemic, with a General Medical Council report finding that more than half (59%) of doctors are struggling with a heavy workload, working beyond rostered hours at least once a week.

In August 2021 alone, the NHS lost two million full-time equivalent days to sickness, including over 560,000 days to anxiety, stress, depression, or another psychiatric illness.

It also comes as two-thirds of A&E clinical leads said they are not confident their organisation will safely manage winter pressures and the Royal College of Physicians (RCP) claims the NHS is ‘woefully underprepared’ to cope with the ageing population.

No workforce planning in the Health and Care Bill

Last year, a letter published in the Times and signed by the chief executives and senior representatives from the Health Foundation, the King’s Fund, NHS Confederation, Academy of Medical Royal Colleges, NHS Providers, Nuffield Trust, National Voices, the BMA and the Royal College of Nursing set out how the Health and Care Bill would be vital opportunity to learn from past failures and improve workforce planning.

They called on the government to amend the Bill to ensure that in future England has robust, independent projections of the health and social care staff that the country will need.

It said that a properly staffed health and care system is central to recovering services after Covid-19 and continuing to deliver the care that patients need and expect.

The letter added: “It takes time to train professionals working in health and care, from nurses and doctors to pharmacists and carers, and so we must act now to prepare for the challenges we know are coming in future with an ageing population.”

“It is time to stop photographing the problem and deal with it.”

On three occasions during the passage of the Health and Care Act 2022, the government voted against amendments which would have required the Secretary of State for Health to publish independently verified assessments of current and future workforce numbers every two years.

Dame Helen Stokes-Lampard, Chair of the Academy of Medical Royal Colleges, told that committee that no organisation should fear a report just because it does not like the outcome, and because it suggests that we might need more of something.

She added: “It does not hinder planning in other areas of our life and society. We create plans. We look to the future. Even if we cannot resource them to the hilt right now, at least we can plan, and we know where we are aiming to get to.”

Recommendations from the report

The committee recommended that the new Secretary of State for Health lays before Parliament objective, transparent and independently audited reports on workforce projections for health, public health, and social care that cover the next five, 10, and 20 years.

These reports should state current staffing levels, future staff projections, and an assessment of whether sufficient numbers are being trained in each profession, specialty, and sub-specialty. Demand should be modelled on demographic changes in the patient population and amongst staff, and should consider the role of technology, and changes to costs and treatments.

It added that it will not be possible to re-recruit those who have voluntarily surrendered their medical licences without addressing the factors which caused them to do so. For many retirees, this means addressing pensions and the development of ‘retire and return’ policies. For others, this means addressing poor workplace cultures.

Other recommendations include:

• The government should review the provision of affordable and flexible childcare for people working in the health and social care sector, and assess whether it is possible to improve it.
• The NHS must commit to a review of flexible working arrangements in all Trusts, with a view to ensuring that within 12 months all NHS staff have similar flexibilities in their working arrangements to those enjoyed by locum or agency staff.
• The government must act swiftly to reform the NHS pension scheme to prevent senior staff from reducing their hours and retiring early from the NHS.
• The workforce plan for pharmacy must consider that by 2027 all newly qualified pharmacists will be independent prescribers and ensure that these graduates are given protected learning time, adequate supervision, and career development opportunities.
• NHS England must ensure that temporary, bank, and agency staff are given full access to NHS training to allow them to level up their skills, to ensure that they are able to sign up for additional shifts.
• Tackling racism is a recruitment and retention issue, and the NHS and government must take it extremely seriously.
• There should be greater accountability from NHS senior and middle management for the reduction of incidents of racist discrimination amongst staff. This should include explicit equality, diversity, and inclusion responsibilities in senior leadership job role descriptions, against which the performance of senior leaders is reviewed, and to which their pay and promotion is linked.
• It is important that the government looks at ways of improving short term efficiency to promote positive mental health and headspace for all frontline workers. It could do this through looking at ways to reduce bureaucracy -perhaps through the use of technology – and reducing the time that frontline workers spend on administrative tasks.

Government has no plan going forward

The British Medical Association (BMA) said a lot of these recommendations and solutions are proposals that they and others have been making for a long time. It added that the report is a damning indictment of a government that has completely failed to take any meaningful action on workforce issues, and has no plan going forward.

It added: “Doctors are sick of being undervalued; whether that’s through years of cuts to our wages, being forced to pay for the luxury’ of parking at our own workplaces, or having no access to a decent meal on night shifts. We’re working in crumbling buildings with outdated and unreliable IT systems that make our jobs more difficult and take valuable time away from treating patients.

“The NHS is its staff, but we cannot run it on good will alone. If the government continues to ignore this – or continued warnings from reports like this – the impact on health professionals, patients and the very health of our society does not bear thinking about.”

The Royal College of Physicians added it has been calling for concerted action to address the workforce crisis in health and care for several years, and today’s report further underscores the need for this.

Sir Andrew Goddard, president of the RCP, said: “While there have been some positive developments, such as confirmation from the Department for Health and Social Care that a workforce strategy will be published by the end of this year, and that progress to regulate physician associates will get underway by the end of 2022, we still have far more to do to ensure the health and care system has enough people. We are expecting far too much of the workforce at present which is being evidenced time and again by growing vacancy rates and poor employee satisfaction.

“As the Conservative party leadership contest continues, the RCP and other medical royal colleges have urged both candidates to make health and care a priority, including by committing to planning and providing a health and care workforce that meets the needs of the population.”