In June 2023, the Conservative government finally published a long-term workforce plan. Although initially welcomed by the Royal Colleges and NHS organisations, it soon became clear that there were problems with the plan and many are sceptical about whether it will lead to sufficient increase in staff numbers. More details of the plan can be found here and criticisms of the plan can be found here.
The 151 page workforce plan document sets out how the NHS is going to train thousands more doctors, nurses, and other healthcare workers to fill the current vacancies in the NHS (currently around 112,000) and to provide staff for the predicted increase in demand over the next 14 years.
The government projections are for the number of people over the age of 85 to grow by 55% by 2037, and this risks a shortfall of NHS staff of between 260,000 and 360,000 by 2036-37.
If the plan is successful, the government believes the NHS will have 300,000 extra doctors, nurses and other health professionals by 2037. The key to achieving this is, according to the government plan, training, retention and reform.
Criticisms of the plan include over the planned reduction in length of medical degree courses (5-6 years to 4 years) and the general vagueness around who will train the expansion in medical students. There is also uncertainty over funding, particularly after the first 5 years of the 14 year plan.
The most striking thing about the plan is the total absence of any mention of pay and its importance in retention. The NHS is currently experiencing a wave of strikes over pay involving a broad spectrum of clinical staff, the latest being consultants and radiographers, yet the plan makes no mention of pay whatsoever.
Pay is “the elephant in the room” according to the Hospital Consultants and Specialists Association, and the BMA noted that:
“Training new doctors will be to no avail if they don’t stay in the workforce, so the focus on retention is important – but doctors need to be valued fairly for their work and expertise or they will leave for better-paid jobs elsewhere. This plan is set up to fail if doctors’ pay continues to be eroded, the pay review process continues to be interfered with and pay disparities across the public health system persist.”
In October 2023, the cross-party Public Accounts Committee heavily criticised the workforce plan in a report, in particular the lack of funding estimates and it has “serious doubts” on how the plan will be achieved.
The committee notes that the “unfunded and uncosted” workforce plan, which promises to train thousands more GPs and double medical school places, risks placing the NHS under ‘unsustainable financial pressure’ in the future.
Dame Meg Hillier MP, chair of the committee, said: “The government and health system need to be alert to the serious doubts our report lays out around the workforce crisis, both the approach to tackling it now and the additional costs funding it in the future.”
This plan has been a long time appearing. In July 2022, the Parliamentary committee noted that the Government has shown “a marked reluctance to act decisively.” The workforce plan promised in the Spring had not yet been published.
Pressure from organisations within the NHS for a funded workforce plan increased. In November 2022, a coalition of over 100 health and care organisations, including the Royal College of Physicians (RCP), signed a letter to the Chancellor in support of publishing the NHS long-term workforce plan in full, including assessments of how many staff will be needed to keep pace with demand.
As well as not producing a workforce plan, they voted against an amendment to the recent Health & Social Care Bill that would have required the government to publish independently verified forecasts of the workforce numbers needed across the NHS to ensure that services are safely staffed.
To protect the patients the NHS must have the right number and mix of staff, with the right level of education, qualification and experience. Numerous studies show that low nurse staffing levels were associated with higher rates of falls and deaths and major safety issues in midwifery. These include The Keogh review, the Berwick review, and most recently the Ockenden review of midwifery.
The parliamentary committee’s report noted:
“The persistent understaffing of the NHS now poses a serious risk to staff and patient safety both for routine and emergency care. It also costs more as patients present later with more serious illness.”
