The NHS at 70: is the workforce fit for the future?

This year, celebrations have been taking place around the country to mark the 70th anniversary of the National Health Service. Much has changed since the birth of the NHS, including the nature of disease, the costs of care and increased life expectancy. The NHS needs an agile, highly-skilled workforce that can foster a patient-led, integrated health and social care system. But right now, the NHS workforce is in crisis — with major deficits in staff numbers and staff time.

The rise in demand and its effect on performance

The UK population is projected to increase by 5.5% over the next ten years — to 69.2 million by 2026. People are living longer lives, and consequently needing more long-term care from the health service. And so the number of people accessing the health service is set to rise significantly. But the strain has already been showing for some time. The King’s Fund state that between 2003/4 and 2015/16 the number of attendees at major A&E departments in England rose by 18%, while the total referrals to outpatient services have increased in the last decade from 3.6 million to 5.8 million.

The NHS is struggling. This is reflected in the decline in performance over recent years, most acutely seen in the national waiting times targets that act as a barometer for the health service. Performance against the four-hour A&E waiting times target has declined, with around a quarter of emergency departments missing the target in early 2018. Waiting times for elective care and cancer treatment have also slipped, with warnings that some hospitals will cancel operations — including cancer operations — because they simply can’t keep up with demand.

The scale of the challenge

With demand set to rise higher and higher, the NHS needs a highly skilled, agile and well-staffed workforce. But there is currently a major deficit in the supply of staff and resources, creating three major challenges:

• Shortage of frontline clinical staff: for example, the number of junior doctors taking up specialist training posts has fallen and there is a 9.4% vacancy rate for nurses, midwives, and allied health professionals. This is likely to be an underestimate of the real need, since hospitals can’t always afford to staff at optimum levels.
• Resource and training: lack of progression, low morale and high pressure means too many skilled staff are leaving the service. In July last year, the Nursing and Midwifery Council released figures that showed for the first time ever, more nurses and midwives were leaving the profession than joining it.
• Financial: the pay levels, and quality of training available, worsens morale and worsens retention. Survey analysis by Deloitte Centre for Health Solutions UK highlights that NHS leaders responsible for workforce planning felt that an immediate priority was to “improve retention rates for those already in the workforce.”

These challenges make the NHS a less attractive place for potential recruits — and reduces the ability of our NHS to retain talent. While the NHS has traditionally relied on international recruitment to fill these gaps, there is widespread concern that Brexit — and the Government’s approach to immigration more broadly — could limit this route. Between July 2016 and July 2017, the NMC reported the number of nurses and midwives leaving the register dropped by 89%.

How can we fix this?

Several changes are needed if we’re to fix the recruitment and retention issues the NHS currently faces. Focusing on the following areas could help achieve this:

• Working environment: improve professionals’ experience of work by ntroducing more flexible work patterns for all staff.
• Recruitment: relieve the strain by increasing the number of pre-registration training places for nurses, midwives, and doctors, coupled with reinstating student bursaries for training healthcare professionals.
• Agile workforce: make better use of existing staff by formalising allied healthcare roles of physician assistants. Provide more opportunity for flexible training, career breaks and progression through better integration of non-consultant, non-training grade doctors within the NHS. Introduce fast-track training routes for experienced healthcare assistants to become Nurses.

These recommendations are a foundation. But a long-term sustainable funding solution for the health service is required if its workforce is to become sustainable. According to current projections by the Institute for Fiscal Studies, the government’s current NHS funding gap is £20 Billion. If not corrected this deficit will leave the NHS unable to invest in schemes to improve retention and increase staff numbers.

The NHS employs about 1.5 million people. It would be nothing without its people — and especially in times of strain, where staff routinely go above and beyond, just to keep it afloat, because they care. Put simply: if the NHS is to survive, it is imperative that it overcomes the current workforce challenges. To do that, we need investment, a change in culture, and more opportunities for staff.

Dr Martin Edobor is a Doctor specialising in General Practice, a Fabian Executive member and a former Young Fabians Chair. He is a member of the Fabian Health Policy Group.

To find out more about the Fabian Society’s health policy group, contact healthgroup@fabians.org.uk or follow us on Twitter @HealthFabians