The Nuffield Trust admits that it has not addressed geographical considerations, but this is addressed by overcapacity. The fact that even this year only one in 10 applicants to medical school is successful speaks volumes. We need virtual medical schools, adverse selection so that rural and poverty stricken areas are allocated a fair share of doctors to train, and a “tie in” whereby doctors can be induced to stay where they are most needed. The overseas doctors we import will doubtless block the opportunities for our own in 1o years time… if we do train enough.
In Action for health: key areas for action in the health and social care workforce (21st March 2019), the Nuffield Trust summarises in Next Step and Conclusions:
The NHS Long-Term Plan recognises that over the past decade workforce growth has not kept up with the demands on the service and that the NHS now needs a comprehensive workforce plan to tackle staffing shortages, improve working lives and better utilise the talents and skills of the million plus people who work in the health service. Few disagree that the workforce is the make-or-break issue for the NHS over the coming years.
Over the past decade, day-to-day spending pressures have crowded out investment in the workforce. This must stop; this short-termism has not served patients, staff or taxpayers. The government has committed to a new pay deal for NHS staff and will be spending £20.5 billion more on NHS services by 2023/24. These are important and substantial first steps. But to tackle the current pressures in the workforce, much more action is needed, including more investment in training new staff and more support for the development and retention of existing staff. The health service cannot afford the government continuing to view education and training as an overhead cost to be minimised. There needs to be a fundamental shift in thinking to plan for ‘over-supply’ of key groups. If this were done and education and training budgets were increased, broadly back to the funding level in 2013/14, our analysis shows that the NHS has the chance to be self-sufficient – in nurses at least – in a decade’s time. But this won’t happen without investment, policy action and managerial focus now and sustained across the coming years.
In some other areas the management of staffing shortages requires even more radical action. The government has had a target to increase the number of GPs by 5,000 since 2016 (NHS England 2016). It is clear that this is not achievable. Over the next decade and across the NHS primary care will need to move to a wider team-based model in all parts of the country. Transforming primary care to a team model, shifting to train for over-supply, paying people competitive wages and investing in all staff so that they have rewarding jobs with terms and conditions which reflect modern life is critical to closing the staffing gap and delivering high-quality care.
But for the next five years we need to be realistic about what can be achieved – turning around the NHS’s staffing problems will not be quick. For the next few years the NHS can only maintain services by recruiting and retaining enough staff internationally. A positive culture and supportive immigration policy is essential alongside having NHS organisations that are ready to be good employers and help people settle. Even with this, the workforce constraints will inevitably shape and constrain the speed at which health services can be transformed and quality of care improved in areas such as cancer and mental health.
There are no silver bullets for the workforce; addressing staff shortages requires consistent and concerted action across the system on pay, training, retention and job roles. While it is possible to point to individual policy failures in the past that have contributed to the current depth of the workforce shortages, the cause of our current problems goes deeper; workforce has not been a policy priority, responsibility for it is fragmented nationally and locally, the information the NHS needs to understand and plan its workforce is poor and the NHS has not invested in the leadership capability and skills needed to manage the workforce effectively. The NHS workforce implementation plan needs therefore to address not just specific policy areas but also the roles, responsibilities, skills and capabilities needed across the system for more effective workforce planning.
Finally, a key part of good workforce planning and policy needs to include thinking through how the NHS can work much more effectively with partners outside the strict confines of the health service. The past few years have clearly shown that good health depends not just on the NHS but also on the social care system; and an effective training pipeline of skilled staff requires strong partnership with further education institutions and universities, especially if we want to broaden the opportunities to ensure that the NHS has a diverse staff group that properly reflects the society it serves. There are a number of actions that can be taken to improve recruitment and retention in social care. However, workforce challenges in this sector partly have their basis in the poor pay, terms and conditions for social care workers. This can only be addressed by government, first through additional funding in the 2019 Spending Review, and in the longer term through comprehensive reform of adult social care funding.