Workforce Shortages Endanger Delivery Of The NHS Five Year Forward View

A new report by The King’s Fund argues that shortages and other critical pressures within the NHS workforce could jeopardise plans outlined in the NHS five year forward view to deliver new models of care.

Workforce planning in the NHS analyses recent trends and pressures in three key areas of the workforce critical to the delivery of the new models of care, finding that each is under serious pressure:

• mental health – the number of inpatient nurses has fallen sharply by 15 per cent over the past five years, resulting in a significant rise in the use of agency staff and a two-thirds increase in requests for temporary mental health nurses since the beginning of 2013/14
• primary care – well-documented pressures on general practice have led to fewer training posts being filled and more GPs planning to retire early, resulting in a growing shortfall in the number of GPs
• community nurses – while the number of health visitors has increased by nearly a quarter over the past five years, the number of senior district nurses has fallen by 30 per cent and there are now 16 per cent fewer community matrons.

The report also underlines the increasing reliance on agency staff among NHS organisations. The Fund’s analysis of recent figures provided by NHS Professionals – the leading provider of agency staff to the NHS – shows that requests for temporary hours more than doubled between April 2012 and January 2015. The report use of temporary staff on this scale represents a substantial financial burden for the NHS at a time when budgets are stretched to breaking point and risks reducing quality of care.

The report highlights changes made at a national level to improve workforce planning, including the establishment of Health Education England (HEE) to provide greater strategic oversight and the introduction of 13 regional local education and training boards (LETBs) to co-ordinate training at a local level. However, while the establishment of Health Education England has led to improvements in planning the workforce of the future, the report argues that it is unclear who is responsible for managing the workforce needed today.

The report calls for a clear plan for the NHS workforce to support the ambitions set out in the NHS five year forward view. This should focus on:

• improved data – a lack of national data, particularly for temporary staff and the independent sector, makes long-term planning very difficult
• better national leadership – stronger, more strategic leadership from national bodies involved in training and developing the workforce of the future
• greater collaboration – across local and regional levels to deal with short- to medium-term workforce pressures in a more joined-up and systematic way
• improved consistency between local and national levels – better co-ordination is needed between bodies responsible for training staff to meet national ambitions and the expectations of local organisations employing staff
• robust assessment of supply and demand – there is currently inadequate national-level assessment of supply and demand for most areas of the workforce.

Rachael Addicott, Senior Research Fellow at The King’s Fund and the report’s lead author, said: ‘The workforce is a key asset for the NHS and is pivotal in meeting the health needs of current and future patients. We need the right people in the right place, able to adapt their skills to changing demographics and work together to support new models of care. However, the trends we are seeing are moving in the opposite direction, with an increasing over-reliance on temporary staff and a “black hole” in the data needed to make effective workforce plans.

‘Staff working for the NHS in 2015 will essentially be the workforce of 2020, so it’s crucial we have the right information to plan locally and nationally for retention and retraining as well as recruitment. National bodies will have to demonstrate leadership on this issue and local leaders should better co-ordinate efforts in their communities and regions to meet current need and build the future workforce.’