If we really want to deliver the high quality patient care we all want in the NHS, we must change our approach to the workforce so that we have the right number of staff, with the right skills, in the right place.
In our report, There For Us: A Better Future for the NHS Workforce, we diagnose the problems and challenges facing the NHS workforce and then offer some solutions.
More people than ever are using NHS services provided by hospitals, mental health trusts, community services and ambulances. Demand is very high and growing fast. We need more staff than we have to meet that need: emergency admissions are up 10%, ambulance calls are up 15% and diagnostic tests up 19%. Yet the workforce has only grown by 6% since 2014.
There is a gap, and it’s one that is growing and increasingly hard to fill. Recruiting new staff and keeping existing staff is more difficult because jobs on the frontline are getting harder and more pressurised.
“I have worked in the NHS for 45 years and I have never seen so many staff work under such pressure for so long.” These are the plain-speaking words of a trust chief executive talking about the workforce situation in their organisation.
Another trust leader told us: “In particular services, people are leaving because the pressure is so great they are unable to cope.”
Money is a major issue. Many staff have not received a pay rise for many years, despite having seen their jobs become more demanding and their hours longer. And funding is an issue more generally because even if the workforce were available, many trusts cannot afford to recruit more staff. Although the government is shifting on public sector pay, it does need to be delivered without strings attached and with additional money so that trusts themselves aren’t footing the bill.
Right now, according to a trust leader, “the NHS is significantly dependent on the heroic efforts of clinical and non-clinical colleagues”. Relying on discretionary effort is not sustainable. Indeed, 59% of NHS staff, for example, said in the last staff survey that they are working unpaid overtime each week.
It’s finally been recognised that we need to grow the domestic workforce, and the government has plans to expand medical education, boost the number of nurses and look at apprenticeships, for example. However we don’t know if this is enough, and it won’t happen tomorrow. It’s certainly not a quick fix.
In the meantime we must acknowledge that we rely on staff from beyond our shores. Thirteen per cent of NHS staff are from outside the UK. They make a welcome contribution and are helping to plug that gap, and we need them to continue to do so. The uncertainty created by Brexit and issues such as language testing and immigration policy is making this much harder. As one leader put it: “We would not be able to maintain high quality care for the people we serve without our diverse workforce. The current lack of progress in the Brexit negotiations is creating unhelpful uncertainty in an already challenging environment.”
Something that is in trusts’ power is to make their organisations, and the NHS generally, a great place to work. That means going all out to create a positive environment, improving the day-to-day experience for black and minority ethnic staff and adopting a zero tolerance approach to bullying and harassment. Obviously external pressures cut across this, but there is still much that trusts can do.
Everyone in government and the many other national organisations with responsibility for the NHS must acknowledge the scale of the challenge in terms of pay, recruitment, retention, rising demand and the impact of pressurised working conditions on frontline morale. “Staff are the most important factor in delivery – and sustainable staffing is the greatest challenge facing my organisation,” says one trust leader. “I have no real sense that the scale of the challenge is truly understood nationally.”
Even more importantly, they must speak clearly, with one voice, about how to overcome it. It may surprise many to know that there is no single workforce strategy for the NHS, despite its strategic importance.
There is hope and much of it lies in recognising that while they cannot solve things alone, if local organisations had more control and greater room for manoeuvre they could get on with the task in hand, backed up by greater support from the centre.
Yet we also must not ignore the central issue: having enough staff is central to the NHS. It cannot function without them.
Saffron Cordery is director of policy and strategy at NHS Providers
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