Workforce challenges will define the government’s record on the NHS

The NHS – like all health services – is critically reliant on its staff. For the government the success with which it handles the current array of workforce challenges will increasingly come to define its record on the NHS.

In the immediate weeks and months ahead, the government will need to find a way through the minefield of NHS pay, staffing shortages and the surge in agency spending. With deficit reduction firmly in place, the pressure to keep NHS pay rises to a minimum will continue, with all the risks this brings to industrial relations. Yet this needs to happen in tandem with attracting permanent staff into the NHS to reduce the number of vacancies and bring down agency spending – something that Secretary of State for Health Jeremy Hunt has committed to today. This interplay of pay, recruitment and managing down agency costs all needs to be done while delivering on the government’s own priorities of high-quality and safe care (also known as safe staffing and nurse–patient staffing ratios) and keeping a grip on A&E and 18-week waiting times.

All this is required just to keep the NHS delivering existing services within budget. Added to this is a new set of commitments to seven-day working and easier access to GPs (or primary care more generally), the latter presumably made possible by the related – but very challenging – pledge to recruit 5,000 more GPs. Achieving seven-day working across the NHS would be a challenge at the best of times, but this new commitment comes at a time when the immediate pressures of recruitment and retention are already exceptionally acute, particularly for general practice. In the hospital sector, the potential need to reform staff contracts and the certain need for a change in the way staff work while still controlling the pay bill look no less daunting. However, with the Prime Minister’s Challenge Fund investing in innovative ways to improve access in primary care and examples of best practice in seven-day working across the NHS we can hope that working differently (rather than just working harder) may hold the key.

Our recent report underlined the long-term difficulties the NHS has experienced in converting national aspirations for more community-based services and better mental health services into actual staff on the ground. With the NHS five year forward view re-emphasising the need to develop new services in new settings, the NHS must also plan for the workforce of tomorrow while managing the workforce of today. This may mean making better use of the skills of existing staff such as pharmacists and physiotherapists. But it will almost certainly mean developing new skills and developing new staff roles. With the long lead times in training the clinical workforce, the NHS cannot afford to wait until 2020 to re-think the workforce that it will need or to start implementing changes.

The NHS needs a comprehensive workforce strategy that meets all these challenges – immediate operational and financial issues, new policy commitments and the need to place the NHS and its workforce on a sustainable path for the future all at a time when money is in very short supply – and that understands the inter-relationships between them. With national workforce responsibilities spread across a range of organisations and without the regional footprint provided by the old strategic health authorities, meeting the challenges successfully will need close co-operation across multiple organisations. So while NHS funding is perhaps at the top of most people’s concerns on health, it is the (admittedly intertwined) approach to workforce that will determine the government’s legacy.

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