How can we plan the future NHS workforce with incomplete information?

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Discussions about the NHS workforce have been prominent in the current election campaign and arose during the recent health debate. The main parties have made various pledges about increasing the numbers of NHS staff. Conveniently round numbers such as ‘20,000 more nurses’ or ‘5,000 more GPs’ have hit the headlines, but is there the money to fund these roles or the eager trainees to fill them?

Before we get to those questions we need to think about whether we actually need more staff on this scale. All of the anecdotal evidence we’ve gathered on access problems and an increasing reliance on agency nurses suggests the answer is a very emphatic ‘Yes’. However, our recent report Workforce planning in the NHS demonstrates that we don’t know nearly enough about the numbers or nature of the workforce currently delivering NHS-commissioned services.

The Health and Social Care Information Centre (HSCIC) collects data about the NHS workforce from the electronic staff record. This provides information on numbers of staff directly employed by NHS providers (hospitals, community trusts, etc) but it does not systematically include information on:

  • other providers that are delivering NHS services, such as social enterprises, voluntary sector providers or other independent providers
  • temporary clinical staff, such as locum doctors or agency nurses.

Given the increasing plurality of providers delivering NHS-commissioned care, and the growing reliance on temporary staff, it is evident that the dataset we use is incomplete. It is therefore insufficient for understanding patterns and trends in the NHS workforce or for identifying, with any certainty, the challenges it faces.

Take the example of district nurses. Our report shows the number of district nurses has declined over time. This might be partly explained as a response to the Transforming Community Services agenda, in which primary care trusts transferred provision from their provider arms to a range of different organisations. It might be the case that overall numbers haven’t declined, but that a greater proportion of district nurses are now employed by non-NHS providers and so are not captured in the HSCIC data. Or maybe the overall number of district nurses has actually declined.

But the point is, we just don’t know.

Instead we rely on anecdotes, surveys, FOI requests and political soundbites. We cannot possibly begin to discuss future workforce numbers in a meaningful way until we get a better grip on the data about the current workforce delivering NHS services.

Health Education England (HEE) is responsible for the future workforce delivering NHS-commissioned services – regardless of the type of organisation providing those services. Given that HEE is making decisions on how to spend an £8 billion training budget, it is worrying that it is doing so on the basis of incomplete information.

It could certainly be argued that we are now in a desperate situation – we have an ageing population with increasingly complex care needs, and insufficient doctors and nurses to deliver that care. But how did we end up in this position? Maybe nobody noticed the warning signs, or perhaps nobody had a comprehensive understanding of workforce trends over time and whether these aligned with the ambitions for the future delivery of health care.

We urgently need a more comprehensive and systematic dataset that captures information on the whole workforce delivering NHS-commissioned services. It is only through doing this that we can build an understanding of the entire clinical workforce, including staff in temporary roles and those employed by non-NHS providers. It is this comprehensive picture that will allow HEE and others to tackle the challenges they face, and give us all a better chance of identifying emerging issues before they become major problems.