An open letter to the Chancellor

Chief Executive of The King’s Fund, Richard Murray, has written an open letter to the Chancellor, the Right Honourable Rishi Sunak, to outline why health and care services need the stability of a multi-year funding deal.

Dear Chancellor

A commitment to grow and support the health and care workforce was at the heart of the government’s election manifesto. The ambitious pledges to deliver more doctors, nurses and other health and care professionals, alongside commitments to improve staff morale and increase funding for training and development, were warmly welcomed by our organisation and others in the health and care sector.

Last year, we worked with the Nuffield Trust and The Health Foundation to produce Closing the gap, a comprehensive analysis of the policy levers available to address workforce shortages, with modelling of how they could be used in combination. This underlined the workforce crisis in health and care and showed that ensuring the right supply of health and care staff, while developing the support and leadership needed for them to want to continue working in the sector, will require sustained action for a decade. Since then, the pandemic has increased pressure on health and care staff and severely restricted the ability to recruit much needed colleagues from abroad, which is the main way of keeping the workforce viable while longer-term measures are developed.

There has been no national NHS workforce strategy since 2003. The key change needed is to shift beyond short-term initiatives and take a more strategic approach, as the Public Accounts Committee and many other bodies, including ourselves, have recommended. The government has introduced some welcome measures to address staff shortages including the introduction of maintenance grants for student nurses, increased funding for nurse apprenticeships and changes to visa rules for NHS staff. However, the NHS People Plan 2020/21 does not constitute a strategic workforce plan and it is not clear that the initiatives announced so far will add up to the sustained balance of inter-linked policy, funding and leadership actions that our research showed is needed.

The decision to undertake a one-year Spending Review, rather than the comprehensive, multi-year approach originally planned, is a pragmatic response to the economic uncertainty created by the Covid-19 pandemic. However, it risks reinforcing the short-termism in health and care workforce planning that has been so strongly criticised by the PAC and others, and jeopardising delivery of the government’s manifesto commitments. Funding for professional education, training and national workforce functions sits outside the NHS budget and has therefore not been agreed beyond the current year. Agreeing a funding settlement for the remaining years of this parliament – as has been done for NHS funding – would be both a practical enabler and a powerful statement of intent for a strategic, sustained approach to NHS workforce planning.

Public appreciation of health and care staff and concern for their wellbeing have never been higher, yet the workforce crisis remains urgent. To develop and support the health and care workforce will require long-term effort underpinned by clarity about the funding available over multiple years. The decision to provide multi-year funding for defence shows that your government is able and willing to make positive commitments in priority areas and, as the pandemic has highlighted, the health and care workforce is one of this country’s greatest assets. We hope that you will use the opportunity provided by the Spending Review to underline the government’s commitment to meeting its manifesto pledges and support the long term approach to NHS workforce planning the country needs by delivering a multi-year settlement for NHS training, education and development.

Yours sincerely

Richard Murray, Chief Executive, The King's Fund