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Spending review cuts led to fewer nurse places, says HEE chief

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Health Education England would “have almost certainly” commissioned more adult nurse training places if it had not been subject to funding cuts by the Treasury, its chief executive Ian Cumming has revealed. 

Mr Cumming said HEE had invested more money in nurse training to deliver a 15% increase in university places during the last three years but the Treasury’s decision to award only a flat cash settlement to 2020 meant its annual workforce plan had to be hastily rewritten, with training numbers balanced against what it could afford.

“Retention is one of the biggest areas we have got to start focusing the system on in the next year”

Ian Cumming

The national workforce plan was published by HEE in December after being delayed. It included a 1.8% increase to adult nurse training places – less than many people in the sector had predicted.

Mr Cumming said the spending review had a “significant impact on every line of the workforce plan”. HEE might have commissioned “an extra couple of hundred” adult nurses were it not for the changes made by the chancellor in November.

Mr Cumming said: “If it was more important to train more nurses we could have taken posts out from somewhere else but we made a conscious decision to try and balance this in terms of what we think is needed.

“If we had more money we would have almost certainly commissioned more training posts,” he told Nursing Times’ sister title Health Service Journal.

He added that HEE had to live within the resources it was given. “We are still paying for earlier years because nursing is a three year course so the costs keep going up and that’s a challenge for us.

“If we had more resource available then we would probably have commissioned more adult nursing places than we are intending to commission [in 2016-17].”

“If we had more resource available then we would probably have commissioned more adult nursing places”

Ian Cumming

However, senior figures within HEE remain confident that the level of extra nurse training places commissioned over the last three years will be sufficient to meet the future needs of the NHS.

Mr Cumming said HEE had increased the numbers of nurses by 2,575 from 2014 as well as tackling university attrition rates. Despite this, HEE predicts adult nursing numbers will grow by just 9.8% by 2020, the lowest growth of any profession.

He said the biggest barrier to achieving the predicted 80,000 increase in the total NHS workforce by 2020 was a failure by employers to tackle poor retention of existing staff.

He said: “Retention is one of the biggest areas we have got to start focusing the system on in the next year because we can keep training more and more people, but if we are not keeping the people we have already trained we are stacking up problems and costs for the system.”

He said “enormous variability” in retention rates between similar NHS providers could not be explained by consistent factors such as pay. “There is something else – what makes a good employer? Is it access to training, leadership and management? Whatever it is, it is making a difference and we want to understand that,” he added.

“We will use our clinical placement funding to incentivise places in certain parts of the country”

Ian Cumming 

Mr Cumming also warned that predicted workforce demand up to 2020 submitted to HEE by employers did not reflect changes in service provision outlined in the Five Year Forward View.

He said: “In some part of the country we have seen a demand line, looking forward three, four or five years, that reflects a much higher level of activity than is being predicted through the Five Year Forward View assumptions. We need to make sure our workforce assumptions are compliant with the forward view.

He said HEE had no issues with what trusts were demanding now but “what we are querying is their figures for five years’ time”.

HEE is facing £70m in extra costs this year but Mr Cumming said savings would be made through changes in the way it provided some non-education based services.

He said: “It’s about prioritisation around what we do. What we are looking at doing is taking that £70m out of a mixture of running costs, money spent on the current workforce and some of the national programme money we have.

“It’s not going to decimate anything but it is going to effectively send quite a clear statement that we are going to have to prioritise producing the nursing and other workforce that people want in the future, which will squeeze our abilities in other areas.”

From 2017 HEE will no longer commission training places. The government plans to end the student bursary for nurse and allied health professional training places and switch to a student loan system.

Although this will mean HEE will not be responsible for training places, Mr Cumming said it would retain control through use of the placement tariff fees worth up to £150m, which are paid to providers to cover the costs of students.

He said: “We will continue to fund clinical placements for nurses and AHPs for the minimum numbers we think the NHS needs.

“We will go through a process to determine how we are going to allocate that £150m to ensure we get the right mix of professions across the country, both geographically and by profession. We will use our clinical placement funding to incentivise places in certain parts of the country,” he added.

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Readers' comments (3)

  • When unemployment was over 2M and health staff were only a year or so into their pay freeze there was not the pull of alternative employment. It is very different now after three years of pay freeze, two years of a 1% pay cap and prospects of another three years or so of the same pay cap continuing so I think Mr Cumming is playing down the remuneration factor in recruitment and retention. Nobody can be sure of the effect of switching to loans instead of bursary on recruitment. Why health professional health training not be thought of justifying ring fencing is a puzzle. I wonder if Mr Cumming can furnish the service with the figures equivalent to a parallel profession - teaching. According to a Guardian article teaching lost 50,000 in 2014 and there are 100,000 trained teachers who have never worked in a classroom!

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  • BINGO - also retention, such as the number not nursing post qualification or who have left services without retiring. The question is not always about lack of money but also bad conditions, bad care legislation, bad management/ leadership and approaches pushing nursing staff out. I suggest the number leaving may equate where a government national approach is being implemented and not working.

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  • I think it's absurd , I think that Bad management,bad care legislation , it's the real answer.

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