Failure to have an adequate nurse workforce plan for the NHS over the past 10 years is one of the major reasons for current escalating deficits among trusts in England, MPs have been told.
Economics and policy experts told the Commons’ health select committee this week that savings had initially been made in the early part of the decade by holding down pay for staff and employing fewer nurses.
“That failure to have a really fit-for-purpose workforce strategy is one of the underlying issues at the heart of the deficit”
The plan to employ fewer nurses was based on the expectation that demand would lessen – through fewer hospital admissions – and that nurse to patient ratios could be reduced, said one expert during an evidence session on health and care finances.
But the strategy proved unsustainable, she said, causing trusts to re-employ nurses at a higher cost from 2013 onwards, when safe staffing initiatives were implemented.
Anita Charlesworth, director of research and economics at the Health Foundation think-tank, said: “I think the most important thing, both about why we are now in the financial mess we are in, and what we need to do, is about workforce issues.
“The NHS was really planning on needing fewer workers. We reduced the number of nurses we brought in from other countries in the early years of this decade, and reduced the numbers in training. And we’ve also seen fewer numbers coming through return to practice,” she told the committee of MPs.
“[Reducing nurse numbers] was predicated on both the ability to reduce demand and the belief we could work those nurses hard through reducing ratios”
“That was predicated in essence on both the ability to reduce demand – the number of admissions that would be coming into the system – and the belief we could work those nurses hard through reducing ratios,” she added.
“That proved to be unsustainable….That failure to have a really fit-for-purpose workforce strategy is one of the underlying issues at the heart of the deficit,” said Ms Charlesworth.
The current NHS deficit is projected to reach £2.3bn by April, by which time around 90% of acute hospitals are forecasted to be in the red, according to recent figures published by the King’s Fund think-tank.
In addition, NHS England’s five-year plan for the health service launched at the end of 2014, called for £22bn savings to be made by the NHS over five years – in combination with an additional £8bn in government funding – to plug an estimated £30bn hole in the budget by 2020.
King’s Fund chief economist on health policy John Appleby
When asked how the NHS would make £22bn savings by that time, all of the experts raised concerns, suggesting previous tactics to cut costs could not be repeated again.
John Appleby, chief economist at the King’s Fund, noted that the NHS had achieved savings in the past few years partly by holding down staff pay, but he said he doubted this could continue up until 2020.
“There are groups in the NHS now who have had a pay freeze for five or six years. That may carry on and you be able to cut costs in that way, I just have my doubts you could do that for another four or five years,” he said.
Nigel Edwards, chief executive of think-tank the Nuffield Trust echoed his comments, saying a pay freeze for the next four years “doesn’t seem plausible”.
“There are groups in the NHS now who have had a pay freeze for five or six years. I have my doubts you could do that for another four or five years”
Meanwhile, Ms Charlesworth called for a “co-ordinated plan to address the workforce problem” in a bid to achieve some of the required savings.
It should include a “concerted” return to practice scheme for nurses, training more nurses and improving retention by understanding why so many leave before the age of retirement, she said.
“Critical to being able to hold down the pay problem – hold down the agency cost problem – is being able to recruit and retain, and the nursing workforce is the big part of that,” said Ms Charlesworth.
She noted that in 2014 just 800 former nurses returned to work for the NHS, while around 16,000 came back to practice over five years at the beginning of 2000.
This was against a backdrop of around 18,000 nurses a year leaving the NHS before retirement age, she told the MPs.
“I am perplexed by why we don’t have – 16 months after the Five Year Forward View – a really good co-ordinated plan to address the workforce problem and we know the workforce is at the heart of many of our cost issues,” she said.