Shortages of nurses in key areas like mental health, district and practice nursing risk scuppering the delivery of the 10-year plan for the NHS, say health service leaders who have called for urgent action to address staffing issues.
Work to boost retention, ensure staff can access continuing professional development, and develop new roles to plug staffing gaps must start immediately, according to senior figures who said the NHS could not afford to wait for the publication of the new workforce plan.
“Production of nurses particularly in those areas has fallen significantly behind demand”
They were giving evidence to the Commons’ health and social care select committee in the first of two sessions to explore the recently-published 10-year plan for the NHS.
The committee heard workforce was key to the NHS Long Term Plan’s success or failure but there was concern over a lack of detail on how the NHS could secure enough staff to deliver the new models of care envisaged, with a promised workforce implementation plan not due to be published until later this year.
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Nigel Edwards, chief executive of the Nuffield Trust, highlighted the fact the number of nurses working in key areas has fallen significantly in recent years.
“While we are prioritising mental health, community and primary care, the production of nurses particularly in those areas has fallen significantly behind demand. In fact, there has been a drop in whole-time equivalent nursing in mental health,” he said, adding that community nursing had also been depleted.
“It is a bit harder to tell what is happening in community services, because when community services are transferred to private sector providers we seem to lose count of the nurses and we’re not really sure. But we think there has been a significant reduction in that,” he added.
“Leaving it that late means next year we’ll just be treading water and won’t make any progress”
Meanwhile, many practice and district nurses were older with “a big retirement bulge coming over the next few years” and there was a general problem with burnout, with UK healthcare staff “suffering from it particularly badly at the moment”.
As well as developing new ways of working he said there was a need to repair the current staffing “deficit” and create an environment “in which people want to stay and work”.
He highlighted the fact the past 10 years had seen a substantial drop in the amount of funding for education and training in the NHS.
“In 2006-07 the training and education budget was 5% of the total NHS budget and it has now fallen to 3%, so to put that back is about £2bn,” he explained.
“One of the most serious cuts recently has been in continuing professional education so you are continually hearing nurses – particularly nurses but actually other medical staff – can’t get released to continue training. That is a major issue potentially.”
Chris Hopson, chief executive of NHS Providers, said trust leaders were grappling with staffing issues on a daily basis, making it hard for them to focus on anything else.
“The implementation plan needs to set out a very, very clear path about how we are going to over the longer term generate sufficient numbers of people to provide the extra demands placed on the service,” he said. But he stressed there was also need for action now to boost staff numbers.
“The bit that everybody seems to keep forgetting is that when I go and talk to current trust chief executives what they say to me is their biggest problem today, yesterday, the day before, tomorrow is the current workforce shortages,” he said.
“So for me, the workforce implementation plan has got to very quickly do some quick things that will enable us to start closing those gaps now.”
He maintained there were a number of measures that could be put into action immediately to help alleviate staffing shortages.
“We know that services across the country are becoming unsafe or are having to close because we don’t have enough staff. And there are quite a few things that you can do relatively quickly if we got all of government working together and mobilised,” he said.
He suggested this should include a temporary expansion of overseas recruitment as well as work to expand roles and responsibilities of support staff.
“We know there are a bunch of new roles that have been created – not just doctors and nurses. If we were to maximise the clinical permissions they had to do different tasks then that could make a significant dent,” he said.
“There is simply too much to do for the money and the workforce that we have available”
But he said: “I can make a relatively confident prediction here today that everything in this plan is not going to be delivered – there is simply too much to do for the money and the workforce that we have available.”
Richard Murray, chief executive of the King’s Fund, said he was concerned at the idea that staffing issues would be addressed down the line in a single plan and said he would like to see efforts to expand international recruitment, boost retention and look at skills mix put into action straight away.
“There is a lot that can be done well in advance of a spending review and I think that leaving it that late means next year we’ll just be treading water and won’t make any progress,” he said
While there was an understandable focus on upping the number of nurses and doctors, he suggested the health service needed to look at developing the roles of other professionals like pharmacists and physios to help take the pressure off over-stretched frontline clinicians.
“It is not that difficult to retrain some of those staff just to add a bit extra on so they can take on wider duties,” he said. “Again I don’t think that needs to wait until the spending review.”
Mug Niall Dickson
Niall Dickson, chief executive of the NHS Confederation told MPs that in the long-term there was a need for “radical changes” to the education and training of nurses and doctors in the UK, and a move away from international recruitment.
He also highlighted the need to develop new roles that could span health and social care and help people navigate care systems.
“There needs to be new types of role so it is not just about producing more doctors, or GPs or more nurses. We have got to look at what the needs are,” he said.
Meanwhile, he said it was vital to re-train existing staff so they were equipped to deal with the challenges of a modern healthcare system and new ways of working.
“If you’re talking about new models of care you have got to assume that even in 10 years’ time probably two thirds of the workforce is already there, so there is something about how we end up supporting them,” he said.
Improving retention rates was also key, he added. “We certainly recognise in our role as NHS employers that we need to support organisations to improve retention. It is no use if you just concentrate on the tap and don’t deal with the plug,” he said.
Ian Hudspeth, chair of the Local Government Association’s Community Wellbeing Board, stressed the need to promote social care as an attractive career option with more opportunities for staff to move between the NHS and social care roles.
He said there was also a need to break down traditional professional boundaries to create multi-skilled roles.
“It is not necessarily downgrading jobs or anything like that but it is making sure that everybody is able to do the appropriate things at the appropriate time, which then means we’re not having a care worker clashing with a district nurse and who actually has supremacy,” he said.
The committee heard that support from frontline health professionals such as nurses will be key to the plan’s success.
While a large number of people had already been consulted and involved in shaping the plan, Mr Dickson said the real test would be what “the average consultant, ward sister or community nurse” made of it.
He said the level of “buy-in” across the NHS was currently “limited” but it was vital clinical staff were at the heart of what was a fundamental shift in the way healthcare was delivered.
“The key going forward is engaging at local level and that means every Sustainability and Transformation Plan/Integrated Care System and every organisation needs to have a genuine discuss with staff,” he said.
Meanwhile, the health leaders warned MPs that a “no deal” Brexit would be a “disaster” for the NHS, ahead of the crunch vote on Tuesday evening on the prime minister’s deal to leave the European Union.
- You can watch a recording of today’s evidence session on parliament TV