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NHS workforce planning has ‘serious shortcomings’

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Current arrangements for managing the supply of clinical staff for the health service in England are “fragmented and do not represent value for money”, according to a report by auditors.

The National Audit Office’s report, published today, highlighted that in 2014 there was a reported overall staffing shortfall of around 5.9%, equivalent to a gap of around 50,000 clinical staff.

“Workforce planning will never be an exact science, but we think it clearly could be better than it is”

Amyas Morse

The body criticised workforce planning arrangements at national, regional and local levels.

It noted that the creation of Health Education England meant that, for the first time, there was a national body specifically tasked with planning the future workforce and that produced a national workforce plan with the help of local providers.

According to the NAO, however, the process for developing the national long-term workforce plan could be made “more robust” and Health Education England should be “more proactive” in addressing the variations in workforce pressures in different parts of the country.

The NAO also reiterated the oft-criticised heavy use of expensive agency workers by hospital trusts, saying it had concluded that there was “room for trusts to reduce spending on temporary staff”.

High levels of temporary staff are an inefficient use of resources, it warned, noting that spending on agency staff increased from £2.2bn in 2009-10 to £3.3bn in 2014-15.

While noting the new cap on how much trusts can pay per shift to help control spending on agency staff, the NAO said such measures were “unlikely to address fully the underlying causes of the increased demand for temporary staff”.

At the same time, the NAO suggested the NHS had made “much less use of overseas recruitment and return-to-practice initiatives to address staffing shortfalls”.

“We need to move away from a model of short-term fixes through agency staff”

Danny Mortimer

The number of overseas nurses has fallen, particularly from outside Europe, where the number of entrants decreased from 11,359 in 2004-05 to just 699 in 2014-15, it said, noting that some of the decline may have been due to tighter immigration rules.

The NAO acknowledged that the decrease was partly offset by a large rise in nurses coming from within Europe, with many trusts sending recruitment teams to countries such as Spain and Portugal.

But, overall, it said a “more co-ordinated and proactive approach to managing the supply of staff could result in efficiencies for the NHS as a whole”.

Amyas Morse, head of the National Audit Office, said: “Given the size of the NHS, workforce planning will never be an exact science, but we think it clearly could be better than it is.

“Equally, the way in which staff shortfalls are filled can be, and often is, unnecessarily costly and inefficient,” he said.

National Audit Office

NHS workforce planning has ‘serious shortcomings’

Amyas Morse

“Since clinical staff are the NHS’s main resource and cost, these shortcomings are serious and the current arrangements do not achieve value for money,” he added.

Unison head of health Christina McAnea said the NAO’s report should “be ringing alarm bells” in government.

“A serious lack of staff, rising agency bills, and a lack of vision or plan on how to maintain the operation of the NHS means the very future of the health service is at risk,” she said.

Meanwhile, NHS Employers chief executive Danny Mortimer described the report as a “helpful analysis of the challenges that employers across the country are facing”.


“We need to get it right to build a sustainable workforce,” he said. “Work is already happening with our recent survey showing that over 99% of providers recognised the need to invest and retain their nursing workforce.

“We need to move away from a model of short-term fixes through agency staff to investing in attracting the best talent to work in the NHS – both from within and outside of the EU,” he said.

He added: “Many NHS trusts are currently facing a stifling shortage of nurses, so we continue to lobby for nurses to be [permanently] added to the shortage occupation list so that NHS trusts can ensure safe staffing for patients.”

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Readers' comments (1)

  • The nhs is no longer an attractive employer. There are far better alternatives. They have dug their own grave!

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