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Return of the MAC: Hell hath no fury like a workforce advisor scorned

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It is rare for a report by government advisors to be quite so stinging as that published on nursing last week by the Migration Advisory Committee, widely known in policy circles as the “MAC”.

The expert panel came out with all guns blazing – ministers, managers and workforce planners all caught in the cross-fire. So, what’s got Sir David Metcalf and his colleagues so riled?

“Home secretary Theresa May subsequently bowed to pressure from pretty much everyone”

If you remember, this was the expert group that ruled in February 2015 that nursing should not be placed on the shortage occupation list after carrying out a review for the Department of Health.

The decision, made in the middle of a national nursing shortage and to the consternation of nursing directors across the land, severely restricted the number of nurses from outside of Europe that could get a visa to come and work for the NHS.

In addition, under new rules on salary levels, it meant many already in the country might be sent home again in the near future because they were not earning enough.

Home secretary Theresa May subsequently bowed to pressure from pretty much everyone, including the head of the NHS Simon Stevens, and had nursing put on the list temporarily in October while the MAC was asked to reassess its position.

Last week, the committee agreed “reluctantly” that the profession should remain on the shortage occupation list due to “the lack of another short term solution” to finding enough nurses.

But why the change of heart? The original decision not to include nursing on the list was arrived at, the committee said, because it “did not receive evidence of a national shortage” of nurses.

It mostly based its judgement on evidence from the Centre for Workforce Intelligence, which it said “essentially distilled” information from NHS providers and the DH.

“One therefore gets the feeling the esteemed committee members felt like they had been hoodwinked”

One therefore gets the feeling the esteemed committee members felt like they had been hoodwinked somehow into telling the government what it wanted to hear last year.

But no longer. Last week’s report said the current situation was the result of shambolic workforce planning and a desire to save money, laying the blame at a number of doors.

The DH, Health Education England and NHS trusts were all criticised for not recognising obvious warning signs over a number of years, with the committee stating that similar financially driven decisions were being made again on nurse staffing.

It predicted HEE would have commissioned 3,000 extra nurse training places for 2016-17, but financial cuts following November’s spending review meant it commissioned only 331 – a tenth of what was needed.

“The Department of Health needs to get its act together,” said the committee, adding that “almost all of the reasons why there is a shortage should have been anticipated by the DH and other related health bodies”.

“Last week’s report said the current situation was the result of shambolic workforce planning and a desire to save money”

It said there was “no good reason” why the supply of nurses could not be sourced domestically, and the long-term solution was “providing sufficient incentive and opportunity” – seemingly at odds with chancellor George Osborne’s dreams of keeping NHS pay rises at 1% seemingly indefinitely.

Here again, the committee went on the attack, highlighting that pay was potentially one of the incentives to attract and retain nurses, but that employers had unrealistically dismissed the role it played as being “only weak”.

In contrast, they “seemed able to understand how their employees left for higher salaries available through agency work”, it said, which indicated they understood wages were in fact an issue.

The advisory committee also criticised the DH, calling on it to “at least explore whether higher pay would improve retention”.

sir david metcalf

sir david metcalf

David Metcalf

“The restraint on nurses’ pay instituted by the government was presented to us, and in the evidence to the pay review bodies, as an immutable fact. It is not. It is a choice,” said the committee.

So, well done to the MAC for not pulling their punches and providing robust evidence-based advice – whether or not it’s what Whitehall wants to hear.

Let’s hope their advice on training and pay is taken on board and the lesson learned by the DH and its arm’s-length bodies about future workforce planning – and the correct way to use independent advisory committees.

Having watched an old episode of Yes, Minister on TV recently, I fear disappointment but we can always hope.

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