The government recently published its response to the Health and Social Care Committee’s inquiry into the nursing workforce. Front and centre of the response, understandably, was workforce retention.
The government now estimates there are 36,000 nursing vacancies. We also have more than 200,000 nurses and midwives over the age of 50, who will retire in the next 10 years. It is clear that urgent action is needed to address the workforce and to ensure the health service can remain sustainable.
The NHS is only as strong as the people who work for it and the workforce crisis has led to some staff feeling unsupported – sentiments that are borne out in the annual staff survey. Indeed, the new Health Secretary, Matt Hancock, used his first public speech to raise the issue of morale, and staff feeling “undervalued”.
So, while the recently announced NHS funding settlement is welcome, we must not make the mistake of thinking that money alone will deliver a sustainable heath and care system. Effective workforce planning and improving culture are both going to be critical to a sustainable health service.
“The NHS has struggled for decades to have effective workforce planning”
The NHS has struggled for decades to have effective workforce planning. This is not a phenomenon unique to the current government – it has been part of the landscape of the NHS since its inception.
In the early 1950s, despite 80,000 funded posts for nurses across the country, there were still 30,000 vacancies unfilled. New opportunities had opened up for women in the post-war era and nursing, with its historic low pay and long hours, was not the attractive proposition it had been before the war, where job security was one of its main attractions.
It was this shortage that prompted the huge recruitment drive from Commonwealth countries.
It is difficult to reconcile this with the early 1990s, when newly qualified nurses struggled to be employed in the areas where they trained. Many had to relocate to different parts of the country or move overseas.
I have huge faith in the leadership of Simon Stevens, NHS England’s chief executive. He has striven relentlessly to increase the budget of the NHS and his efforts have and are likely to succeed further, with a new financial settlement to be announced soon.
This money is needed to bring us up to the European average of healthcare investment. It is demoralising to staff when the performance of some European countries is compared to the NHS, without the vital context that countries such as France, Germany and many more spend significantly more per person on their healthcare systems and have done so for over 50 years.
We should however beware; increasing the number of doctors and nurses is only part of the solution.
Improving culture in the health service is also key to its success, and it is everyone’s responsibility. Staff at all levels must feel accountable for the care they deliver and feel able to raise concerns when they see the opposite being delivered.
The scandal at Gosport Memorial Hospital serves as a stark and recent reminder of what happens when things go wrong. A culture of learning must be nurtured and promoted to continually improve patient care.
“Investing in staff is not just about pay”
I also believe that the goodwill of NHS staff is also too often taken for granted. They are the NHS’s greatest asset. Investing in staff is not just about pay, but about creating an environment that gives them the time and space to think creatively about improving patient care and one that supports staff to realise those ideas.
To deliver the best services, those in leadership positions must stop thinking of NHS sustainability as primarily a ‘fiscal challenge’, and start seeing the workforce, culture and staff wellbeing as central to their long-term sustainability.
If forthcoming policies on funding, the workforce, and social care are disconnected it will do little to address retention issues. The prime minister, along with the secretary of state for health and social care, need to support Simons Stevens to ensure these polices are developed in tandem and not lose sight of what drives the NHS – its people.
Peter Carter OBE is an independent healthcare consultant and former chief executive of the Royal College of Nursing