The NHS workforce falling short – beware of false prophets?

“Debate about the forthcoming General Election about the NHS and Social Care focusses on claim and counterclaim concerning which party will commit most money? 

All very credible because we all know services to be overstretched and underfunded - and that ‘Keeping the NHS Safe’ has wide popular appeal. 

Yet a recent report suggests politicians are wasting their breath – because no matter how much cash is promised, managers will not be able to spend it on the required nurses and care workers - since the right people with the right skills are just not available (Buchan et al, 2019). 

Stark facts reveal:

• Numbers of NHS nurse recruits have halved since 2010 - giving a workforce shortage of 10,000
• Complexities in social care are worse – with a deficit of 12,200 – 25% are on zero-hours’ contracts – over 40% are from overseas made worse by restrictive immigration policy
• In 2011 nurse training places reduced by 10% - the removal of the bursary designed to expand places has failed nationally being far below the anticipated 25% expansion - fewer mature students are entering training
• Cost of living is a significant barrier to nursing students -1:4 fail to complete their course
• Failure to train and recruit leaves a predictable reliance on an annual 5,000 nurses from abroad until 2023/24 

Hence, the pledges of major party leaders to employ tens of thousands of more nurses and care workers by throwing money at the problem are vacuously delusional. Furthermore, they duck the main problem – that the NHS workforce cannot be disaggregated from that needed for social care. Paradoxically, because the NHS provides better pay, conditions and careers, it is parasitic on social care for its own staffing and is thus bleeding the already-stretched social care workforce to death. 

The dogmatic short-termism of the last decade is being felt and yes, additional funding is critical - but not without a sensible workforce strategy resonant with the NHS Long Term Plan. The Plan identified a fine conceptual route to better health care yet without the semblance of a proper Human Resource Strategy -  nor the wit to accept EU recruitment is a necessity - and without recognising the unique financial problems of nursing undergraduates. 

Addressing staffing shortages in the NHS will come at an inevitable cost; namely the dilution of skill mix (Guardian, 2019). Cheaper, unskilled people must be employed because qualified staff are neither available nor affordable. Accumulative evidence proves the ratio of unqualified support staff to qualified clinicians and therapists is increasing inexorably without any systematic understanding of its impact on patients’ experience, their safety or the quality of care they receive? 

So take heed of plausible political delinquents bearing gifts for the NHS – commentators encourage rather than help them minimise their irresponsibility. But on this subject beware of them all - because each is about as convincing as a prophet who has not been stoned.”

References: 

Guardian (2019) Nursing shortages forcing NHS to rely on less qualified staff – report The Guardian, 28 November 2018

Buchan J, Gershlick B, Charlesworth A & Seccombe I (2019) Falling short: the NHS workforce challenge: Workforce profile and trends of the NHS in England,
The Health Foundation,  London. 27 November 2019.