The delayed Interim People Plan, authored by NHS Improvement, opens with some straightforward admissions.
“The culture of the NHS is being negatively impacted by the fact that our people are overstretched – this is evident from the 2018 NHS Staff Survey where more people have reported bullying, harassment and abuse in their workplace in the last 12 months”
The report points the finger at NHS management, identifying that “workforce planning has been disconnected from service and financial planning.”
NHS boards are often distracted by operational and financial issues. The authors remind us that another period of big change in the NHS has started,
“We need different people in different professions working in different ways” and they echo the themes set out in the long-term plan, around new multi-disciplinary teams working increasingly outside of hospitals.
The overall challenge is complex; new staff must be recruited, ex workers enticed back and training quickly increased, but the report also acknowledges that factors like pay and the conditions in which staff work, will all need to be tackled.
But the report has been slow in coming out and admits that it can’t publish “detailed, costed action plans” until after the comprehensive spending review.
It promises a stepped approach “to take immediate action in 2019/20 while we develop a full five-year plan” For an NHS workforce that has endured truly testing times and has waited a long time for support from policy makers, this will sound like warm words, when most are desperate to see action.
Boosting staff numbers?
The report admits that “urgent” and “accelerated action” is required to fill nursing vacancies in primary, community and mental health sectors.
The plan sets a target to raise nursing numbers by 40,000 by 2024, using four approaches
- international recruitment by appointing lead agencies to co-ordinate the process
- ensuring more nurses enter training
- improving retention rates by placing a greater emphasis on career developing
- encouraging nurses back into the NHS with the
- promise of flexible working opportunities
However, the size of target has already been questioned by research that estimates the number of nurses needed will be nearer 70,000 by 2024.
There are also no plans to reverse George Osborne’s disastrous decision to stop paying nursing students’ tuition fees and maintenance grants, which has led to a huge drop in those applying to be nurses – 31% fewer between 2016 and 2018, at precisely the time when the profession needed to boost its intake.
Workers from abroad?
Throughout its history the NHS has relied on foreign health staff. One in eight of current NHS employees are foreign nationals.
The health secretary Matt Hancock has himself called for another Windrush generation, but the suggestion runs against the strong desire of Tory Party supporters to see immigration fall.
The Observer reported that plans to announce a 5000 a year target of nurses from abroad were recently dropped. The proposal would be hampered by immigration rules that could bar more than 40% nurses as they would need to earn at least £30,000 a year.
Many rightly question the morality of a recruitment policy that could drain talent from countries that badly need it for their own development. However, Mark Dayan policy analyst at the Nuffield Trust think tank believes that the options are very limited.
“Even if you take all the actions that we could identify in terms of boosting nurses in training, preventing them from leaving at the same rate, the nursing gap is not going to shrink at all in the next five years without international recruitment.”
He says that 5000 extra nurses a year would half the recruitment gap by 2023/24 but still leave a lot to do, but without it pressing issues around patient safety and treatment delays will remain.
Few will fault the plan’s ambition of “Making the NHS the best place to work”, but the much of the detail, money and urgency that is needed is still missing.
A national return-to-practice scheme – set up in 2014 is being expanded and a new marketing partnership with Mumsnet aims to advertise job opportunities and entice nurses that have left the NHS to come back to work.
A major staff engagement exercise will be launched this summer, led by new chief people officer Prerana Issar, to “create an explicit offer to staff” that will address their major concerns.
However urgent action is needed, to stem the flow of staff leaving the NHS. The turnover of staff is high, one in 11 NHS staff quit every year, staff sickness is 2.3% higher than the wider economy.
Tough working conditions, poor career development and low pay have combined to drive thousands of trained staff away from their NHS careers.
UNISON head of health Sara Gorton said:
“Holding on to staff is probably the biggest challenge facing the NHS. All workers across the health service need to know they’re valued and must be given the right training opportunities to use their skills and experience to move into more senior Roles.”
Working under pressure
Routine gaps in the workforce make it difficult to fill medical and nursing rotas.
The everyday pressures of working long hours, sometimes beyond the limits of safety, are still widely felt amongst staff.
Over half work unpaid overtime every week. Stretching beyond safe limits sometimes results in tragic consequences.
Trainee doctor Hadiza Bawa-Garba was found guilty of manslaughter by gross negligence in 2015 following the tragic death of a six-year-old boy from sepsis on a night when she was ooking after six wards of patients without supervision.
The case sent a strong message to NHS staff that you can pay a big price for shouldering the burden of systemic staffing shortages.
A survey of nearly 8,000 doctors found that 95 per cent were fearful of making a medical error and more than half feared they would be blamed for problems arising from failures in the system, a factor in many doctors not completing their training.
It is hard to escape the fact that NHS relies on its staff but without taking proper care of them. It can be as simple as being able to get a warm meal even if you’re working a night shift, or having somewhere to rest, but fundamentally the capacity of the NHS must rise before staff will feel less overworked.
NHS Improvement has promised to change the leadership culture. No time should be wasted before dealing with the evident bullying problem in some workplaces or in vanquishing the resistance to achieving ethnic diversity in NHS leadership positions.
Almost 30 per cent of NHS staff said they had been bullied by patients or their families in the past year, with 25 per cent reporting abuse by other workers.
Matt Hancock said he is “horrified” that NHS staff surveys revealed 12 per of staff felt discriminated against, rising to 24 per cent for BME staff.
Dido Harding, chair of NHS Improvement, which is leading the work on the People Plan, said it was clear that there were “challenges” with staff.
She said “I want front-line NHS staff to know we have heard their concerns about the pressures they face and we are determined to address them.
“The NHS needs more staff. But that, on its own, is not enough. We need to change the way people work in the NHS and create a modern, caring and exciting workplace.”