Despite the headline-grabbing challenges of the pandemic, the problem of staff shortages – following more than a decade of underfunding – remains the biggest long-term issue facing the NHS, and the new Health and Care Bill does little to redress this situation.
Even before the virus hit, research by thinktanks the Nuffield Trust and the King’s Fund showed staff shortages were rife across all sectors of the NHS – from midwives (where one in five posts are unfilled) and mental health professionals (down by 3,000 since 2009) to GPs (with 2,500 vacancies), hospital doctors (with more than 9,000 vacancies) and radiologists, as well as nurses (where there are 38,000 vacancies).
NHS hospitals, mental health services and community providers together report shortages totalling almost 85,000 staff. The Health Foundation noted last December that the numbers in community nursing, mental health nursing and learning disability nursing were all lower than they were in June 2010, and that the UK ranks below the average of high-income OECD countries in terms of the number of practising nurses and the annual number of new nurse graduates relative to its population.
The UK has just under eight practising nurses per 1,000 population, while the OECD average is nine. Germany has more than 13 practising nurses per 1,000 population, while Australia has 12 and Belgium and the Netherlands each have 11.
So will the much-touted Health and Care Bill solve the problem of chronic staff shortages? Not according to the King’s Fund, which earlier this month said, “The measures in the Bill to address chronic staff shortages remain weak. A new duty to publish regular workforce supply-and-demand projections should be added [to it].”
This plea was reiterated two days later in a joint letter to The Times – signed by ten leading voices from within the health sector – which described workforce shortages as the biggest challenge facing the NHS and social care, and referring to the Health and Care Bill as a once-in-a-generation opportunity to learn from past failures.
The letter stated, “We urge the government to amend the Bill to ensure that in future England has robust, independent projections of the health and social care staff the country will need, to help make shortages a thing of the past. The lack of these provisions in the Bill is a glaring omission.”
However, the announcement by the soon-to-retire NHS England chief executive Sir Simon Stevens a week later of unrealistic plans to introduce five additional waiting time standards for A&E departments – reducing targets for certain admissions from four hours to just one – with no matching increase in staff suggests the letter’s message has yet to hit home.
The plan came just days after rising staff absences among nursing staff (many of whom had been told to self-isolate by the NHS covid app) forced the government to allow fully vaccinated nurses to carry on working if their presence was essential to the safe running of services. Before this latest move, NHS Providers chief executive Chris Hopson said one trust had lost 500 of its staff to self-isolation.
But tweaking app strategies represents no more than a sticking plaster solution to the structural problem of staff shortages, which needs long-term planning and proper funding.
And attracting and retaining staff when many in the NHS are dealing with burnout from the past 18 months also calls for more than last week’s 3 per cent pay offer. Analysis by the TUC questions the value of that offer (up from a less-than-generous 1 per cent a week earlier), and shows that – even after taking it into account – pay across the health service will have fallen by more than 7 per cent since 2010.
The Health and Care Bill has already had its first and second readings in the Commons and is now at the committee stage. Let’s hope MPs grab this once-in-a-lifetime opportunity to give the NHS what it so desperately needs, and amend this Bill long before it moves on to the Lords and gains royal assent.
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