The cross-party Public Accounts Committee has heavily criticised the government’s 15 year workforce plan in a new report, in particular the lack of funding estimates and have “serious doubts” on how the plan will be achieved.
The committee notes that the “unfunded and uncosted” workforce plan, which promises to train thousands more GPs and double medical school places, risks placing the NHS under ‘unsustainable financial pressure’ in the future.
Dame Meg Hillier MP, chair of the committee, said: “The government and health system need to be alert to the serious doubts our report lays out around the workforce crisis, both the approach to tackling it now and the additional costs funding it in the future.”
Published in June 2023 after many years of waiting, the NHS long-term workforce plan received a mixed reception; relief that a workforce plan had at last been published, but criticism of its lack of detail.
The BMA at the time noted the lack of detail in the plan on measures to retain staff, improve the culture and how exactly funding would be provided:
“As ever, the devil will be in the detail – especially when it comes to funding.”
Details of how the plan will be funded and its full cost have failed to materialise. The MPs highlighted that although an additional £2.4 billion is to be provided to cover training costs for the first five years of the 15-year plan, there is no estimate of total additional running costs for the 260,000 to 360,000 extra workers the plan says will be needed by 2036-37.
Detail is also missing on how productivity is to be improved; the workforce plan includes a projection for future staff requirements that assumes staff productivity will increase by 1.5% to 2% annually, but the committee noted that it “lacks meaningful detail on how this will be achieved.”
Noting, “there is no information available on either the scale or source of how staff costs in future years will be met. Neither is there any cost or funding information on the other enablers without which the plan will fail for patients, such as expenditure on other salaries, estates, technology, and infrastructure.”
As well as criticising the workforce plan, the MPs covered failings in urgent and emergency care and patient discharge. Finding that “the quality of patients’ access to urgent and emergency care depends too much on where they live.”
In London in 2021-22 the average ambulance response time was 6 minutes 51 seconds, but in south-west England it was 10 minutes 20 seconds. Ambulances aim to respond to the most serious life-threatening injuries and illnesses in an average time of seven minutes.
Ambulance response times are often dependent on how quickly patients can be transferred into A&E, and this in turn is governed by availability of beds. The committee noted that not enough is being done to tackle the problem of delayed discharges, which mean beds are not available.
More patients are remaining in hospital when they no longer need to do so. In Q4 of 2022– 23, there was an increase of 12% in patients remaining in hospital despite no longer needing to, compared with the same period in 2021–22. Lack of adequate social care is a major factor in delays, but the MPs also criticised NHS England for its slow implementation of electronic patient records and electronic bed management systems, noting that “NHS England has identified where there is good practice and poor performance but is weak at implementing and rolling out best practice more widely.”
In response to a report, Saffron Cordery, deputy chief executive of NHS Providers, said:
“The committee has highlighted accurately the huge pressures being faced in urgent and emergency care….The NHS needs more staff, beds and equipment and significant investment in social care….And with 125,000 unfilled jobs across the NHS today, MPs are right to highlight that we still don’t know exactly how all of the ambitions in the long-term workforce plan, published in June, will be funded.”
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