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The REAL Centre’s role in assessing NHS England’s projections modelling

29 June 2023

About 2 mins to read
  • On 30 June 2023, NHS England publishes the long term workforce plan for the NHS in England. The plan sets out long term workforce supply and demand projections for the NHS in England to 2036/37, as well as proposals for how to address chronic workforce shortages in the NHS.
  • In February 2023, the Health Foundation’s REAL Centre was asked by NHS England to undertake an independent assessment of the modelling approach used to inform the staffing projections in the NHS workforce plan. We were pleased to do so and found that NHS England’s approach to the modelling and the assumptions underpinning this were plausible.
  • The assessment took place over 2 weeks in February 2023, with the REAL Centre being provided access to relevant documentation describing NHS England’s modelling approach up to 17 February 2023. The assessment was submitted to NHS England on 22 February 2023. Our assessment was of the modelling approach only – as it stood at the time – not the projections for the number of staff needed or likely to be available. Since then, NHS England have made changes to some of the assumptions underpinning the modelling approach.
  • We have continued to discuss the approach to the modelling with NHS England as it has evolved but have not assessed the final version of the model used for the NHS workforce plan or the staffing projections it contains.
  • We welcome the commitment to independent scrutiny. It will be important in the future that fuller independent verification is integrated into the approach to updating workforce demand and supply projections.

The project

In February 2023, the Health Foundation’s REAL Centre was asked by NHS England and Health Education England to undertake an assessment of the modelling process used to inform the projections in the long term workforce plan. We were not asked to review the plan or any of the policies underpinning the projections.

The assessment was based on NHS England’s modelling as of 17 February 2023 and took place over 2 weeks in February 2023. The following documents were submitted to NHS England on 22 February 2023:

What was involved

We were given access to the draft projections (as of 17 February 2023) and a range of model documentation and outputs. We held a series of workshops with colleagues from the NHS England modelling team to understand the data, assumptions and modelling approach.

We used the UK Statistics Authority Code of Practice, which sets the standards for producers of national and official statistics, to guide our approach and specifically focused on the domains of quality and value. We identified key lines of enquiry focused on:

  • the suitability of data sources
  • soundness of methodology
  • level of clarity and insight
  • plans for innovation and improvement.

Our process examined whether and how the models used for workforce projections have been subject to quality assurance testing, in line with the Aqua Book principles (the good practice guide for government analytical and modelling quality analysis). However, we did not undertake model quality assurance. 

Our assessment

At the time of the review, our overall assessment was that the data sources and methods used in NHS England’s model were appropriate and the assumptions used by NHS England to develop the baseline models were plausible.

Three areas for improvement of the model were identified:

  1. Addressing issues of regional distribution: the projections focus on national demand and supply but geographical workforce gaps are also important.
  2. Recognising wider labour market dynamics and independencies: in particular the links with the social care labour market and the role of relative pay in recruitment and retention.
  3. Factoring in higher and lower rates of productivity growth: The projections are very dependent on the assumptions made about the rate of productivity improvement in the future, an area of considerable uncertainty.

The REAL Centre’s independent assessment is of the modelling approach only. It is not an endorsement of NHS England’s projections.

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