After a decade of austerity, it looks like parties across the political spectrum are promising a public service spending spree. In 2017, Theresa May told a nurse who hadn’t had a pay rise for eight years 'there is no magic money tree'. Nurses’ pay is now increasing and the purse strings may be loosening. But that doesn’t mean all’s well with the NHS.

Staffing, as much as funding, is now the make or break issue for the NHS in England. It is therefore not surprising that we have seen a slew of workforce pledges from the main parties in recent weeks, including an extra 6,000 GPs from the Conservatives, 24,000 nurses from Labour and a promise to increase the mental health workforce from the Liberal Democrats.

People with the right skills are in short supply. The UK has fewer doctors and nurses than most other western European countries and it shows. NHS hospitals reported more than 40,000 nursing vacancies at the end of the last financial year. Most worryingly some of the greatest problems with recruitment and retention are in areas where improvements are most needed, such as mental health. The number of nurses working in mental health and community care in 2019 remains below the staffing levels of five years ago, despite a growing and ageing population and rising demand.

The problems are not just confined to nursing. General practice and social care are both struggling. Despite a government commitment in 2015 to recruit an additional 5,000 GPs by 2020, the latest data to June 2019 shows the number of qualified, permanent GPs has in fact fallen by 1,700 full-time equivalents since then. In social care, turnover for frontline care workers is at 40% a year and around a quarter of the workforce are employed on a zero hours contracts.

In this general election campaign, we need to move beyond an exclusive focus on money to challenge the notion of a 'magic people tree'. The length of time it takes to train professionals, falling application rates and high attrition in nursing, perverse incentives to work less for senior doctors due to problems with their pension scheme, and challenges in international recruitment mean that shortfalls will persist for some time.

Commitments to improve NHS or social care services need to be challenged where there is no convincing answer for how the extra professional staff will be recruited. If promised improvements in care turn out in the cold light of the workforce crisis to be undeliverable, the risk is that the NHS is seen as 'failing'. In fact what has happened is that it has been set up to fail.

The stark reality is that the health and care system are in a fragile state. Extra funding is needed, but it needs to be focused on the basics: training more people, ensuring pay and pensions are competitive and investing in the kit and buildings they need to do a good job.

In the years of austerity money was focused on shoring up waiting times and access to care. This was understandable, but it papered over substantial and growing cracks in the fabric of the health and social care workforce.

If we really care about the NHS the priority now is to secure the fundamentals: investing in the doctors, nurses, care workers and range of professionals who actually deliver care on a day to day basis.

Anita Charlesworth is Director of Research and Economics at the Health Foundation.

This blog was originally published in the Times Red Box on Thursday 14 November 2019.

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