Health care is a people business but is the NHS approach to workforce fit for purpose?

The government and national leaders need a radical new approach to inspire an NHS workforce that is too often stressed, stretched and disaffected, according to a new report published today by the Health Foundation.

The report comes on the same day as the Health and Social Care Information Centre released its latest workforce census revealing significant ongoing problems in the supply of NHS nurses. With an increase of less than 1% in nursing staff over the last year, supply continues to be out of kilter with demand. There is currently an estimated shortfall of 7% in the number of nurses. These problems are symptomatic of a short-sighted approach to NHS workforce planning in England, which has exacerbated current financial challenges and fails to recruit and retain the people needed to care for our ageing population.

The Health Foundation’s report, Fit for Purpose? provides an overview of NHS workforce policy in England and calls for an overhaul in how the NHS plans, trains, regulates, pays and, most importantly, supports its people.

It highlights the lack of a nationally shared vision for the NHS workforce in England, around which the array of national bodies can coalesce.

Crucially it concludes that when the future of the health service depends on new ways of delivering care, too much workforce policy continues to happen nationally, crowding out local employers’ interests and restricting their ability to innovate.

The report recommends that the government and national leaders across health and social care should come together urgently to develop a long-term vision for the NHS workforce in England.

The early priorities of this strategy should include: a review of medical education to ensure that the billions of pounds we spend each year are training doctors with the skills and attitudes needed for the future NHS; the effective development and sustainable implementation of new roles to support high value care; and understanding why England continues to be beset with staff shortages and what needs to be done to address this for the long term.

But a more fundamental shift is needed if the NHS is going to inspire its workforce to make the improvements in quality and productivity so vital to future of the health service. In challenging times, policymakers need to rely less on contracts, financial incentives and regulation and instead work with NHS staff in a new style of policymaking. This should go with the grain of their professional instincts and recognise the pressures and daily dilemmas they deal with.

Richard Taunt, Director of Policy at the Health Foundation said:

'Today’s workforce census reveals the sheer size and scale of human enterprise that makes up our NHS. Workforce policy is critical to the NHS and, as the current nursing shortage shows, the stakes are high when it goes wrong. If we care about the NHS, we need to care about its people too. And in challenging times, it’s people working in the NHS who will improve quality and increase productivity – no one else. National leaders need to come together urgently to develop a long-term vision for the NHS workforce in England that brings the NHS frontline to the forefront of policy and revives its relationship with Whitehall around a common purpose - high-quality, compassionate care.'

Notes to editors:

Media contact

Lewis Pickett, Public Affairs Officer

Lewis.pickett@health.org.uk

0207 257 8017

Key findings

Our report found:

• Workforce policy in England is heavily centralised. The detailed pay, terms and conditions of 1.4 million staff are agreed in national negotiations under supervision from Whitehall.
• National workforce planners draw on local estimates, but can and do override them.
• The standardisation of professional regulation and education nationally, reinforce separate professional cultures and practices at a time when the health care provision across the NHS needs to be multi-disciplinary.

NHS finances

According to our recent report on NHS finances, ‘A perfect storm’, 63% of NHS providers’ total expenditure on went on staff costs in 2014/15.  In addition, NHS spending on agency staff increased by 27% between 2013/14 to 2014/15, rising to £3.4bn in the last financial year.

Staff satisfaction

29% of GPs in the UK want to leave the profession in five year according to a recent Commonwealth Fund survey jointly funded by the Health Foundation.

The latest NHS staff survey revealed that 25% of staff reported experiencing harassment, bullying or abuse from other staff in last 12 months, while 37% of staff reported suffering work related stress over the same period.

Supply of NHS staff

The National Audit Office, in its recent report on clinical workforce numbers, found that the gap between the supply of, and need for, staff was greatest for nursing, midwifery and health visiting, with a shortfall of 7.2% of the workforce in 2014.