Funding constraints and workforce shortages jeopardising Five Year Forward View delivery, says Health Foundation

11 July 2016

New report highlights key pressure points in the NHS workforce requiring policy focus

The Health Foundation, an independent health care charity, today publishes a new report on workforce in the English NHS, which concludes that the greatest threats to the delivery of the Five Year Forward View are funding constraints and workforce shortages.

Staffing matters; funding counts examines the profile and features of the current workforce; health labour market trends; relevant international data and comparisons from other countries; and a series of specific pressure points in the English health care workforce.

Two professions which are facing particular shortages are examined in detail, and identified as areas that continue to need a strong policy focus:

  • Nursing, with the National Audit Office estimating that the NHS was short of around 28,000 nurses, midwives and health visitors in 2014; and
  • General Practice, where recruitment and retention are major issues, as well as an ageing workforce, with one in five GPs aged 55 or older.

Key findings of the report include:

  • Mismatches between funding and staffing levels, along with repeated reorganisation, have led to a “boom and bust” approach to the NHS frontline.
  • The less costly, reactive and short-term solutions - being used by national and local leaders to tackle current problems - are quick fixes, and will only put a sticking plaster on deep-seated and systemic problems for the NHS.
  • More effective use of temporary staff and international recruitment can help to buy time while a more long-term, sustainable approach is implemented
  • Investment in current staff should not be disadvantaged by an overemphasis on introducing new roles; some new roles are necessary but will not have a major impact unless there is significantly more central support for scale up.
  • Policymakers need to look at how targeted and aligned policies covering the effective use of temporary staff, retention of existing employees and international recruitment, can be used to address current shortages in order to buy time, while a more long-term, sustainable approach is introduced.

Anita Charlesworth, Director of Research and Economics at the Health Foundation, said: ‘Funding constraints and workforce shortages without a doubt present the greatest risks to the delivery of the Five Year Forward View – and the longer-term sustainability of our NHS. The current approach to workforce policy needs to be overhauled so that staffing and funding are treated as two sides of the same coin.

‘The recent decision for the UK to leave the EU will create additional challenges – both in terms of finances and the ability to attract and retain valuable European staff. We urgently need a fully aligned and coordinated national approach to workforce policy and planning, underpinned by greater predictability on funding, to ensure the NHS can sustain high quality health care for the long term.’

The six critical aspects of the profile and dynamics of the current national health care workforce covered in detail – and key findings of each – are:

What will be the impact of the change in student nurse bursary arrangements on the future supply of student nurses? UCAS data showing that demand for student nurse places exceeds the supply of funded places, local NHS precedents of self-funded degrees and relevant policy experience from Australia are explored.

The report concludes that removing the current cap could lead to an increase in the number of student nurses, but much will depend on the attraction of nursing as a career, and the availability of high-quality training placements.

Is international recruitment a viable long-term solution for the NHS? International recruitment has been used as a quick, relatively cheap, fix for employers faced with the immediate pressure to fill vacancies. About one in eight nurses in the UK was trained in another country. The rate of international trained nurses has risen since 2009, with migration from EU countries accounting for most of the increase. The implications of Brexit on these flows are as yet unclear, but will increase concerns about this source of workforce supply.

The report concludes in the short term, policymakers need to look at how international recruitment can be used alongside policies focused on staff retention and effective use of temporary staff to address current and looming workforce shortages. This requires more effective coordination of different central government departments, including Health, Home Office and Treasury, as well as professional regulation. In the long term, there is a role for government in monitoring and moderating international recruitment, so it becomes a more integral part of a more sustainable, long-term approach to the effective supply of health professionals for the NHS.

Can the recruitment, retention and distribution of GPs be improved? Recruitment, retention and distribution of GPs are critical issues for the English NHS, and workload is rising faster than workforce and funding available.

The report concludes that policy needs to give greater consideration to achieving a more equitable distribution of current GP services. International experience suggests this requires looking at skill mix changes, service redesign and better use of technology, as well as trying to increase the number of GP hours available.

Can the physician associate become a significant part of the workforce? Similar roles have been introduced in the US, but with only around 200 physician associates currently employed in the NHS, and a suggested training intake of 650 per annum, it would take 20 years or more for NHS numbers to reach a comparable level. 

The report concludes this role is not a viable option for addressing short-term workforce shortages, unless there was to be significant increase in investment. A cost effective alternative would be to invest in current staff, such as nurse practitioners, in an effort to close skill gaps and improve productivity. 

Can the planned new ‘associate nurse’ role make a difference? The NHS has a mixed track record of introducing new roles, and questions remain over how training of nurse associates will be funded, how many are required and to what timeline.

The report concludes this role will not be a quick fix for current and looming nurse shortages. An alternative would be to improve productivity by investing in the skills and retention of current staff. 

Can the NHS make more effective use of temporary staff? Temporary staff provide flexibility for local employers faced with current and looming staff shortages. The arbitrary top-down national cap on costs risks undermining the flexibility of local employers to address staffing shortfalls and exacerbating ineffective and reactive use of temporary staff.

The report concludes that policymakers need to look at how targeted policies can better align temporary staff use with retention and international recruitment to address current shortages, in order to buy time, while a more long-term sustainable approach is introduced.

Media contact

For further information please contact Jenny Rushforth on 020 7257 8047.

Further reading

Research report

Staffing matters; funding counts

July 2016
Research report

This report examines the profile and features of the NHS workforce in England, including; health...

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