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The Ward Round: How the long-term workforce plan will land

Published on: 8 Mar 2023

Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce.

It has often felt like the political hot potato that is the long-term workforce strategy would never see the light of day, and I’m sure the Treasury had rather hoped it wouldn’t.

But those close to it are still quite optimistic the negotiations between NHS England and the rest of government are in their final stages, with a reasonable chance of the plan finally landing this month.

To no-one’s surprise at all, however, HMT is up to its old tricks and seeking to block and water down the document as far as it can. Some sources say HMT officials have been putting their figure on the “productivity” scales, seeking to reduce future staff requirements with fantasy assumptions about improved technology, skill mix and “ways of working”.

Even worse, HMT is said to be looking to “remove all numbers” — as these commitments to increased staffing in future years are what will bind the NHS, and therefore the government, to spend money in both the short and long-term.

The now chancellor Jeremy Hunt accused the Treasury in 2020 of exactly this move. But now Mr Hunt is in the hotseat and his credibility will be shot — certainly within the health sector — if he doesn’t produce the full-blooded plan he suggested he would last autumn.

I predict that a compromise is in the offing, and a significant one. Instead of specific figures for future numbers of doctors, nurses and other professions, instead we are likely to see forecast ranges, taking account of different scenarios.

Such an approach would allow the Treasury to focus on numbers at the lower end of the range (which would allow it to imagine there will be no great cost); while the NHS can tell itself that, in reality, it will be at the upper end. 

This would mean HMT does not formally need to committ in print to increased future spending, both for training more staff nor to pay their wages, for 15 years into the future — which is officials’ great concern. The NHS will therefore have to keep fighting it out over future Budget and spending review periods.

That’s not ideal, but — so long as some spend is committed upfront — it is a lot better than nothing.

Published ranges will be hard to brush back under the carpet. The NHS and its supporters will be able to compare what is happening on the ground to the forecasts and assumptions.

It will highlight government trade offs, such as how if it decides against training more doctors or nurses (or if it is not able to retain more), them it will inevitably mean more recruitment from abroad is required. 

Another critical bit of the plan — still there in recent drafts, I understand — will commit to revisiting the figures every few years: not dissimilar to the two-yearly independent assessments which Mr Hunt was pushing for a year ago, when he was a mere campaigning chair of the Commons health and social care committee.

Whether assessments will be “independent”, and if so who will check them, remains unclear. A recent letter from NHSE to the new Commons committee chair suggests it is still waiting for government to decide.

The Times suggests the National Audit Office might be in the frame. Many within the NHS would prefer an organisation with a lot more health expertise.

It’s not over until it’s over, but the need to get a long-term workforce plan out in the next few weeks still has vocal support from the top of NHSE.

If the plan does fall short — such as by leaving out numbers — the NHS may well axe it altogether, or there will be widespread revolt from professional groups.

The need to get the long term worforce plan out still has vocal support in high places. Speaking at a NHS Confederation International Women’s Day event only yesterday, Amanda Pritchard said it was crucial to “delivering the size and the make-up of the workforce” needed.

“We need to be able to match the demands of the future,” Ms Pritchard said.

The service needs staff to “want and to be able to stay in the health service”, in turn requiring “nailing health and wellbeing offers to people at every stage of their lives” and getting work/life balance right, particularly for people with caring responsibilities.

In terms of what else might be in the strategy, as previously reported, the plan is likely to push for a greater use of the apprenticeship model to train more clinical staff and get them working more quickly. However, this brings valid concerns about whether the model is fit for purpose and if the service has capacity, and funding, for supervision and back-fill.

It is also likely to try to map medical training places to health inequalities, which is linked to an already established HEE programme of work.