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 is strange, considering there has been no proper workforce strategy for the NHS in nearly 20 years, that if one is now brewing, there’s been no fanfare about it, and many people who should really know are totally unaware.
Tony Blair once said that if he wanted to keep something secret, he should announce it in a speech in Parliament, because nobody pays attention.
In that spirit health and social care secretary Sajid Javid has told the Commons health and social care committee twice about the new strategy, and work on it now appears to be tentatively getting underway.
In November Mr Javid said a workforce plan for health and social care would “hopefully” be ready by spring, then just a few weeks ago he spoke in no uncertain terms to the same committee, saying: “One thing I have also done very recently, and I am happy to tell the committee about, is to commission the NHS to develop a long-term workforce strategy. That had not been done before because I wanted to kick off the work first with [Health Education England].”
The HEE project he mentioned caused some of the confusion – many in the sector have assumed Mr Javid has only been referring to a project he kicked off last summer, asking HEE to “review long-term strategic trends for the health and social care workforce”, known as its “framework 12”. I’ve been told this work is due to wind up over the next few weeks, with a final webinar with stakeholders to be held mid-March.
The DHSC confirmed to me this morning that it had indeed now “commissioned NHS England to develop a workforce strategy, and will set out the key conclusions of that work in due course”, and that this is what Mr Javid was referring to in the 25 January committee evidence session, and is distinct from framework 12.
The mystery deepened earlier this week with a message to the service from NHS chief executive Amanda Pritchard, which referred to the plan, but only in a somewhat coded fashion. She said: “The experience during the omicron wave must be the final reminder, if one were needed, that a long-term plan for the workforce is essential, and I’ll continue to work hard and make the case for that plan to deliver and get the backing it needs, for staff and patients alike.”
So there is a plan? But we still need to make the case?
What emerges is that work is under way on a plan across NHS England and HEE – which are now much closer together under Ms Pritchard and Navina Evans, and are looking ahead to their merger – but that it is all being treated rather secretively.
That, in turn, is likely because of the ongoing opposition to a strategy happening at all (or at least, immense wariness) from the Treasury, which is not at all keen to commit to years of expensive workforce spending for the years to come. Hence the need, still, to argue for the “plan to deliver and get the backing it needs”.
HSJ believes the terms of the work that is getting underway covers all the right things, including hammering out the crucial new trainee numbers, which would only pay back in trained numbers quite a few years in the future.
Yet of course, without Treasury backing and wider government signoff, all that would be of little use.
Hope for the amendment
Speaking to Chris Hopson, chief executive of NHS Providers, about all this yesterday, he recounted the “long-running story” of the NHS trying to a produce a “long-term, number-based, projections of workforce need”, but parts of government, particularly the Treasury, not being prepared to let them see the light of day.
“The NHS’ position is absolutely clear. It is impossible to run the NHS effectively without a numbers-based plan that [runs] beyond the spending review period,” Mr Hopson told me.
On the potential workforce strategy he questioned whether it would have the “independently verified element” that has been called for by senior politicians and healthcare leaders.
An amendment was put forward to the Health and Care Bill put forward by Jeremy Hunt in the Commons, and again by peers including Lord Simon Stevens in the upper house, that would require government to publish workforce projections every two years.
It will be heard again early next month in the Lords report stage of the bill, and Mr Hopson said: “Our reading is that there is a significant head of steam behind this amendment and a degree of confidence and optimism that the Lords will vote in favour of it at report stage in early March.”
Though this would give government a poke in the eye – and keep the issue on the agenda – what is crucial is whether ministers will accept or make their own amendment on the issue. If they remain opposed, once the bill returns to the Commons, they will relatively easily overturn any Lords amendment which they don’t like.
Mr Hopson is clear: there must be a way to combine proper workforce planning for the NHS and satisfy the Treasury that it is not “pre-committed” to future expenditure, which it would not sign up to.
By publicly mentioning the workforce plan – something of a soft launch, if you will – perhaps the health secretary and Ms Pritchard are putting their cards on the table.
Demand on district nursing
Part of the workforce that desperately needs a more rigorous approach to workforce planning are district nurses; numbers have been in sharp decline for almost a decade.
This week, the Queen’s Nursing Institute published its workforce standards for district nurses, which set out the key themes that need to be considered when planning “workforce to meet demand” and also areas of risk that should be escalated.
The standards were developed by the QNI’s International Community Nursing Observatory over the past 18 months, led by its director, Alison Leary, chair of healthcare and workforce modelling at London South Bank University.
“[District nurses’] workloads are far exceeding the capacity of services,” Professor Leary said. “From the qualitative data we have collected over the last seven years, there appears to have been a shift towards district nursing teams acting as a failsafe for other NHS and social care services.”
“District nursing services rarely refuse patients or close a caseload, leading to unremitting demand and this is a high-risk strategy,” she said.
These safety standards are needed to protect district nurses and their patients, but will employers be able to put them into practice, considering the pressure on other services and shortages of DNs? Surely, to protect nursing services and patients, they must try.
The biggest workforce story of the year so far is still rumbling on. The government’s U-turn on mandatory vaccines may be a relief for employers worried about staff shortages, but the issue of staff vaccination has not gone away.
In particular, questions remain about the role of the regulators when it come to NHS staff having their covid jab.
Andrea James, partner at law firm Brabners, said the health secretary’s plan to push the responsibility for enforcing vaccination on to regulators has largely failed.
“Whilst the regulators have all issued statements strongly encouraging vaccination, all those who have been specifically questioned about vaccination refusal and fitness to practise have made clear that they do not think that refusing vaccination would in itself amount to a fitness to practise concern,” Ms James said.
“So, being unvaccinated will only form the basis of a fitness to practise case if it’s part of a wider concern such as lying about one’s vaccination status or knowingly attending work whilst covid positive.”
Employers should watch out for a separate government consultation on strengthening the regulators’ role when it comes to staff covid vaccination — the outcome of this could be very significant.