The Ward Round: Why the workforce plan was leaked

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, will make sure you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce.

The Times’ front page story earlier this week detailing plans to boost international nurse recruitmentmay have whipped some commentators into a frenzy, but, to many in the NHS, it was no surprise. Trusts – both individually and collectively – have been recruiting internationally for years. Some pockets of England rely heavily on overseas hiring to fill rotas and deliver safe patient care.

Boosting international recruitment has been an important priority for several years, especially given data like that from the Nursing and Midwifery Council this week, which revealed more nurses are leaving the register than joining. The leaked plan to recruit 5,000 international nurses a year to 2024 is not enough to plug the current vacancies for more than 40,000 nurses. With patient demand predicted to increase even further over the next few years, the plan’s ambitions - if we are to trust the leak - are conservative to say the least.

The lack of new money is a major sticking point for the interim workforce plan which cannot be ignored. It could be argued this leak was intended to put pressure on the Treasury to pump money into the spending review and increase the domestic supply of nurses. As previously reported by HSJ, this interim plan will act as a bid for the final plan, due after the spending review later this year. It is clear that more funding is needed for workforce retention, migration and domestic training, but it is not in the interim plan’s gift to provide this.

No magic rabbit

One senior leader in the NHS told HSJ getting international recruitment right is but a small part of the overall plan. Instead, the priority will be to make the NHS a better place to work by treating staff in a manner which makes them want to stay and build their career. Flexible working and making the NHS more appealing at the beginning and end of people’s careers will clearly play a part in this. 

This might not be as exciting as some have hoped. However, as one NHS leader said, the plan is not about money and numbers and there will be no magic rabbit pulled out of a hat. Various people involved in producing the interim plan have stressed repeatedly that ”it feels different this time”. One pointed out simply getting everyone around the table in the first place is a significant leap forward.

Before this piece of work, workforce planning has been fragmented, with the Department of Health and Social Care (along with NHS Employers) negotiating pay, Health Education England leading on training, and NHS Improvement overseeing spending. Senior leaders in the government and the NHS have acknowledged publicly there is a serious problem, which should not be underestimated, and HSJ has heard there is an appetite to continue this collaborative working after the workforce plans are published.

It is too early to say what a permanent group would look like, but it is recognised there is a real risk that, after this work is done, the NHS will go back to business as usual. This is not an option. 

Patience wearing thin

The interim plan has also apparently committed to two recommendations set out in the Kark review, including to introduce a register for NHS managers – arguably a symbolic move.

It seems the focus on values will extend to the regulators. One suggestion I’ve heard is the plan might include a ‘360-degree’ review on the regulators both regionally and nationally. Dido Harding has publicly acknowledged the need to improve NHS culture from the very top.

It was interesting that proposals to tackle the ongoing pensions crisis look like they have been removed from the interim plan. Although this will frustrate senior doctors, managers and employers – who run the risk of breaching their annual allowance, and being stung with additional tax charges, if they take on extra work or responsibilities – HSJ has learned the Treasury is minded to do something about this, and this omission was down to the tight timeframe of the interim plan, rather than a lack of intention to address the problem. 

There have already been a few of false alarms and  NHS leaders waiting for the interim plan are becoming impatient. When this work was first mentioned in the long-term plan, expectations were high. Perhaps it should have been made clear then what the interim plan would set out to do. A permanent workforce collaborative could result in long-term change, but it is unclear whether this will satisfy the need for immediate action.

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