HEE launches plan to 'future-proof' NHS and care workforce

The NHS needs radical action to improve working conditions, boost training and retention and become a ‘model employer’ for staff, a report on the future of the health and care workforce has concluded.

Facing the Facts, Shaping the Future, A health and care workforce strategy for England to 2027 is a whole national system consultation document, produced by Health Education England with content from NHS England, NHS Improvement, Public Health England, the Care Quality Commission, National Institute for Clinical Excellence and Department of Health.

The draft strategy takes an uncompromising look at the challenges faced by the health and care system, charting the growth in the NHS workforce over the last five years while setting out the critical workforce challenges that will be faced over the next decade.

The strategy is a draft document with a number of areas that will now be consulted upon widely over the coming months and a final report will be produced next July to coincide with the NHS 70 anniversary as the first comprehensive health and care workforce strategy in over 25 years.

While the NHS is employing more staff now than at any time in its history, with significant growth in newly-qualified staff from 2012 across the majority of professional groups, the report concludes that more must be done to keep up with increased demand as the population expands and grows older.

It responds by setting out a range of measures to improve productivity, boost training and retention, open up new routes into nursing and prepare the future workforce for technological advances such as genomics, artificial intelligence and digital robotics, which are poised to transform modern medicine.

Among the specific measures are:

• targeted retention schemes to encourage staff to continue working in healthcare, including support for local NHS organisations on how to improve retention rates, an expansion of the nursing Return to Practice scheme and efforts to encourage European nationals to stay by ensuring a streamlined, user-friendly service for obtaining settled status
• improvements to medical training and how junior doctors are supported in their careers, with a greater emphasis on producing more doctors in areas where there are the biggest shortfalls, including general practice and psychiatry, and ongoing efforts to improve the working practices of doctors in training, such as improving access to training opportunities and better communication around rotations and shift patterns
• a far-reaching technology review across England, led by Dr Eric Topol looking at how advances in genomics, pharmaceuticals, artificial intelligence and robotics will change the roles and functions of clinical staff over the next two decades and what this will mean for future skills and training needs.
• making the NHS a more inclusive, ‘family-friendly’ employer – the strategy also acknowledges the changing shape and expectations of the NHS workforce, with more people wanting flexible working practices to enable them to balance work and family life. It concludes that NHS organisations will need to develop an employment offer that remains attractive for all staff.

The draft strategy looks at the major workforce plans for the Five Year Forward View priorities: cancer; mental health; maternity; primary and community care; and urgent and emergency care.

While acknowledging increasing demand from patients and increasing pressure on NHS staff, and the fact that up to 42,000 posts in nursing, midwifery and the allied health professions are not currently filled by substantively employed staff, it also reveals that:

• the number of clinicians substantively employed since 2012 has risen by 40,000, a rise of over 7 per cent;
• there has been an unprecedented programme of expansion in training over the past three years;
• medical and nursing undergraduate places will both rise by 25 per cent;
• we are now seeing the highest-ever number of people entering GP training in the history of the NHS;
• NHS workforce vacancies reduced by up to 9.8 per cent during 2016/17; and
• this reduction, combined with successful measures to control agency spending, has released £700 million in savings for the service.

Professor Ian Cumming, Chief Executive, Health Education England said:

Continuing with a business as usual approach to workforce planning is no longer sustainable. There needs to be a major shift in the ways we plan in order to make sure we can meet the health needs of the country’s diverse and growing population in the future.

The report tells us there are some areas of strength, 6,000 more staff working in primary care, the highest-ever number of people entering GP training in the history of the NHS. However, increasing the workforce alone is not the only answer, we need to look at ways to tackle the number of vacancies and staff leaving the profession.

This much anticipated report underlines just how big the workforce challenge is and will spark debate, rightly so. I would urge key stakeholders, including patients, service users, carers, to get involved in the consultation and let us know what you think works well or what can be done better to help inform the final workforce strategy for the NHS which will be published next summer.

As the NHS heads into its 70th year, more than ever, patients deserve nothing less than safe, high quality and compassionate care.

The strategy also acknowledges that the population continues to grow – by more than two million (4 per cent) between 2012 and 2017.

The new ten-year forward look shows that if no further action is taken to reduce demand through prevention, productivity and service transformation, the NHS will need to grow by 190,000 posts by 2027 to meet demand.

And there is a proposal for six overarching key principles that we believe should be adopted for all future workforce interventions. These are:

• securing the supply of staff that we need to deliver high quality care;
• training, educating and investing in the workforce to give new and current staff the professional flexibility and adaptability to meet the needs of patients;
• providing career pathways for all staff rather than just ‘jobs’;
• ensuring that people from all backgrounds have the opportunity to contribute to, and benefit from, healthcare;
• ensuring that NHS in its entirety is a modern model employer with flexible working patterns, career structures, and reward mechanisms; and
• ensuring that in the future service, financial and workforce planning are intertwined.

Health Secretary Jeremy Hunt said:

NHS staff are our health service’s greatest asset, but for too long, Governments of all parties have taken a short-termist approach to NHS workforce planning. We need a proper plan that stretches beyond any electoral cycle, and secures the supply of NHS staff for future generations. This important work kickstarts that process.

Professor Sir Malcom Grant, Chair, NHS England said:

I very much welcome the publication of this draft strategy. We need to ensure the future health and social care workforce can meet the needs of a diverse and ageing population and I look forward to contributing to the consultation.

Duncan Selbie, Chief Executive of Public Health England, said:

Helping people to stay well for longer and to stay in their own homes for as long as possible is dependent on investment in a confident and forward facing health and care workforce and this consultation is a big step on the way to securing this.