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Workforce shortages threaten delivery of NHS Five Year Forward View

Mental health, primary care, and community nursing under serious pressure, says King’s Fund

Caroline White

Wednesday, 29 April 2015

Staff shortages and other critical pressures within the NHS workforce could jeopardise plans outlined in the NHS Five Year Forward View to deliver new models of care, concludes a report from health think tank, the King’s Fund, published today.

The report, which analyses recent trends and pressures in three key areas of the workforce critical to the delivery of the new models of care—mental health, primary care, and community nursing—finds that each is under serious pressure.

In mental health, the number of inpatient nurses has fallen by 15% over the past five years, prompting a significant rise in the use of agency staff and a two thirds increase in requests for temporary mental health nurses since the beginning of 2013-14, says the report.

The well-documented pressures on general practice have led to fewer training posts being filled and more GPs planning to retire early, resulting in a growing shortfall in the number of GPs, it says.

And while the number of health visitors has increased by nearly a quarter over the past five years, the number of senior district nurses has fallen by 30% and there are now 16% fewer community matrons.

The report points to the increasing reliance on agency staff in NHS organisations. The Fund’s analysis of recent figures provided by NHS Professionals, the principal provider of agency staff to the NHS, shows requests for temporary hours more than doubled between April 2012 and January 2015.

The use of temporary staff on this scale represents a substantial financial burden for the NHS at a time when budgets are stretched to breaking point and risks reducing quality of care, says the report.

It highlights changes made at a national level to improve workforce planning, including the establishment of Health Education England (HEE) to provide greater strategic oversight, and the introduction of 13 regional local education and training boards (LETBs), to co-ordinate training at a local level.

But while the establishment of HEE has led to improvements in planning the workforce of the future, it is unclear who is responsible for managing the workforce needed today, argues the report.

The report calls for a clear plan for the NHS workforce to support the ambitions set out in the NHS Five Year Forward View. It says this should focus on improved data because a lack of national data, particularly for temporary staff and the independent sector, makes long-term planning very difficult, added to which assessment of national level of supply and demand for most areas of the workforce is inadequate.

And it calls for stronger more strategic leadership from national bodies involved in training and developing the workforce of the future.

There should also be greater collaboration across local and regional levels to deal with short to medium term workforce pressures in a more joined-up and systematic way, says the report.

And better co-ordination is needed between bodies responsible for training staff to meet national ambitions and the expectations of local organisations employing staff, it says.

Rachael Addicott, Senior Research Fellow at The King’s Fund and lead author, described the workforce as a key asset for the NHS, and pivotal in meeting the health needs of current and future patients.

But she said: “We need the right people in the right place, able to adapt their skills to changing demographics and work together to support new models of care. However the trends we are seeing are moving in the opposite direction, with an increasing over-reliance on temporary staff and a ‘black hole’ in the data needed to make effective workforce plans.”  

And she added: “Staff working for the NHS in 2015 will essentially be the workforce of 2020, so it’s crucial we have the right information to plan locally and nationally for retention and retraining as well as recruitment. National bodies will have to demonstrate leadership on this issue and local leaders should better coordinate efforts in their communities and regions to meet current need and build the future workforce.”  

Danny Mortimer, chief executive of NHS Employers, said the report was a useful addition to current thinking on workforce planning.

“It’s important that any future policies support the ability of local NHS organisations to deploy staff in the best way to support high quality and efficient patient care. This will allow them to build on the examples of innovation we see across the NHS,” he explained.

He added that NHS Employers was working with organisations across the system to increase the supply of groups of healthcare professionals in short supply and to support health care providers to retain and develop their existing workforce.

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