The welcome NHS Workforce Plan must mark the start of a challenging reform agenda
Publication of today’s long term NHS Workforce Plan marks a milestone for two reasons. Firstly, because its content is genuinely reforming – significant commitments with the potential to address critical financial and operational challenges in the system. We have long needed a supply-side increase in clinical staffing – half a million more medical trainees by 2028, 50% more GP training places and a doubling of adult nurse training places to 50,000 by 2031. The UK is finally set to free itself from its long-standing and deliberate policy of undersupply – a policy which has suited short-term thinking in trade unions and HMT alike but has left the NHS short of numbers and dependent on overseas labour and temporary staffing.
The second way today’s strategy marks a critical staging post is in its transfer of focus and accountability for these ills from government policymaking to NHS implementation and improvement. With the supply side blockers tackled, it is now for the NHS and its various constituents to tackle the workforce challenges and ways of working which have undermined services.
For the many years during which the NHS workforce plan has been “long awaited”, the service has been able to point to government, rightly demanding remedies from Whitehall. Political leaders have exacerbated this with a collective failure to deliver. In 2017, the then Health Secretary and I were almost successful in persuading the Prime Minister Theresa May to include a doubling of medical school places in the Conservative Election Manifesto. Six years have since passed in which this and other reforms were overlooked. It has taken the alignment of various factors to create the conditions for progress, finally (not least Jeremy’s arrival at HM Treasury to overturn its institutional resistance).
With the staffing numbers now boosted, the focus is now on the service itself to deliver against a substantial reform and productivity improvement agenda. As Prof Sir John Bell said recently, simply tipping more pounds, doctors and nurses in at the top resembles something of a “Battle of the Somme Strategy” – more and more bodies thrown at the problem in the forlorn hope they can prove sufficient to the massive onslaught created by the pressures of an ageing society, costly new treatments and rising consumer expectations. We have to remodel how the system uses these resources, what the roles and careers of healthcare workers look like, and how patients interact with the services they depend on. If the increased numbers announced today simply serve to embed the outmoded and inefficient working practices that taxpayers, patients (and increasing staff) are frustrated by then it will have failed.
Today’s Strategy doesn’t attempt to address each and every one of the ways in which this must happen, and inevitably there are thorny issues and enablers for long term workforce reform which are notably absent. However, several new measures have been set out which are focussed on this remodelling and the NHS ecosystem is now under pressure to deliver against them. For example, non-degree educated Nursing Associates will increase by 40% and taken on work currently undertaken by nursing staff while having a route into the profession. Medical degrees may be condensed from five to four years. Apprenticeships will be expanded and trainees will start work on wards and in practices sooner, while arcane and complex recruitment processes will be streamlined.
We must hope that the changes to training and careers do not now get bogged down by cautious regulators and obstructive professional interests. But more broadly, government and the NHS must treble efforts to drive more flexibility, automation and productivity into how services actually operate. Whether it be broadening prescribing rights, digitising low level clinical processes, reforming pay and rewards frameworks, improving skills mix or any of the other reform agendas which need to be embraced, this is not the end of the journey. Today’s strategy is an important marker and creates some of the conditions for success, but it should be seen as the start not the end. Ahead of us is a difficult programme of reform which government, regulators, professional bodies and providers will need to commit to with new enthusiasm.
By Ed Jones
Ed is a founder and Senior Partner at Newmarket Strategy. He previously served as Chief of Staff to Jeremy Hunt MP and Special Adviser at the Department of Health and Social Care from 2013-2019.