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07.03.19

A Critical Moment for the NHS

As part of our guest blog series, chief executive of NHS Employers, Danny Mortimer, reflects on a recently published Health Foundation report on staffing trends of the NHS - and what he believes should be done at this critical crossroads in the lifespan of the healthcare workforce.

The title of the latest research paper from the Health Foundation on NHS staffing trends is well-chosen: we are indeed at a critical moment in the lifespan of the health service, as we face the worst workforce crisis in recent history.

This excellent piece of work reinforces key messages from employers in recent years, and this is reassuring in one way at least: it demonstrates that the challenges we face are well-understood, as are some of the required responses.

There are two major areas in the paper that we maintain require action from policy makers, recognising the asks we have put to government in recent times: the reinstatement of funding for continuing professional development (CPD) and clarity over future immigration policies.

Immigration in particular has been a thorny issue, especially in the wake of the Brexit referendum.

The report’s finding that uncertainty about the status of EU nationals after Brexit has contributed to a reduction in the inflow of health professionals from the EU tallies with the work of the Cavendish Coalition, which is a group of health and social care organisations that works together on post-referendum matters linked to workforce.  

There have, of course, been measures to improve pay (and starting salaries in particular), education and training, routes into professions, and attraction into roles domestically, but there simply aren’t enough skilled domestic staff across many professions to meet increasing service demand. 

More must be done to support training in our areas of greatest risk (mental health and learning disability nursing, therapeutic radiography) but we agree with the Health Foundation that more staff groups need to be added to the Shortage Occupation List, and have gone further in arguing that all staff groups should be added to the list.  

For many employers, recruiting nurses from overseas forms a critical part of meeting demand and delivering high quality patient care. In social care, furthermore, the contribution of EEA nationals is also vital, as they make up as much as 5.4% of the workforce. As of June 2018, 144,074 NHS staff (12.7%) are reported to have a non-British nationality.

Of even greater concern is the proposed £30,000 salary threshold for so-called “skilled workers”. This is an ill-judged policy both in what it says to UK nationals in our teams and to our colleagues from across the globe. Everyone in the NHS in particular should make clear their grave concerns that a crucial source of valued social care colleagues will be cut off by the proposed threshold.  This will have an impact on our communities and in particular on our elders.

Employers want and need a future immigration system that is responsive, agile and easy-to-use for both them and those applying to roles in the UK, to support international recruitment.

Digging into the findings on CPD, we were glad to see a spotlight being shone on the issue of a lack of investment in this area, drawing attention to the fact that central investment in CPD for existing staff is now a third of its 2014/15 value, with £84m dedicated to workforce development for clinical teams in 2018/19. 

It is important to stress that the majority of this funding was used for the professional development required by clinicians to run existing services day to day.

CPD is not typically about investing in that which is new or seen as ‘transformational’: it is about enhancing practice in core services such as critical care or long term conditions, it is about good workplace teaching and mentorship and it is about supporting safe and evidence based practice.  It is above all a sign to our leaders and teams that the leadership of the NHS so values learning and development for our clinicians that it will set aside and protect money nationally for that purpose.  

The consistent view of NHS leaders, and nurse and workforce directors in particular, remains that steps must be taken to start to reinstate that funding in advance even of the spending review settlement for HEE (whose real terms budget reduction from 2015 resulted in the cuts to CPD funding).  To begin to restore that budget would be a sign that the centrality of our people to the NHS Long-Term Plan is recognised by Simon Stevens, David Prior and Baroness Dido Harding.  To begin to restore that budget would give substance to the workforce implementation plan.

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