Clinical staff shortages caused by government ‘mismanagement’ – PAC

Government “mismanagement” means that NHS trusts have suffered persistent staff shortages caused by efficiency targets, a damning new report from the Public Accounts Committee (PAC) says.

The report states that the NHS clinical staffing shortage of 5.9% or 50,000 people, was due to real-terms efficiency savings targets of 4% in 2012-15. NHS Improvement has now accepted the targets are unrealistic, but NHS England CEO Simon Stevens said yesterday that the NHS will aim to make savings of 2-3% until 2020.

The PAC said that the Department of Health, NHS Improvement and Health Education England must report back by December 2016 on what co-ordinated efforts they have identified to address staffing shortages.

Meg Hillier MP, chair of the PAC, said: “There are serious flaws in the government’s approach to staffing the NHS and without urgent action the public will pay for it on multiple fronts. Frontline staff such as doctors and nurses are the lifeblood of the service, yet the supply of these staff in England is not keeping pace with demand. This poor workforce planning means patients face the possibility of longer waiting times and a greater cost to the public purse.

“It is unacceptable for the government to blame staffing agencies for the growth in spending in this area when its own mismanagement is a major contributor to the size of the bills. At the same time, taxpayers are being asked to accept uncosted plans for a seven-day NHS – plans which therefore present a further serious risk to public money.

“It beggars belief that such a major policy should be advanced with so flimsy a notion of how it will be funded – namely from money earmarked to cover all additional spending in the NHS to the end of the decade. Taxpayers are entitled to ask questions about the financial security of the NHS and the level of service it is able to provide both now and in the future.

“If the government hopes to reassure the public it has credible plans for staffing and service delivery we urge it to demonstrate leadership in addressing the pressing concerns detailed in our report.”

The efficiency savings were combined with an increased demand for nurses to maintain safer staffing levels following the closure of the Mid Staffordshire trust.

Many trusts interpreted the recommendation for a maximum of eight patients to a nurse as a requirement, when it wasn’t. There are also not enough new nurses being trained to meet the demand, although this is expected to improve after 2020 because Health Education England increased the number of training places.

However, many colleges raised concerns that plans to abolish bursaries for student nurses would lead to further shortages, and Health Education England admitted it didn’t know what the effects of the changes would be.

Janet Davies, chief executive and general secretary of the Royal College of Nursing, called for the government to halt its plans to abolish bursaries, saying: “The Government has not thought hard enough about the risks of their student funding proposals or of reducing the funding for continuing education. The proposals don’t reflect the reality of modern nurse training or address the risk that they will reduce access to nursing and make workforce planning even more difficult. The risks are so serious that the proposals should be immediately stopped until a more suitable model of funding can be found as the evidence to justify these changes just isn’t there.”

Lack of co-ordination

Other problems highlighted as contributing to a shortage in nurses included a lack of co-ordination of efforts to recruit nurses overseas, the under-utilisation of schemes to encourage former nurses to return to practice, and no specific work to ensure affordable homes were available for nurses.

Health secretary Jeremy Hunt claimed on Monday that the NHS is ‘turning the tide’ on agency spending, as NHS Improvement figures said it had saved £300m by introducing the agency cap.

However, the PAC said that the agency cap was not sufficient to tackle spending on agencies and the Department of Health and NHS Improvement must take action to address the underlying causes.

The PAC also said that NHS Improvement should review trends in clinical staff leaving the NHS; the Department of Health should set out a plan to address clinical staff’s housing requirements; and the department and Health Education England should assess the impact of the changes in education funding on nursing levels.

More generally, the committee recommended that all major health policy initiatives should specifically consider the staffing implications and the Department of Health should report back, again by December 2016, with a summary of the workforce implications of the seven-day NHS.

New University of Manchester research suggests that the ‘weekend effect’, used to justify the seven-day NHS because it allegedly shows that higher death rates among hospital patients are linked to lower staff levels on weekends, does not exist.

Government promises seven-day NHS introduction by next March

A Department of Health spokesperson said: “This report doesn’t properly take account of the dramatic workforce increases we have delivered, or our clear plans to increase capacity in the future in order to deliver a safer, 7-day NHS.”

The department said that despite the criticism from the PAC, it plans to introduce seven day care to a quarter of the population by next March.

It added that it had introduced 25,300 clinical staff since 2010, and by 2020 would have 11,420 more doctors in work and 10,000 more health professionals training as a result of the bursary abolition.

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