The number of health service staff in England is a political issue. Labour has criticised the government for effectively causing NHS job cuts by demanding that trusts do more with the same budgets. In December, it released Department of Health figures stating that 7,060 clinical staff have been made redundant since the coalition took power in 2010. But an analysis of NHS workforce numbers, using Health and Social Care Information Centre data drawn from the electronic staff record system that pays virtually all staff, shows that the health service's overall size is almost unchanged over the last four years. In October 2009, the English NHS (excluding GPs and their staff) employed the full-time equivalent of 1.052m people. Four years later, the health service employed 1.046m, 0.5% fewer. As the thick black line on the graph shows, numbers have fluctuated over this period, but have not moved dramatically.
What has changed significantly is the mix of staff. The number of doctors employed by NHS trusts rose by 6.9% over the four years to last October, to 105,056. Within this group, the number of consultants rose nearly twice as fast, up 13.2% to 40,709. Numbers of qualified ambulance and technical staff rose slightly. Meanwhile, nursing numbers initially fell, leading to criticism from Labour leader Ed Miliband. But numbers have since recovered to 310,924, up 994 (0.3%) over the four years, with clinical support staff following a similar pattern.
But there have been big NHS job cuts in one area: infrastructure support staff, down 10.2% over the period. Within this group, the people suffering the biggest cuts have been non-senior managers, down 18.5% to 24,349, and senior managers, down 22.1% to 10,197. Many left as the result of the government's phasing out of primary care trusts and strategic health authorities, completed last April.
Candace Imison, deputy director of policy at health service research charity the King's Fund, says: "One of the real risks in cuts in funding is that we have cut management capacity to the bone. But I think in the future, it needs to become everyone's job."
Imison says that the best healthcare organisations involve all their staff in management, by allowing and encouraging them to improve processes. This model is used by a few NHS trusts, including Salford Royal foundation trust, but is rare.
She adds that the increase in hospital doctors is an example of the NHS deploying its staff in potentially the wrong places, given that most experts believe more healthcare should be carried out in the community rather than in hospitals. However, one answer is for consultants specialising in chronic conditions such as diabetes, heart and respiratory disease to spend part of their time training and advising GPs. This would tend to reduce the number of patients referred by GPs to consultants, but would see consultants helping to maintain the health of far more patients.
The Health and Social Care Information Centre also tracks job numbers at individual NHS trusts, with big differences in rates of increase and decrease. This is shown on the map of the 30 largest trusts, with green pointers showing fast-growing trusts, yellow showing those growing more slowly and red those shrinking in the year to October. The centre also tracks regional changes, although these figures are less clear. Last April's reorganisation transferred many jobs to central organisations outside the regional classification, meaning that every region appears to have lost posts, although the staff are often still working in the same places. For regions, the map indicates levels of decrease, with green areas showing the fewest and red the most, although none have changed that much.
In many cases, big increases at trusts over the last four years are due to them absorbing primary care trusts' community healthcare staff or taking over other trusts. Central Manchester university hospitals foundation trust, which had 47% more staff last October than four years previously, has done both. Staff numbers at King's College hospital foundation trust jumped by 2,393 to 9,937 between September and October last year when it took over services from the dissolved South London Healthcare trust.
But the largest NHS trust, Barts Health, saw staff numbers drop by 3.1% in the year to last October, to 13,129. It was formed from a merger of three trusts in April 2012, and standardisation of staffing levels led to 400 posts being cut, including 123 redundancies as well as the removal of vacant posts and not replacing retirees. The trust also says that many staff were transferred to other employers.
However, numbers are now increasing. "We are currently conducting the largest recruitment exercise that Barts Health has undertaken," says a spokesperson, through which it expects to have offered around 700 nursing jobs by the end of March. "Additional staff have already been recruited to areas, including surgery and medical departments to increase the number of staff caring for older people, particularly at night."
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