Responding to the first NHS long-term workforce plan, in 2023, the King’s Fund thinktank described staff shortages and gaps in England as amounting to a “deeply entrenched crisis”. That document was meant to be the start of something. Under the Conservatives, parliament rejected the idea that NHS England’s jobs strategy should be subject to independent scrutiny. But given the initial estimate of a 260,000 shortfall in England’s health workforce (including doctors and nurses), there was a promise to review the position in two years.
That date is fast approaching. Fixing the workforce should be among the big themes of Labour’s 10-year plan for the health service, when it is published in June. Attention in recent weeks has focused on the centre, following the announcement that NHS England would be scrapped and its functions, along with around half of its 15,000 staff, brought back inhouse to the Department of Health and Social Care. Manoeuvring at the highest level continues, with Sir Chris Whitty filling the role of permanent secretary on an interim basis. But what of the changes on the frontline that will be needed if the government is to succeed?
The deployment of community health and wellbeing workers to 13 more areas, following a successful pilot, is one clue to what lies ahead. While not clinically trained, like health visitors, these workers are responsible for checks on households in a given area that are known to need support, and can help with housing or other practical issues as well as health. Early results are promising. This kind of holistic outreach looks consistent with the government’s aim of pivoting towards prevention in the community, and reducing the proportion of health budgets spent in hospitals.
But developing new roles and projects like these while simultaneously slashing budgets and jobs will be challenging, to say the least. Instructions to NHS trusts to cut by 50% the cost of their corporate functions, such as HR and communications, could lead to the loss of 100,000 posts in total – and a huge redundancy bill. Integrated care boards are also under instructions to slim down and focus on commissioning.
At the health select committee on Tuesday, Wes Streeting depicted himself as a warrior against bureaucratic bloat. Far from a power grab, he told MPs, the merger with NHS England is intended to push decision-making down the line to neighbourhoods. On the reduction of centralised targets, he stuck to his guns. Ministers want more “doers” and fewer “checkers”.
Will community and primary care services be able to deliver what is asked of them? However the 10-year plan is framed, this looks like being a key question over the next few years. How to reconcile a commitment to local innovation with demands for fairness is another. On waiting lists, and GP numbers, there is modest progress to report. The risk is that cuts and reorganisation cause more problems than they solve. Talking up the importance of “doers” is one thing. But staff morale and patient satisfaction are both at worryingly low levels, with further strikes a strong possibility. The entrenched crisis in the NHS workforce is ongoing.
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