The National Audit Office (NAO) has found weaknesses in NHS England’s (NHSE) long-term staffing plans, prompting Unison to warn that planning alone won’t turn the staffing crisis around.
The warnings came as the NAO published its report on NHSE’s modelling for the long term workforce plan (LTWP). This sets out projected staffing needs over the next 15 years.
The NAO found weaknesses in the model that it said must be addressed, although it acknowledged that creating the model represented a significant achievement.
It warned that plans were based on overly optimistic assumptions that needed to be revisited. For example, NHSE’s plan assumes increases in NHS productivity above the long-term historical average. It also assumes there will be a significant change in how general practice operates. Under the model much more work would be done by trainee GPs.
The NAO recommended that future versions of the plan should explore the uncertainty of these assumptions in more detail and consider what might happen if they fall through.
The NAO also found that the model assumes that the number of undergraduate places in medical school can be doubled by 2031-32.
“Such a rapid expansion in capacity presents challenges, which the modellers did not factor in. These include the impact of rapid expansion of student numbers on the quality of training, and whether existing staff have capacity to provide on-the-job training to that number of students.”
However, the report said that as the full increase in student numbers is some years away, NHSE has time to adjust its plans.
Under the plans, the NHSE assumes that increases in domestic medical education will mean that its historical and growing reliance on recruiting professionals trained overseas will be reversed. In broad terms, NHSE expects the number of international recruits to fall as domestic training grows.
“NHSE’s modelling projects that there will be no international recruitment of doctors at all from the mid-2030s. In our view, this is not a reasonable modelling assumption and, if the rest of the plan is implemented in full, risks too many medical students being trained from the early 2030s onwards,” the NAO said.
Helga Pile, head of health at Unison, said: “Getting pay right is key to turning around the fortunes of the NHS, its staff and patients, and slashing the backlog too. Ensuring decent wages, manageable workloads, workplaces that are free of harassment and discrimination, and truly flexible jobs is what will make a huge difference. Experienced staff will then be more likely to stay and recruitment rates soar.”
She said that: “Unless there’s a new approach to staff wages, much of the workforce plan will remain pie-in-the-sky thinking.”
Danny Mortimer, chief executive of NHS Employers, part of the NHS Confederation, said:
“We have always known that meeting the ambitions of the NHS LTWP will be no easy feat due to the scale of the challenge in filling existing gaps and boosting staff numbers to meet future demand, and the significant delay in commissioning the plan.
“We have always maintained that one of the most important aspects of the eventual publication of the plan was the commitment to regularly refresh it. It is helpful therefore that the NAO have given advice to how future iterations can be improved, building on the huge expertise and practical understanding already held in the NHSE team.”
Mortimer added: “There is also a real desire to see an equivalent plan for social care: we are very supportive of the work being done by Skills for Care, and look forward to government support for the recommendations Skills for Care will make.”
The NAO report was published in the same week that a YouGov survey found that the majority of adults believe the NHS is in long-term decline. The survey also found that people think employers need to take more responsibility for protecting employee physical and mental health.
