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The NHS Long Term Workforce Plan one week on – PPP staff reflect and react

Cautious optimism is the theme as PPP staff offer their reflections on the NHS Long Term Workforce Plan. The plan itself brings up a host of organisational challenges – many of which have no obvious answer.

Cannot ignore the issue of pay forever

– Gabriel Blaazer, Content Editor –

Between 2010 and April 2022, NHS nurses saw their pay fall by 8 per cent in real terms (compared to 6 per cent across the wider public sector), equivalent to a reduction of more than £3,000. More recently, NHS bosses have repeatedly warned that lower band NHS staff are increasingly unable to afford to get to work, feed their families and heat their homes. 68 per cent of NHS trusts report a “significant or severe impact” from staff leaving to find work in other, often better paying sectors, such as hospitality or retail.

The government and medical unions remain far apart in pay negotiations.

Rishi Sunak recently intimated that the government would ignore the upcoming pay review body was not for ministers to decide on public sector pay, arguing instead that this should be determined by PRBs. It is difficult to see how the NHS will manage to attract and retain sufficient staff in the short-term without a substantial uplift in current pay and conditions – a fact the government does not appear to be reconciled with.

If the government does indeed want to reduce the NHS’s “reliance on foreign-trained healthcare professionals”, a greater emphasis on making careers in health and care rewarding and viable for all members of society will be essential.

Training, education, skills – how the regulators respond will be crucial

– Samantha Semmeling, Policy Analyst –

With NHS vacancies currently estimated at more than 150,000, the ambitions of the Long Term Workforce Plan to double medical school and GP places, and almost double adult nursing places by 2031, are welcome goals. Alongside increasing the number of training places available, NHS England is also exploring the option of reducing the time it takes for these professions to enter the workplace and offering students the opportunity to ‘earn whilst they learn’ via degree apprenticeships. This will not only help to plug the gap quicker but will also widen the net of students able to take up medical training.

Nevertheless, conversations are yet to happen with regulators to provide answers around the feasibility of reducing the length of medical degrees, and the BMA has aired caution around the currently ‘untested’ medical degree apprenticeships to be piloted in 2024/25.

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Extra training places may be academic if the number of job postings does not also increase.

Despite these hurdles, significant levels of funding are contained within the plan, so they should not be disregarded as unattainable. However, the lack of detail surrounding infrastructure and capacity for training extra individuals in these specialisms poses significant questions. With a recent GMC report outlining that medical trainers are already under pressure and are less likely to feel supported by senior medical staff, it is paramount that a concrete plan is developed to increase trainer numbers to prevent overburdening current trainers and compromising patient safety. Trainers in the sector are also often clinical practitioners themselves, so their recruitment could reduce front line NHS staffing.

The focus of headlines on extra medical training places risks missing the point that if job posts further up the hierarchy of medical training are not increased, extra training places may not translate to an increased number of specialised and clinically practising doctors. Previous attempts to increase medical student numbers have been met with challenges, including the almost 800 medical students reportedly last year missing out on foundation year training programmes. Although the plan does highlight the need for an expansion of speciality training programmes aligned with the increase in medical student numbers, a clear path is required to prevent bottlenecks at every level.

Social care can no longer be ignored

– Mary Brown, Policy Analyst –

If anything was highlighted by last week’s Workforce Plan, it was the manifest need for a comprehensive and fully funded social care workforce plan of equal measure.

Despite the continued drive towards full integration of health and care services the NHS workforce plan misses the opportunity to deliver a truly integrated workforce plan to support a struggling and continually neglected social care sector, this oversight will ultimately impact NHS services.

The plan does acknowledge the interconnected nature of the health and social care sectors, and states clearly that pressures in the social care system directly impact the burden on the NHS. It acknowledges the high vacancies, low wages and poor retention of the workforce, and calls for broad government support and increased investment into the social care sector.

“Leaders have long called for a dedicated and fully funded workforce plan for adult social care.”

Some recommendations of the plan are relevant for the social care workforce, including the suggestion of more integrated workforce planning, which may include “joint teams, joint training and rotation between NHS and social care settings”, and “more diverse and integrated clinical placements” which may take place in social care settings. It also suggests “upskilling social care staff to take on healthcare tasks… such as insulin administration”. However, in the main, the report disregards and shirks responsibility for the prominent issues in the social care workforce.

Leaders have long called for a dedicated and fully funded workforce plan for adult social care. The social care white paper published in December 2021 – People at the Heart of Care – offered a broad outline of a workforce strategy for social care, including plans for improved training and progression, the introduction of care certificates, wellbeing and mental health support, digital training, and improved recruitment. Initially this strategy was promised alongside £500 million of funding for the social care workforce, however in April of this year that figure was halved to just £250 million. The care sector and its workforce require more than vague promises if they are to confront significant recruitment and retention issues and provide high quality care for those in most need.

In our report, The Social Care Workforce: Averting a crisis, PPP makes a series of recommendations to contribute to a social care workforce strategy, formulated during a series of roundtable conversations with our Social Care Network. These recommendations include:

  • Raising the minimum wage of adult social care workers, mirroring the NHS Agenda for Change pay scale, to ensure social care staff are adequately renumerated for their skills, and to facilitate the better integration of services and the formation of multidisciplinary teams.
  • The promotion of social care careers in schools are a technically skilled and fulfilling career, in which care professionals improve the quality of life of those most in need through relationship building and practical care.
  • The establishment of a Royal College of Care Professionals, to recognise and set the status of the workforce, and raise its public perception.
  • The creation of new cross-sector roles between health and care, as well as placements and secondments of NHS staff into social care. This will increase awareness and visibility of social care in the NHS and aid the integration of the two workforces.
  • Government backing and investment for the proposed Social Care Leaders Scheme, learning from the success of similar schemes such as Teach First
  • The integration of volunteers into a workforce strategy, given the benefits to staff and system users, and for workforce recruitment

Detail on retention left wanting

– Anvar Sarygulov, Deputy Head of Content and Policy –

Retention is increasingly a challenge for the NHS, with the 2022’s NHS Staff Survey showing almost a third often thinking about leaving the organisation. The Long Term Workforce Plan makes retention one of its key pillars, and we particularly welcome the focus on improving occupational health and wellbeing services. As outlined in PPP’s Workforce and Talent Development report, supporting wellbeing is important for improving retention, and both commissioners and providers should agree a common set of metrics to ensure that maintaining mental and physical health and resilience is monitored and acted on to achieve this.

Leaving rate of NHS staff, 2015-2022 (click to enlarge)

However, it was disappointing to see a lack of concrete commitments on issues around pay and conditions: poor occupational health and wellbeing are themselves symptomatic of current conditions and to significantly increase retention, these root causes must be tackled. Satisfaction with pay has been declining across all groups of NHS staff over the last couple of years, and there is significant evidence for the post-Covid drop in morale leading to lower discretionary effort across the service, on which the NHS has always relied significantly. While increasing access to flexible working will help, it is not sufficient to improve conditions, especially if staff numbers do not increase in line with increases in flexibility.

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