How can we ensure the NHS has the workforce it needs?

As one of the UK's leading experts and House of Lords appointed specialist advisor for the work of the Select Committee on the long-term sustainability of the NHS, Anita Charlesworth CBEspoke on the first morning of the Conference with a data driven and ominous account of the reality facing the NHS workforce. 

Director of Research and Economics at the Health Foundation, Charlesworth's presentation focused on the two big groups of NHS staff where consistent data is available: Nursing; and GPs and the Primary Care workforce. Although the data painted a stark picture throughout, the theme of inconsistent or unavailable data raised the question of whether the reality in other pockets of the NHS workforce not represented here might actually be better, or indeed worse, than we anticipate.

Using a series of charts and up to date evidence, Charlesworth quickly detailed the UK's position vs. other Organisation for Economic Co-operation and Development (OECD) countries, showing that the UK has fewer doctors and nurses per head of population than most other OECD countries. There's clear evidence that the system is under pressure, and struggling to think about its needs and provide continuity of care for its patients. This is perhaps not surprising given the current data on the numbers in nursing; add to this the fact that nurses in the UK are relatively less well paid compared to comparator countries, with 4 per cent more than the average earnings in the UK in 2015 versus a typical margin of 14 per cent. It is not just nurses who are suffering from a shortfall – when looking to increase numbers of doctors to make up for existing shortfalls, the sheer length of their highly specialised training is a problem.

Another pertinent issue is the UK's dependence on foreign trained nurses, who comprised 14 per cent of the workforce in 2015 versus the OECD average of just 6 per cent. The UK lacks a convincing domestic supply solution, and the great unknown of Brexit looms large.

It's not all doom and gloom: staff numbers have increased by around 7 per cent. Unfortunately, demand has increased by more than this and there is an estimated shortfall of 100,000 staff against an assessment of needs to deliver the care the service has committed to. Perhaps more worryingly, this figure is only based on existing commitments and does not include any improvements to services, leading to an overall shortfall of 250,000 staff between supply and demand versus even a moderate prediction of future needs. Add to this the increase in staff taking early retirement and a low pipeline of new nurses coming through… this could add up to a shortfall of some 350,000 staff.

So what is being done? Between 2010-2017, ONS figures based on show that the amount of care delivered by the NHS grew by 23 per cent, while the number of nurses available to deliver that care grew by only 1 per cent. Ministers are announcing extra staff but this does not provide a magic solution, as these roles are highly specialised and require years of investment in training. The shortage only grows when we consider holistic, person-centred care for people who need it on a sustained basis. Charlesworth queried the impact on stability within hospitals and care settings. This churn is particularly present in community health services and mental health services, areas where the depth of relationships between service users and staff are crucial. There is an urgent need for new models of care which take into account the requirement for continuity of care in these areas and the high pressure environments that they present.

In addition to looking at training, there is a challenge of retention. The mental health of the NHS workforce is in a poor state: Charlesworth stressed that there are real people behind these issues. The figures for BAME staff are particularly woeful, with increases in reported discrimination combined with a lack of support and lack of opportunities to progress. Work-life balance is reported as a key reason for the droves leaving in later career phases.There are limited options for those who do not wish to work 12 hour shifts into their 60s, and our ageing population has seen an increase in workers with responsibility for the care of their parents, children and grandchildren. 

Numbers are only one part of the problem – the pace of change within the NHS requires a team model that enables staff to work in a multi-professional way, sharing knowledge of their patients and enabling the multidisciplinary team management of patients across their care lifecycle.

Charlesworth's summary of the evidence was that we don't have to live with shortages forever – it is possible over the longer term to have enough staff, but the change needs to start today. These complex workforce issues are only increasing in their urgent need for meaningful intervention. Although the bulk of the slides showed the evidence and data, Charlesworth herself presented a series of challenges to psychologists throughout her keynote. Her concluding statement mirroreda trend across the conference for experts in other fields to throw the gauntlet down to psychologists – 'what are you going to do about this?'

-    Read more about the changing NHS workforce in our upcoming interview with Professor Michael West.

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