NHS workforce planning is in disarray, MPs warn

MPs have urged the government to review levels of NHS clinical staffing in England after they found that there had been “no coherent attempt” to assess the headcount implications of the government’s proposal for seven day services.

In a new report published on Wednesday 11 May the House of Commons Committee of Public Accounts raised serious concerns about the NHS workforce with regards to supply, budgeting, agency costs, and leadership.1

The committee said that the Department of Health and other national bodies had failed to provide effective support to tackle current and future workforce pressures, and it urged them “to get a better grip” on the supply of medical and nursing staff.

The report criticised the health department for failing to provide separate costing for seven day services and other major policy initiatives and questioned whether the extra £10bn (€12.7bn; $14.4bn) in funding pledged for the NHS from 2020 would be enough to fund all the government’s objectives.2 “We are therefore far from convinced that the department has any assurance that the increase in funding will be sufficient to meet all of its policy objectives,” the report said.

Meg Hillier, Labour MP for Hackney South and Shoreditch and chair of the committee, said that the government must deal with the “serious flaws” in its approach to staffing the NHS and improve its “poor workforce planning.” On seven day working, Hillier said, “Taxpayers are being asked to accept uncosted plans for a seven day NHS—plans which therefore present a further serious risk to public money.”

She added, “It beggars belief that such a major policy should be advanced with so flimsy a notion of how it will be funded—namely, from money earmarked to cover all additional spending in the NHS to the end of the decade.

“If the government hopes to reassure the public it has credible plans for staffing and service delivery we urge it to demonstrate leadership in addressing the pressing concerns detailed in our report.”

The committee said that unrealistic efficiency targets for NHS trusts and foundation trusts had prompted hospitals to produce “overly optimistic and aggressive staffing profiles.” These profiles had subsequently led to staffing shortfalls, which were exacerbated by poor retention of clinical staff, the MPs said.

In 2014 there was an overall shortfall of around 5.9% between the number of clinical staff that organisations said they needed and the number of staff they had in post, equating to a gap of around 50 000 staff, said the report. Staffing shortfalls were hampering the NHS’s ability to provide efficient and effective services and could lead to longer waiting times and poorer quality of care, it warned.

The committee said that hospitals’ subsequent reliance on agency staff and the substantial increases in spending in this area were caused more by inaccurate headcount planning from the government than from “rip-off” staffing agencies.

Although the health secretary for England, Jeremy Hunt, reported this week that the government’s capping of agency staff pay had so far saved the NHS up to £300m this year,3 the committee said that national bodies needed to deal with “the fundamental issue of the increased demand for agency staff,” with the NHS still expected to spend a total of £3.7bn on agency staff by the end of 2015-16. It urged ministers to “explicitly consider the workforce implications” of all major health policy initiatives and urged the health department to report back to the committee with a summary of these implications in relation to seven day working by December 2016.

The report asked the health department, NHS Improvement, and Health Education England to provide “greater national leadership and co-ordinated support to help trusts reconcile financial, workforce and quality expectations.”

The MPs specifically highlighted the need to tackle the shortage of nurses over the next three years, with firm plans that included better coordination of overseas recruitment. In addition, they asked NHS Improvement to review trends in clinical staff leaving the NHS and present a plan to improve retention of clinical staff to the committee by the end of the year.

On the issue of agency staff spending, Hillier said, “It is unacceptable for the government to blame staffing agencies for the growth in spending in this area when its own mismanagement is a major contributor to the size of the bills.”