What should a health and social care workforce strategy look like?BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1906 (Published 29 July 2022) Cite this as: BMJ 2022;378:o1906
This week’s cross-party parliamentary report on the NHS and social care workforce paints a bleak picture. Highlighting Nuffield Trust estimates, the committee points out that the NHS has struggled with 12 000 hospital doctor vacancies and more than 50 000 nurse and midwife vacancies.1 Although the majority of these may be filled from day to day with temporary staff, many thousands are not. To make matters worse, staff absences across healthcare providers caused by sickness or self-isolation have topped 100 000 a day at various points during the pandemic.2 The situation, in most respects, is worse in social care.
In the words of the committee, “it is time to stop photographing the problem and deal with it.” To do so, the report is clear that credible NHS and social care workforce strategies—things that have been repeatedly kicked into the long grass—are necessary. But what should such strategies cover?
Five essential components
Firstly, a credible strategy will have to include practical, effective measures to improve staff retention. The committee’s report laudably recommends, at a minimum, that all NHS staff have access to hot food and drinks 24 hours of the day, as well as places to rest, shower, and take breaks. More radical perhaps are their recommendations about: reviewing working conditions to reduce the intensity of work felt by many; improving provision of childcare; and taking further steps to allow flexibility and less-than-full-time working. What seems to be missing though—and what must inform any future strategy—is a detailed understanding of why staff are leaving; an area where current data fall short.3
Secondly, a proper plan would set out how to deliver an increased, sustainable supply of new staff. In the short term, international recruitment—done in an ethical way—is a key part of the solution. On this, the committee recommends removing administrative barriers. For this vital source of overseas recruitment to work in all services, settings, and parts of the country, there will need to be collaboration between providers, and a strategy should incentivise and support this.
On longer term solutions to the supply of NHS staff, there must be clear plans for more home grown professionals to fill the workforce shortages. This may well include increasing clinical student intakes, but it is not clear that the committee’s recommendation to add 5000 medical school places would represent value for money on the considerable investment it would require given the known leakiness in the pipeline for converting students into (clinical) boots on the (NHS) ground. The report recommendation to review how providers are funded for training staff could be part of a more responsible first step to improving the domestic training pipeline.
Thirdly, to be credible, a workforce strategy will need to set out how to tackle current levels of discrimination. The moral and legal cases to ensure diverse and inclusive health and social care workforces are indisputable. But the evidence also points to this contributing to improved quality of care, a more sustainable workforce supply, and increased efficiency of services.4 Although there is some good practice that can already be adopted elsewhere—the report highlights some promising examples—the committee also recognises the need for a more evidence based strategy, endorsing our suggestion for a government commissioned “What Works Centre”—an organisation to collect knowledge on effective solutions—which could also benefit the wider public sector.
Fourthly, a strategy should not overlook the unique challenges in the social care workforce. Recognising the need for “meaningful professional development structures, and better contracts with improved pay and training,” the committee recommend: restoring free access for social care staff to the same NHS training as community health colleagues; proactive enforcement of minimum wage or living wage, as we had recommended; and a substantial and sustained hike in funding to social care. However, the concern with social care is even more fundamental. While the government has made some workforce commitments on training and wellbeing covering the next three years, we are left unclear whether a long term strategy to deal with the systemic issues is even in the pipeline.5
Finally, to be credible, workforce strategies for health and social care need to learn lessons from previous failures. This is perhaps implied in the committee’s report without fully reflecting on past experience. Certainly, shaky projections and flawed clinical workforce plans are as old as the NHS itself.67 There are many reasons for this, including failing to align roles, responsibilities and funding while also failing to balance the relative risks of under- and oversupply of staff. Not sufficiently reflecting the needs of different regions, settings and providers has been another problem. Future workforce strategies cannot be a refresh, but must learn from previous mistakes and provide a bold and distinct approach.
Workforce planning is not easy, with the considerations above not an exhaustive list of what a credible plan should cover. However, we should not accept a failure to deliver an effective workforce strategy. The report is right not to shy away from the potential impact of continued mishandling of the workforce: persistent staff shortages pose a serious risk to staff wellbeing and to patient care.
Competing interests: none declared.
Provenance and peer review: commissioned, not peer reviewed.