The must-read stories and debate in health policy and leadership.

…And checking it in due course

In the first full review of the shortage occupation list since 2013, the Migration Advisory Committee has recommended all doctors should be added because of “high vacancy numbers, poor workforce planning and a high leaving rate”.

However, MAC chair Alan Manning told HSJ  the difference this would make for trusts would be “not much in practice”, as problems recruiting doctors from overseas were eased after they were removed from the tier 2 visa cap last year. He added this was more about sending a message than a drastic change, although doctors would see “slightly lower visa fees”.

The suggestion represents a broadening of policy. Previously only consultants in clinical radiology, emergency medicine and old age psychiatry, certain emergency medicine trainees and core trainees in psychiatry were on the list.

The MAC has also recommended nurses – who were also removed from the tier 2 cap last year – remain on the shortage occupation list, as has been the case since 2015. Alongside medical practitioners, nurses make up the largest share of migrant workers, with EEA migrants more likely to contribute to the provision of healthcare than its consumption.

Other healthcare professions the MAC recommended adding included psychologists and speech therapists. Although the committee also suggested prosthetists, orthotists and healthcare scientists be taken off the list, the report was a clear acknowledgment that almost all those hiring in healthcare are encountering significant skills shortages.

“The health and social care sector is faced with a number of workforce shortages, which are affecting the delivery of services,” said Danny Mortimer, co-convener of the Cavendish Coalition. “The analysis and recommendations by the MAC clearly reinforce that position.”

A Home Office spokesman welcomed the “very comprehensive report”, adding: “We will consider it carefully and respond in due course.”

Accounting speak

A lack of clarity over funding and all-round financial pressures have increasingly prompted auditors to raise concerns over the viability of NHS trusts.

In accounting speak, this means there are lots of “material uncertainties” being raised around the “going concern” basis of many providers.

In normal speak, this means many trusts have become heavily indebted to the Department of Health and Social Care, and continue to spend far more money than they receive.

In a letter seen by HSJ, the DHSC essentially tells trusts not to worry, as they will continue to provide bailout cash so staff and suppliers can be paid (although the latter will probably be paid late).

That’s all well and good, but trusts urgently need more clarity about what they can expect to receive, in what form, and when.

Otherwise it’s going to be near impossible to set realistic recovery plans that local leaders support, and make crucial decisions about recruitment and investment.