Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, will make sure you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce. Contact me in confidence.
At face value, Health Education England does not have a complicated mission statement. It was set up in 2012 with a protected £5bn budget to plan for and train the workforce the NHS needed.
Some would argue HEE has failed to do this. There are 100,000 NHS vacancies and health experts have predicted, without serious investment, this could reach 250,000 by 2030.
However, the workforce storm has been brewing long before HEE came into the picture. There has not been a clear workforce strategy in 20 years and there is historic woeful investment in workforce – until recently, NHS finances and service provisions were the priorities. And nurse training places have been cut over a number of years spanning back to 2005 – almost a decade before HEE’s existence.
But there are legitimate reasons why NHS leaders and the workforce hold a degree of animosity towards the education and training provider.
In 2016, HEE announced a new nursing associate role, which resulted in an adversarial debate between those who questioned why this money hadn’t been invested in registered nurses and those who championed it as a new route into nursing.
HEE has also been unable to protect the workforce from government decisions that have had a huge impact on recruitment and morale. The scrapping of the nursing bursary went unopposed and numerous issues with junior doctor’s training were raised during the contract dispute.
As trust leaders watched their workforce numbers dwindle, it is understandable why the blame was placed at HEE’s door.
But HEE has been seriously undermined since 2015. Its budget was slashed by 20 percent, resulting in redundancies and cuts to continued professional development after being removed from the ringfence. And, just last year, Matt Hancock stood up at an event and said HEE would move under the jurisdiction of NHS Improvement and it was revealed Dido Harding would be leading the workforce strategy.
HEE’s new chair Sir David Behan did not agree it had been undermined, and he dispelled rumours a merger was on the cards. He reiterated the importance of a standalone body responsible for education and training and revealed HEE was put in an impossible position in 2015 – to pay for 3,000 more nurses, it was forced to cut CPD funding.
Sir David made clear HEE does not see itself as a second class citizen in the workforce implementation plan. He told HSJ its relationship with NHSI is respectful and his own relationship with Dido Harding strong. Much of the final plan will be based on “good quality” work already done by HEE.
It is clear there is much work to be done to restore faith in HEE. Sir David has signalled spend in CPD will increase to at least £120m in 2019-20. He also spoke of the importance of speaking to NHS leaders around the country and getting them to tell him how it is. HEE has a key role in strategic planning, but HEE’s new chair makes clear employers have a responsibility too, as do individuals.
There remain some interesting questions about what Sir David’s presence could mean for the future of HEE. Despite a stable leadership team since 2012, why haven’t closer links with NHS Improvement already been established? And why hasn’t the regional variation he described been tackled?
“People are finding out about each other’s organisations,” he told HSJ. “We might be surprised they didn’t know that before.”