A draft of the NHS pay and workforce strategy for 2008-11, seen by HSJ, outlines significant problems matching the supply of health professionals to the demand required to meet future service targets, such as the maximum 18-week wait.
The forecast for workforce capacity by 2010-11 shows:
- an excess of 3,200 whole-time equivalent (WTE) consultants 'which we cannot afford to employ';
- an excess of 16,200 WTE allied health professionals, healthcare scientists and technicians;
- a shortage of 14,000 WTE nurses;
- a shortage of 1,200 WTE GPs;
- a shortage of 1,100 WTE junior and staff-grade doctors.
The draft document, written on 27 November, suggests a 'very volatile' workforce profile, with a 'sharp reduction' in staff numbers this year - reducing the workforce by 2.7 per cent - followed by high growth, and then 'a clear dip' in demand for nurses and consultants after the 18-week deadline of December 2008 passes.
Solutions discussed in the strategy, which covers the Treasury's comprehensive spending review (CSR) from 2008-11, expected to be published later this year, include:
- encouraging foundation trusts to create 'more cost-effective' sub-consultant roles ñ ¡ move it acknowledges would be 'bitterly opposed by the British Medical Association';
- encouraging more doctors to train as GPs instead of specialists;
- boosting investment in nurse training;
- 'managing down' the supply of AHPs, healthcare scientists and technicians;
- encouraging more use of fixed-term appointments and temporary staff to cope with expected fluctuations in demand.
The paper suggests the NHS should make increasing use of a 'market model' for employment, bringing in skills as and when they are required. It says it may be 'increasingly hard and possibly undesirable at a strategic level for the NHS or DoH to seek to control a fluid, pluralistic market'.
Instead, organisations should 'concentrate on buying in the skills they need to the standards they require without necessarily seeking to predict, commission or control the supply.' Such an approach would 'break the link between the output from higher education of potential health professionals and the jobs available in the NHS', the document adds.
The draft strategy, written by the DoH workforce directorate, for discussion in the DoH's December board meeting, also sets out a number of highly controversial routes to bring down increases in the national pay bill over the next CSR period. Options discussed include:
- greater use of local and regional decisions to bring down nurses' pay;
- the use of unemployment to 'create downward pressure on wages', which, it concludes, is likely to be ineffective in the case of specialist doctors;
- a review of the clinical excellence awards for doctors to reduce its costs and improve its incentives; which it recommends, while warning that this will have a limited impact as it would only affect doctors on new contracts, unless current contractual entitlements were bought out;
- the introduction of a three-year 'back-loaded' pay deal, which the unions might back if they were offered something of 'sufficient longer term value'.
The document concludes that the best option might be a 'cafeteria style' total reward package, under which staff can trade hours and leave for pay. This could offer diplomatic benefits, it says: the unions 'could claim' it permitted the sought-after 35-hour week, while 'in practice most staff might be expected to cash in extra hours and leave for more pay'.
The DoH said the document was 'an early draft plan' and that figures should be seen in the context of significant staff increases in recent years.