Confed chief: Politicians should recognise workforce cost reality

Rob Webster said workforce was one of four issues political leaders across all major parties were failing to recognise during the election campaign.

His comments follow former NHS chief executive Sir David Nicholson today predicting the NHS would need to take “emergency action”, such as vacancy freezes, in the near future to address funding shortfalls.

Mr Webster said political parties were not being realistic about the severity of the NHS’s financial problems, and in particular had not addressed rapidly falling spending on social care.

He also criticised “arbitrary targets for increasing specific sorts of staff” in manifestos. He questioned whether they were either “affordable” or “desirable”, and instead said the focus should be on “team based working”.

“There needs to be a fundamental understanding that we spend most of our money on people,” Mr Webster said.

“If we want to be more efficient and more productive we have to get more out of the people we have got and we have to cut the costs of those people.”

He said practical ways to begin this were supporting staff better in order to reduce sickness absence, and effectively rostering staff to improve efficiency and reduce the need for agency staff.

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In relation to agency staff costs, Mr Webster also called for a national “market intervention” in the “temporary labour market”. He did not give a specific proposal for an intervention but pointed to the creation of NHS Professionals, the national organisation established in the early 2000s to improve temporary staff availability and standards.

Mr Webster also said all parties should be “explicitly backing the NHS Five Year Forward View” in order to give consistency, and committing to no nationally led structural reorganisations. Although the Conservatives commit to implementing the forward view in their manifesto, neither Labour nor the Liberal Democrats have mentioned it.

“The last thing we need is a period of uncertainty,” said Mr Webster. However, he accepted there were “some things we could do with tidying up and clarifying” in the NHS structure and rules following the Health Act 2012.

This included clarifying “roles on competition” he said. “At the moment there is confusion. Is it that the commissioner decides or is it that the law decides [about whether competition is required for a particular service]?”

He said rules should be clarified without repealing legislation but that if a party “believe there is a little bit of legislation required to make that clearer that is their choice”. Labour proposes to repeal the 2012 act and replace competition regulations with an “NHS preferred provider framework”.

Mr Webster said the focus of a new government should be accelerating change through existing processes, such as the NHS England led emergency and urgent care review to form networks; or making service decisions across wide areas through specialised commissioning structures.

He said if sufficient funding was not found, or efficiencies not achieved, it would result in “changing the NHS offer” or poorer access. Health service leaders “need to be clear with people when things can be delivered and when they can’t”, he added.