Andy Cowper on workforce as the biggest issue facing the NHS currently

Workforce is the biggest issue facing the NHS right now. Funding is not fully sorted, at all (particularly capital funding), but as I have previously written, the Treasury Munchkins’ expressed preference for inadequate NHS funding increases is swiftly followed by a revealed preference for coming up with the cash when Munchkin feet are held to the fire of DEL breach reality.

Treasury Munchkins in ‘not deities’ shock

(Fellow fans of the Treasury Munchkin community may have taken some delight in their pearl-clutching response to the maverick capital “long-lifing” accountancy tricks used by or recommended to many NHS trusts.

I would hope that with this, we could finally put to bed the notion of “Treasury” as being God-like superpowers with mystical powers, and regard them as what they rightly are, as I wrote: the banking function of government. They are not omniscient or omnipotent. They are, at best, accountants, and on the basis of this, not particularly well-informed or streetwise ones.)

Workforce is issue number one right now, as I suggested back in 2017 in my five linked pieces of the biggest problems facing the NHS. (Five Easy Pieces they weren’t.)

Mind the gap

This week’s publication of ”Closing The Gap”, a definitive joint report on the subject between the holy trinity of health thinktanks, Health Foundation, King’s Fund and Nuffield Trust, reminds us of the fact.

It is an excellent and comprehensive piece of work. And it makes it clear that, as I wrote in 2017, “the first of Cowper’s Universal Laws Of Healthcare: while solving a workforce crisis is neither cheap, nor easy nor quick, it is straightforward. You find out why people are leaving early, and you fix that (see the later “culture” instalment in this series); and you spend a lot of money and a great deal of care on recruiting more of the right kind of people into the right kind of careers and roles”.

It’s straightforward. It’s expensive. It’s not quick. And it’s not cheap. “Closing The Gap” puts a price of just slightly under a billion pounds by 2023-24, which is one-twentieth of the promised funding increase.

King’s Fund chief executive Richard Murray told HSJ that the money should not come out of that £20 billion, however: “[You] could take it off the £20.5bn, but if you do that, it would mean it isn’t there for the other promises made in the long-term plan. Almost all workforce issues were parked for the workforce implementation plan. [This was] probably unnecessary and probably a mistake.”

Localism in workforce planning?

The latest word from the centre, in the joint letter from NHS Engroovement-Improveland co-chair (pro tem) Baroness Harding and national executive lead Julian Hartley suggests that local areas will be given much greater control over NHS workforce policy with responsibilities being devolved to local areas from national bodies.

So for workforce, will localism prove more effective than central planning? Mmmmmmm. It is interesting that all the long-term plan had to say about workforce was that ”an implementation plan is en route, chaps, don’t panic!”

Baroness Harding’s invitation by the prime minister to lead the development of the workforce implementation plan can look an awful lot like a hospital pass.

The taper trap

The NHS needs more staff. It needs to retain its current staff and try to get them to do more. And the annual allowance taper on pensions has produced some, seriously perverse incentives for consultants, as this Twitter thred by Financial Times pension correspondent Josephine Cumbo neatly encapsulates.

If this is not resolved, then the likelihood of improvement on waiting times is more than remote. The National Audit Office this week described progress on this agenda as insufficient.

Helpfully, the NAO put a one-off price of £700 million to cut the waiting list to its March 2018 level – which is a target NHS bosses originally set the system to achieve by this month in the 2018-19 planning guidance. And as my colleague James Illman points out, the system has tacitly acknowledged that it is going to miss that target too.

Towards a geonomics view: a call to long-term plan action

I almost got to the end of this column without mentioning our PC-World-loyalty-card-toting Secretary Of State For The Time Being, Matt ‘Ancock. But the sheer poetic beauty of his announcements this week about his genetic testing showing that he is at a 15 per cent higher risk of prostate cancer by the age of 75 (50 per cent higher than average) cannot pass unremarked.

Far better scientists than I have micturated from appropriate heights on his interpretation of the results.

In the spirit of national unity that we all so sorely need, I want to offer Mr ‘Ancock some heartening news of a fellow-geonomics testing veteran. The veteran in question is, of course, me.

Using extensive genetic testing, I have discovered that I am at 100 per cent risk of mortality from a medical condition known as “death”. The margin of error in this test prediction is marginal. Obviously, this news alarmed me greatly. I instantly went onto the most digital app I could find and booked a video consultation appointment with my GP to discuss what preventative strategies my mobile phone can deploy to remove my risk of this so-called “death”.

Readers can be reassured that I won’t take “death” lying down, and I pledge to all HSJ readers that I will not miss a single one of my NHS “death” screening appointments. Every little helps.