Elective activity goals to add to workforce pressures

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Planning guidance says workforce plans must be affordable and trusts must remain within agency staff ceilings
NHS England wants to see a 4.9 per cent growth in outpatients and a 3.6 per cent growth in admissions
Guidance on pay increases will be published at a later date following government commitment on pay

NHS trusts will come under pressure in 2018-19 to deliver a new “step change in elective activity” while keeping workforce plans “affordable” and within their ceiling for agency spending.

New planning guidance, published today by NHS England, has reiterated the need for trusts to have realistic workforce plans to deliver the extra capacity needed, while warning “it remains essential that providers manage within their agency ceilings.”

The guidance makes clear that extra funding from the government will be used to deliver increased elective activity to stabilise the national waiting list and reduce long waits.

This will include a 4.9 per cent growth in outpatient attendances for England as a whole, and a 3.6 per cent growth in elective admissions.

In May 2017, the Royal College of Nursing found there were 40,000 nursing vacancies across England while the Royal College of Physicians has reported medical vacancies of up to 40 per cent with significant rota gaps across medical specialties. There are also shortages within allied health professional roles and among diagnostic staff.

The planning guidance said the 2018-19 allocations “now allow for improvements in the volume of elective surgery being funded next year, and improvements in the number of patients waiting over 52 weeks.”

It said the aim would be to ensure the referral to treatment waiting list, measured as the number of patients on an incomplete pathway, will be no higher in March 2019 than in March 2018 and, where possible, providers should aim for it to be reduced.

The document said: “Provider plans will need to consider the capacity required to deliver the growth in non-elective and elective activity and the impact on workforce, finance and productivity. Alongside these capacity considerations it remains essential that providers manage within their agency ceilings.”

It added: “Provider workforce plans will need to consider the significant workforce supply and retention challenges in the NHS. For 2018-19, providers are expected to update their workforce plans to reflect latest projections of supply and retention, taking into account the supply of staff from Europe and beyond, changes to NHS nursing and allied health professional bursaries, improvements expected in agency and locum use.

“Plans should also be updated to take account of the strengthening of bank arrangements and opportunities identified for improved productivity and workforce transformation through new roles and/or new ways of working.”

It said the plans needed to be well modelled and align with financial and service activity plans to ensure “the proposed workforce levels are affordable, efficient and sufficient to deliver safe care to patients. The workforce plans submitted will be used nationally for pay modelling during the year.”

NHS England said it was working through the implications of the chancellor’s commitment to fund a pay rise for Agenda for Change staff if a deal on contract reform could be agreed.

NHS England said it would publish further guidance in due course, adding: “Until this is available the impact of any changes to NHS pay beyond the 2017-19 published assumptions should be excluded from plans. It is essential that the 2018-19 pay costs in financial planning returns are an accurate reflection of the cost of the current, published pay assumptions.”