HEE £900m budget boost needed to tackle workforce crisis – report

The King’s Fund, Nuffield Trust and The Health Foundation’s review called for a “regionally led, but nationally funded” ethical international recruitment drive to cut the 12.5 per cent nurses vacancy rate to 5 per cent in 2023-24.

The report, Closing the Gap, set out a series of policy actions that should be “at the heart of the NHS’ new workforce implementation plan”, an interim version of which is expected imminently. The report largely focuses on nursing staff and GPs.

It detailed recommendations aimed at addressing retention rates, culture and leadership within the NHS, which it said should be covered by pumping in an additional £900m per year by 2023-24 for HEE.

This would push the HEE budget up to £5.2bn.

Major components of the £900m proposed include: £250m for workforce development; £420m for cost-of-living grants for nurses; and £140m for other support for nurses such as tuition fees for post graduates and placement costs.

NHS Employers said it was a “well-considered report”, adding in a statement it was “clear that there will need to be [a] minimum of £900m more invested every year for the next five years”.

“Employers accept that there is more they must do to improve our workplaces but they also need tangible national support and extra investment,” NHS Employers said.

King’s Fund chief executive Richard Murray told HSJ the international recruitment programme was expected to cost a relatively modest £10m-a-year.

“The reason it’s not more expensive than that is the long-term plan already assumes it can find the nurses, so their salary is covered in the £20.5bn,” Mr Murray said. “You’re only paying for the additional overlay of getting somebody in.”

The think tanks called for the international recruitment drive to be regionally led.

“You don’t want to find people from one [strategic transformation partnership] bumping into each other in Manilla, trying to recruit at the same time,” Mr Murray said. “[International recruitment] has to match local needs and local demands.”

Mr Murray said it should come out of the spending review later this year.

“[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,” he said. “Almost all workforce issues were parked for the workforce implementation plan. [This was] probably unnecessary and probably a mistake.”

The three think tanks also called for all health care professions to be added to the shortage occupation list, with “corresponding exemptions from the salary floor” and extended beyond January 2021, when new immigration rules are expected to come in.

They also said the costs associated with migrating to work in the NHS should be paid from central funding and regulators should “standardise and streamline” their processes for international recruits.

The report also made recommendations around creating a better leadership culture in the NHS. It said the national arm’s-length bodies need to “deliver on their own pledges” to change their own behaviour.

“It’s great talking about compassionate leadership, but if the national bodies don’t do it, that is a limiting factor,” Mr Murray said.

Recommendations made in the report included:

Increasing nursing numbers

• Increase financial support for nursing students with “cost of living” grants of around £5,200 a year on top of the means-tested loan system
• Cover the cost of tuition fees should also be done to triple the number of postgraduate nurses in training

Team-based general practice

• Expand multidisciplinary team-working in GP practices
• Recruit 3,000 more pharmacists and 6,000 more physiotherapists into general practice to take workload off GPs and nurses in general practice
• Launch large-scale pilots to provide for mental health needs of patients presenting in primary care

Retaining current staff

• Agenda for Change will run until 2021 but pay will need to continue to rise in line with wider economy earnings
• A fourfold increase in the workforce development budget to support staff enhance their skills
• The NHS Pension Scheme must be more flexible and a 50:50 option should be explored where members pay half the contribution rate for half the benefit