Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, will make sure you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce. Contact me in confidence.
It is difficult to accurately measure how many vacancies there are in the health service – they are currently counted by job adverts published on the NHS’ recruitment website – but the latest stats suggest there are close to 100,000 vacant posts, with over 40,000 for nurses and midwives.
What is for sure is that demand is rising in all areas of health and social care, underpinned by a severe lack of staff. So it’s disappointing that the staff shortages experienced by so many trusts have not taken centre stage in the NHS election pledges so far.
Over the last decade or so, workforce patterns have been complicated, with no overall trend for all staff groups. According to Nuffield Trust analysis, the number of medical consultants has increased by 64 per cent since 2004, whereas for nurses the numbers have stagnated, with an increase of less than one per cent per year since 2009.
For specialist nursing groups, such as district nurses, health visitors and learning disability nurses the picture is bleaker, as numbers have plummeted.
However, much of the dialogue so far around the NHS has been dominated by talk of privatisation, the threat of Donald Trump and secret meetings with big pharma.
Richard Sloggett, former special advisor to Matt Hancock wrote for HSJ this week about how the Conservative party will continue to give a “clear line” on how the NHS is not on the table with any US trade talks and said voters should expect media attention on the big-ticket investments in equipment and technology for the front line, illustrated by Boris Johnson’s numerous hospital visits.
At the recent NHS Providers conference, Matt Hancock said one of the “most pressing demands” in the health service was for people. But as of yet only £60m is ear-marked for delivering the forthcoming People Plan and it is unclear if further investment will be announced in the manifesto.
Before the election was announced HSJ reported funding for new financial support for nurses could be announced before the end of the year, but sources have since suggested the election could bring a knee-jerk announcement of a large amount of money for all student nurses, rather than just mature students and those on threatened courses.
On the other side of the campaign, Jeremy Corbyn’s first major speech of the general election campaign focused on the NHS not being “up for sale”, but earlier this week the party published Freedom of Information Act requests on the number of operations cancelled and the reasons why, which included a lack of staff and poor quality equipment.
John McDonnell also called for pharmacies to be “in-house” in a recent LBC interview but further detail on this will perhaps have to wait for their manifesto.
As for the Lib Dems, the party has pledged to invest £11m into mental health services and treat them with the “same urgency” as physical health, but there is little else on health from Jo Swinson’s party as of yet.
So how does this rhetoric cut through with the public?
According to Ben Page, chief executive of pollsters Ipsos Mori, when the public is asked what the biggest problem is in the NHS, they always say it is underfunded.
Mr Page questioned whether Labour would be able to “land blows” on the Tories and said in order to do this Labour needed to show how privatisation in the NHS creates less resources.
“Most people are pragmatic and accept an operation done by [a private provider], free of charge and paid for by the taxpayer,” Mr Page said. “Most people are not as ideological about it as Labour.”
“Announcements about new things are generally well-received [as] there is no good news on waiting times,” he said.
He warned that despite the health service being a traditional area of strength for the Labour party, a recent poll run by Delta had a six-point lead for the Tories when voters were asked who would be best for the NHS.
“Privatisation may be motivating for [party] members, but the bottom line is resources in the NHS,” he said.
Freedom of movement
No party is yet to state the most obvious short-term solution for staff shortages is to ethically boost international recruitment and make it as straightforward as possible for foreign workers to come and work in our health and social care system.
The two main parties are at loggerheads on this issue: Labour has a conference commitment to “extend” freedom of movement, whereas home secretary Priti Patel told Tories at their conference she would end it “once and for all”.
There are of course very serious concerns about what the government’s suggested refined points-based system would mean for the future workforce supply – particularly for social care workers who even at present find it difficult to get a UK work visa.
Mr Page said polling has shown six in 10 people would support an NHS visa – perhaps linking back to his previous point about public pragmatism when it comes to the NHS.
If the public has recognised the importance of properly staffing the NHS, why can’t the politicians?