Behind the NHS recruitment crisis
pharmafile | May 22, 2017 | Feature | Business Services, Manufacturing and Production, Medical Communications, Research and Development, Sales and Marketing | NHS, NHS Providers
NHS Providers, the membership organisation and trade association for the NHS, laid a stark warning at the door of the government, in regards to staff pay, with the release of its paper ‘Investing in success – NHS priorities for the new government’. The group reported that the move to limit pay increases to 1% per year until 2020 had severely damaged morale and had led to recruitment difficulties.
Pharmafocus reached out to speak to the organisation for its specific concerns about the recruitment crisis facing the NHS and what should be top of the agenda for the party coming into power at the up-coming election. Phillippa Hentsch, Head of Analysis at NHS Providers, spoke to us to provide us with the organisation’s major concerns.
On your press release, the first point NHS Providers calls for is an increase in funding to the NHS – what figure are you calling for and where should these funds be invested as a priority?
The NHS is currently in the longest and deepest financial squeeze in its history. Cost and demand on the health service is rising by around 4% a year, but, between 2010 and 2020, health funding is still set to increase by less than 1% a year. An extra £4 – £5bn is needed just next year in order to keep the NHS meeting current demand and what has been asked of it in terms of balancing its provider debt, meeting constitutional waiting time targets and meeting cancer and mental health commitments. An additional £10bn of capital investment is also needed; this is to spend on the bricks and mortar as well as equipment and IT. This figure will be needed to tackle both the maintenance backlog and to deliver the transformation of services set out in the Five year forward view. Both are vital if trusts are to continuing providing the highest quality of care of patients in the right setting.
Along with other healthcare organisations, we have called for extra funding to be invested in social care as this has a knock on impact on NHS organisations as they struggle to get medically fit patients into the right setting in the community. It is vital that additional money for social care is spent in a way that benefits the NHS and as well as supporting other council services. As part of our manifesto, we have called for funding increases which match rising demand to be enshrined in the NHS constitution to ensure that we have a health service that is fighting fit to tackle the challenges and complex needs of an aging population.
One of the key points that reoccurs in the paper is the focus to improve funding and support to mental health and social care. This is perhaps something that is not raised as an issue of itself, where does social care and mental health support stand?
It is critical that appropriate funding for mental health and social care is put in place but equally that it reaches the front line and to where care is delivered. We must continue making progress on tackling the stigma of mental health conditions and moving towards seeing mental health and physical health on an even footing. Mental health treatment does not begin and end in hospital. Individual needs will be complex and will require a package of continuing care across mental health services, housing, employment and social services, as well as being continued support within the community when discharged.
Demand for mental health services is rising and outstripping supply, which in turn sees patients waiting longer to access the care they need. This can have a hugely damaging effect on patients, often leading them further into crisis which results in longer stays in hospital and the need for more intensive support, which has a cost implication for the health service.
At the point of leaving hospital, there are also concerns as cuts to social care services have a direct impact on mental health patients. Official NHS figures show that the number of patients who are delayed from leaving hospital while they wait for an appropriate care setting to be found outside of hospital is increasing faster in mental health trusts than in the acute sector. Social care and the health service are intertwined and we are seeing the effects across the whole service of cuts to local authority budgets which have seen squeezes on housing, drug and alcohol services, which often bolster the care provided by community-based mental health treatment teams.
Often the government, opposition parties and even ourselves in the press only talk of the NHS in terms of numbers and funds – does this miss out the crucial element of the people behind whom the funds are supposed to support?
The NHS is at the heart of our nation. All of us will access it, and need to use it, at some point in our lives. The NHS provides care for 54 million citizens free at the point of use. It is also our largest employer with around 1.2million members of dedicated staff. With a service this vast, the numbers are big and can easily dominate the debate. However, the NHS is a people centred service and polling continues to show that the public remain very satisfied on the whole with the quality of care they receive from the NHS, but over half (57%) think its ability to deliver the care and services it is expected has been worsening and they expect a continuing decline.
While performance against well-established targets has slipped in percentage terms, we know that the actual number of people being treated at A&E and through referrals has increased – so more patients are continuing to get timely access to high quality services. Behind the numbers, there are individuals with different needs, so it is vitally important that we continue to talk about the numbers and the funds. Funding because that has an impact on how quickly and where patients can access the services they need, this can sometimes have a significant impact on their health and in turn the care they then receive. The NHS is working hard to tackle differences in the quality of services people access in different parts of the country to ensure everyone has access to the right care in the right setting. We support patients having a say in their own healthcare which leads to a more positive experience and better health outcomes for patients in terms of recovery. This remains a key priority for the NHS.
I personally know quite a few junior doctors and many are being attracted, or at least tempted, to move to other countries, such as Australia, for the shorter working hours and higher pay. This is an issue raised in your paper, what does NHS Providers believe can be done to stem this flow away from the UK? Is it as simple as providing increased pay or do more areas need to be overhauled?
Junior doctors, and all NHS staff, are the lifeblood of the health service. We must ensure that NHS staff feel valued and the vital contribution they make is recognised. To continue to attract this talent we need we must make sure that the NHS in England is a fantastic place to train as a junior doctor or nurse so that these staff choose to stay here. Ensuring that pay is competitive is part of the solution and in our manifesto we have called on the next government to work with NHS bodies to determine how and when the pay cap ends, but this isn’t the only solution, we must look at working conditions, support and progression as whole.
After the controversy last year, a new contract for junior doctors is now being rolled out through the service, which includes support mechanisms including ‘Guardians’ of safe working hours and a junior doctor forum at every trust. We support these measures to improve the working life and support structures for junior doctors. But we recognise that there is more than can be done such as making sure senior leadership are present at inductions and supporting doctors’ to rest during night shifts when appropriate to do so. It’s important for trusts to work together and share good practice on these kinds of initiatives which can have a big impact on the well-being and the morale of our NHS workforce.
What would be your message to the new government that will be decided on June 8th?
NHS Providers has released a seven point manifesto which sets out the issues that the new government will need to tackle. We have deliberately led these with a call to action on tackling the increasing staff recruitment and retention issue facing the health service. NHS trust chairs and chief executives have told us in our own State of the NHS Provider Sector report that they believe workforce challenges are now just as difficult as balancing the finances. Over half (55%) told us they are worried or very worried that their trust may not have the right numbers or mix of staff to deliver the high quality of care expected, worryingly most of them expected the situation to worsen.
Patient safety will be put at risk unless the next government commits to action to tackling the increasing number of vacancies in key roles needed to mental health, ambulance, community and acute care. The gap between the supply of trained staff and the increasing demand for services has set the NHS on a collision course in terms of the timeliness, quality and the safety of care that patients receive. We’ve put at the heart of our message to the next government that pay restraint in the NHS must end. We are seeing dedicated NHS staff leave to take up jobs in other sectors to seek better working conditions and pay.
The NHS needs to be able to offer competitive pay and working conditions for its entire staff. The next government must also act quickly to offer assurances to the 161,000 EU staff who work in the NHS about their right to remain, losing this vital component of the NHS workforce would have devastating effect on the ability of the service to respond to the level of demand increases we are seeing year on year. The government must recognise the pressure on NHS trusts caused by workforce issues as well as those caused by financial pressures.
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