THE NHS AND SOCIAL CARE in England face the greatest workforce crisis in their history, compounded by the absence of a credible government strategy to tackle the situation, say MPs. In the NHS, persistent understaffing poses a serious risk to staff and patient safety in routine and emergency care.
The Workforce: recruitment, training and retention report outlines the scale of the workforce crisis. New research suggests the NHS in England is short of 12,000 hospital doctors and more than 50,000 nurses and midwives; evidence on workforce projections say an extra 475,000 jobs will be needed in health and an extra 490,000 jobs in social care by the early part of the next decade; hospital waiting lists reached a record high of nearly 6.5 million in April.
The report finds the Government to have shown a marked reluctance to act decisively. The refusal to do proper workforce planning risked plans to tackle the Covid backlog – a key target for the NHS.
The number of full-time equivalent GPs fell by more than 700 over three years to March 2022, despite a pledge to deliver 6,000 more. Appearing before the inquiry, the then Secretary of State, Sajid Javid, admitted he was not on track to deliver them. The report describes a situation where NHS pension arrangements force senior doctors to reduce working hours as a “national scandal” and calls for swift action to remedy.
Maternity services are flagged as being under serious pressure with more than 500 midwives leaving in a single year. A year ago the Committee’s maternity safety inquiry concluded almost 2,000 more midwives were needed and almost 500 more obstetricians. The Secretary of State failed to give a deadline by when a shortfall in midwife numbers would be addressed.
Pay is a crucial factor in recruitment and retention in social care. Government analysis estimated more than 17,000 jobs in care paid below the minimum wage.
A separate report by the Committee’s panel of independent experts rates the government’s progress overall to meet key commitments it has made on workforce as “inadequate”.
On workforce planning, experts found no evidence that targets for staff numbers were linked with patient and service need and little evidence of social care workforce planning at a local or national level. According to many stakeholders the Panel heard from, the lack of workforce planning by the government is having a negative impact on recruitment and retention in both sectors.
On building a skilled workforce, the government was unable to give a breakdown of spending for social care to demonstrate how the extra £1 billion committed annually was spent on additional social care staff, better infrastructure, technology, and facilities.
On wellbeing at work, rates of bullying, harassment and abuse in the NHS remain “concerningly high” with more than one in four NHS staff experiencing at least one incident of bullying in the preceding 12 months.
Professor Dame Jane Dacre, Chair of the Expert Panel, said: “We could not give the government any higher than an ‘inadequate’ rating on its overall progress in meeting its own targets set for the NHS and social care workforce. We were unable to rate progress on any of the individual commitments we evaluated as good.”
“Rates of bullying in the NHS are far too high, and we found measures to tackle the problem were either inadequate or require improvement. Worryingly, our evaluation found that overall progress on all the government commitments we looked at which involved social care, was inadequate.
“In terms of learning how better to support staff, the government has underestimated the complexity of the fragmented delivery model in the social care sector and failed to put a mechanism in place to listen to the their views.”
Responding to the Committee’s report, Royal College of Nursing Director for England, Patricia Marquis, said: “The findings of the Committee show in the starkest of detail the workforce crisis across the whole of health and social care in England. That persistent understaffing in all care settings poses a serious risk to staff and patient safety should shock ministers into action.
“As ministers continue to make claims about the number of new nurses, evidence submitted to the Committee found a significant lack of transparency on workforce planning and in fact that 475,000 jobs will be needed in health and an extra 490,000 jobs in social care by the early part of the next decade just to keep up with patient need.
“On pay, the Committee was very clear saying it is unacceptable that some NHS nurses are struggling to feed their families, pay their rent, and travel to work. Their recommendation that nursing staff should be given a pay rise that takes account of the cost of living crisis should make government rethink the latest pay deal that follows a decade of real terms pay cuts that will force even more to leave the profession.”
* Read Workforce: recruitment, training and retention in health and social care here.
Read: Expert Panel: evaluation of Government’s commitments in the area of the health and social care workforce in England here.
* Sources: Health and Social Care Committee and Royal College of Nursing