“The National Health Service and the adult social care sector are facing the greatest workforce crisis in their history”, said Parliament’s Health and Social Care Select Committee in July. The aspirations to rebuild services post-Covid, and tackle rising waiting times and other access challenges, are limited by the same challenge: there are simply not enough staff.
The public understands this. While public satisfaction with the NHS has plummeted to a 25-year low, as many people say the NHS should prioritise tackling staff shortages as say it should reduce waiting times.
Successive governments have either looked the other way or actively frustrated attempts to create a plan to confront these shortages. The failure to develop a workforce strategy that brings together all the available levers – training, retention, international recruitment and skill mix – has left both services adrift for years, hurting not only people using services and staff, but the government’s reputation for running the NHS.
There is now meant to be a workforce strategy for the NHS later this year: it is difficult to overstate its importance.
Politicians may be put off from confronting workforce shortages by the simple fact that it takes many years to train new doctors, nurses and other clinicians. Boosting the training pipeline may only make a material difference to services long after the current set of ministers have moved on, yet it is key to long-term sustainability. However, there are other measures that provide a quicker return that can be used while the future pipeline of domestically trained staff is repaired.
Firstly, shortages in social care are, if anything, worse than in health. Probably the quickest way to boost capacity in health and care would be to give social care staff a pay rise. Right now, for many care staff, the way to get such a pay rise is to work for Lidl (or any other supermarket). The resulting shortages in social care hurt not only those using those services and their families, but also the NHS, as patients remain stuck in hospital beds for longer.
Secondly, although it is true that the UK already draws heavily on staff from overseas (over half of all new entrants to the GMC’s register are international graduates), there remains scope to do more. Changes to visas, additional support to new arrivals, centrally-led recruitment campaigns and support for smaller employers (like GP practices) that struggle to manage the bureaucracy associated with recruiting from abroad, may all help.
While these efforts are guided by global codes of practice, taking staff from poorer countries may still seem distasteful to many and may not be sustainable for long as worldwide shortages for healthcare staff grow. It might be made more palatable if the UK began to provide direct financial support to training in countries we draw on the most.
Thirdly, the NHS and social care need to industrialise their partnerships with the voluntary sector and with volunteers more generally. There are opportunities to draw on the skills of voluntary sector organisations, even in areas that might seem unlikely at first sight. For example, many may be aware of the role St John’s Ambulance plays, but may be less aware of the many other roles volunteers can take across the NHS.
At a time when the cost of living crisis is disproportionately hitting people on lower incomes, the power of the voluntary sector to reach out to those poorly served by statutory services is an asset we cannot afford to waste.
Fourthly, while it’s hard to find an area that isn’t in shortage, there are still opportunities to make more of the skills of existing staff. For example, community pharmacies stepped up to deliver an increasing share of the Covid-19 vaccination programme, and the clinical skills of the pharmacy profession are widely considered to be underused. The opportunities are not limited to pharmacists; physiotherapy is another large and growing profession. Many such staff may be well suited to work in primary care, alongside GPs. Some progress has been made but changing the nature and skill mix of general practice needs proper implementation support.
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And lastly, we are losing staff through burnout, and this is part of a wider problem of retention. Pay is part of this, but the challenges of unsupportive working environments and heavy workloads are important too.
Faced by rising demand for services, making promises about manageable workloads when there aren’t enough staff lacks credibility, but there are other routes to improve the working life of staff, including through supporting teamwork and addressing bullying and discrimination. This needs to include tackling head-on the racism many health and care staff face at work, either from colleagues or the public.
Not only is this a moral imperative, it might also help the health and care system retain and motivate its ethnically diverse workforce.
Richard Murray is the chief executive of The Kings Fund
