Comment / The right numbers

The autumn statement may well have provided the NHS with as good a deal as it was going to get. The economy is in poor condition and other public spending departments face a significant squeeze on their resources.

The £3.3bn increase in each of the next two years for the NHS at least addresses some of the service’s concerns about inflation and potentially allows some headroom for pay rises above the 2% allowed for in the original spending review settlement.

The extra funding for social care, with some funds specifically focused on accelerating discharge of well patients from hospital, is also good news.

But no-one in the finance community believes next year will be easy financially – as the HFMA finance director survey has underlined. There are just so many things on the must-do list – the elective backlog, the need to expand mental health capacity, workforce problems in general, and the urgent requirement to improve access in general practice and ease GPs’ burden.

As HFMA president Lee Bond says above, there is a concern that new programmes focused on prevention, health inequalities and population health could fall victim of the need to meet these pressures, while staying within budget. These initiatives are how the service will move to being sustainable, so it would be a false economy to cut them.

Perhaps the best news in the autumn statement was the commitment to an ‘independently verified’ long-term workforce plan. The government has long resisted this, despite a barrage of calls from every corner of the NHS. But, given that the new chancellor had himself called for such an assessment while chair of the Health and Social Care Committee, it was perhaps difficult to continue turning a deaf ear.

This, too, is all about the future and is an important development. Such an exercise a decade ago might have prevented the workforce crisis the NHS now finds itself in. It takes 10 years to train a GP from when they first go to university – longer for other specialties. So, boosting medical school places now won’t help fill the more than 9,000 medical vacancies across England right now, according to recent statistics.

But it should mean the NHS of the future has a better chance of filling the medical positions it needs to run services.

That would have numerous consequences. With the right number of staff, the NHS should be able to maximise its capacity, improving flow and patient experience. It should reduce pressure on, and stress within, the current workforce. And it should reduce costs as reliance on the temporary staffing market reduces.

Of course, a workforce plan on its own won’t achieve anything. It needs to be backed with funding and there needs to be a strategy to achieve whatever increase the report decides is needed. And with vacancy rates uneven across the country, thought will have to be given to how all areas can access the workforce they need.

But it is a good start. It would seem hard for a government to ignore the numbers produced by such an independent report – and it would certainly be held to account for refusing to back the findings with the required investment.

It won’t solve the workforce crisis on its own. The NHS desperately needs to tackle issues around retaining staff. GPs, hospital doctors, nurses and other health professionals are all leaving the service in too high numbers.

Improved retention, keeping those skills and getting the best value out of the investment in their training is all tied up with how staff are paid and valued in other ways. The current industrial unrest demonstrates that this balance is not right at the moment.

Better retention also means ensuring healthcare staff achieve a good work-life balance – something unachievable for many of them in recent years.

Beyond the NHS, social care needs its own long-term workforce plan and at some point the government will need to bite the bullet on improving social care staff pay to enable it to attract and retain this vital workforce.

The promised NHS long-term workforce plan is by no means the complete solution to current workforce challenges in health and social care. But it has at least moved the service one step in the right direction.