Bill criticised over lack of workforce measures

Managers, unions and MPs are increasingly worried about staff shortages, and the effect Covid may have on increasing early retirement, part-time working or the number of staff leaving the NHS. Last month, the Commons Health and Social Care Committee called on Health Education England (HEE) to publish annual assessments of whether enough staff are being trained to meet forecast future needs over five, 10 and 20 years.

However, an explanatory note issued alongside the bill said that the health secretary would publish every five years a report ‘describing the system in place for assessing and meeting the workforce needs of the health service in England’.

The note continues: ‘[The report] will not set out workforce targets or give any bodies new functions.’

HEE and NHS England will be able to contribute to the report if asked by the health secretary.

King’s Fund chief executive Richard Murray (pictured) said the service has been dogged by chronic staff shortages for years. He added: ‘Yet the measures in this bill to address workforce issues are wholly inadequate. We are calling for a new duty to publish regular workforce supply-and-demand projections to highlight where action is needed to avert a deepening of the workforce crisis.’

NHS Providers chief executive Chris Hopson added: ‘It's vital that the legislation addresses the lack of a transparent, costed and funded long-term workforce plan.’

The service entered the Covid pandemic with an historical workforce crisis that has worsened as staff became exhausted, according to British Medical Association deputy chair David Wrigley.

‘Crucially, this legislation must be used as a key opportunity to boost the NHS workforce and strengthen accountability for the delivery of adequate numbers of staff,’ he said. ‘Having a fully-fledged workforce is instrumental to safe patient care now and in the future and to tackling the backlog of care.’

The bill also includes provisions to sanction integrated health boards (ICBs), including the dismissal of their chief executive, if they are failing to discharge their duties. It said that NHS England must conduct and publish a performance assessment of each ICB every financial year. They will be assessed against six duties:

• Improvement in the quality of services – securing continuous improvement in the quality of services and outcomes (categorised as effectiveness, safety, and patient experience)
• Reducing inequalities – in respect of access and outcomes achieved
• Obtaining appropriate advice – from a broad range of professional expertise in the prevention, diagnosis or treatment of illness, and the protection and improvement of public health
• Public involvement and consultation – in the planning and proposed changes of commissioning arrangements
• Finance – the implementation of NHS England financial requirements, joint financial obligations, banking guidelines and directions on use of resources
• Having regard for the assessments and strategies of the Local Government and Public Involvement in Health Act 2007. This refers to local assessments of relevant needs and any joint health and wellbeing strategy.

ICBs must take account of guidance issued by NHS England and the health secretary on the discharge of ICB functions. And NHS England will consult relevant health and wellbeing boards on the steps taken by the ICB to implement any relevant joint local health and wellbeing strategy.

If an ICB is considered to have failed or is failing to deliver its functions, or if there is a significant risk they will fail, NHS England may give the board or its chief executive directions to discharge its functions. Directions could include prohibiting or restricting the delegation of functions. NHS England could also terminate the employment of the chief executive and direct the ICB chair or other board members to appoint a successor chosen by NHS England. The national body could perform the functions itself, or direct another ICB to do so.

The HFMA has produced a summary of the bill. You can read it here