Government must prioritise workforce in spending review

The fund added that the spending review, which will be announced on 27 October, must provide clarity on capital budgets, public health spending, and tackling waiting list backlogs in primary, mental health, and social care, as well as shortfalls in public health allocations.

In a briefing, the fund said a workforce crisis existed before the Covid pandemic hit. However, staff shortages had been exacerbated by the pressures of the NHS response. While the NHS long-term plan had acknowledged the strain on staff, and the NHS people plan was subsequently published, neither came with the multi-year funding needed to implement the plans and increase staff numbers, it said.

In its 2019 election manifesto, the government committed to increasing nursing numbers by 50,000 through recruitment and reducing the number of nurses leaving the service. The briefing acknowledged the government had taken steps in the right direction to boost recruitment by reintroducing nursing student maintenance grants and investing in training places.

However, the King’s Fund warned that for the government to achieve its staffing ambitions, the spending review must be used to ‘clarify and allocate resources for training, development and other support needed to deliver a multi-year workforce plan’.

It added: ‘The health and care workforce in England is in crisis: urgent action is required to tackle a vicious cycle of shortages and increased pressures on staff, which have been exacerbated by the Covid-19 pandemic. New funding is essential to provide the training, development and other support needed to help deliver a multi-year workforce strategy.’

Lack of capital investment has stored up problems for the future, the report said. Indeed, today’s Eric (Estates Returns Information Collection) figures show backlog maintenance has reached £9.2bn – up from just over £9bn in 2019/20. ‘Failing to give the NHS the investment it needs means staff and patients will increasingly be exposed to safety risks from unreliable equipment and deteriorating facilities,’ the fund said.

NHS Providers added the backlog maintenance was ‘alarming’, underlining the need for a multi-year capital funding settlement in the forthcoming spending review. Its deputy chief executive Saffron Cordery said the benefits of capital investment are substantial.

‘A multi-year settlement would allow the NHS to increase physical and diagnostic capacity, accelerate digital transformation, reconfigure hospitals to deal with future waves of Covid-19 and winter pressures, as well as creating safe therapeutic environments for mental health services and investing in new ways of treating patients to improve outcomes,’ she added.

‘We welcomed the government’s recent announcement of increased revenue funding for the NHS, but this will not deliver the desired improvements without appropriate capital expenditure.’

Capital funding began to increase again in 2019/20, and the Department of Health and Social Care has announced a national hospital building programme. However, the fund said the government had failed to deliver its promised multi-year capital budget, and the uncertainty over capital allocations has materially impacted local NHS leaders’ ability to plan future improvements in health services. A ‘more coherent and sustainable’ capital funding strategy must be part of the spending review, it added.

Public health budgets must be increased, the fund said, calculating that restoring local authorities’ core public health grant to 2015/16 levels would cost £1bn. Services such as health visiting and smoking cessation have been cut and this has been compounded by the pandemic to create a backlog in demand.

Funding given to local authorities to manage Covid – through test, trace and contain measures, for example – has totalled £2bn over 2020/21 and 2021/22, but it is due to end in March next year. The spending review must address this, the report insisted. ‘This presents a cliff edge for local authorities which have used the funding to target support at the worst affected groups, to invest in specialist support like behavioural-science expertise and to maintain contact-tracing services. Given that there will be a need to maintain these services in years to come, local authorities will need funding to do this.’

The King’s Fund added that the government had taken the first steps to reform social care, but there is concern the money raised by the national insurance increase will be subsumed by the NHS in future years. There should be clarity on how the additional £5.4bn over three years will be divided, and additional funding will be needed to address pressures such as the backlog of people waiting for social care needs assessments.