1 Introduction
1. Workforce planning should be simple: decide what
workforce is needed in the future and recruit and train it. In
reality, the task is difficult and complex. The future workforce
is not easy to predict: technological and social changes mean
that some skills are likely to become redundant. Consider the
cardiac surgeons made surplus to requirements by the introduction
of vascular stents; surgeons need to acquire general skills in
their education that can enable them to change speciality in mid-career.
Even basic numbers are hard to forecast: we may, for example,
require fewer nurses and more doctors in 10 years time. The problems
are exacerbated by the length of time it takes to train staff:
two to three years for a nurse, three years for a physiotherapist,
about fifteen years for a surgeon. In addition, workforce planning
has to be co-ordinated with financial and service plans. Unfortunately,
the skills required to plan workforces are in short supply; people
in human resources rarely specialise in this area and traditionally
it has been a low priority for NHS managers.
2. In view of the importance of the subject the Health
Committee undertook an inquiry into Future NHS Staffing Requirements,
which was published in February 1999.[1]
Many of the Committee's recommendations were accepted and the
Government set out a plan for improving workforce planning in
A Health Service of all the talents in April 2000.
New structures, based around regional Workforce Development Confederations
dedicated to workforce planning, were established. Emphasis was
put on improving productivity and looking at whether other staff
could do some of the work previously undertaken by doctors.
3. A Health Service of all the talents
was a good blueprint, but by 2005 there were concerns about
its implementation. While figures for a planned expansion of the
workforce were set out in the NHS Plan in 2000,
a range of pressures, from the European Working Time Directive
to central targets, combined to cause the health service to employ
ever more staff. The number of staff employed by the NHS increased
by 260,000 between 1999 and 2005, an increase in workforce size
of more than 24%. Over this period the number of GPs increased
by 17%, nurses by 22%, consultants by 37%, staff employed in 'central
functions' by 42% and in senior management by 62%. These figures
far exceeded those proposed in the NHS Plan. Hoped for
increases in productivity were not happening: it was easier to
employ more people than to think about how to perform a task more
efficiently. As we discussed in our report into NHS Deficits,
in some trusts workforce planning was undertaken without reference
to financial planning. New staff were employed by organisations
which did not have the money to pay them.
4. Eventually, the boom turned to bust. The new Resource
Accounting and Budgeting regime revealed deficits in many trusts.
The deficits grew and the Secretary of State decided that the
NHS should return to balance. Many posts were either removed or
frozen and some staff, albeit a very small fraction of the workforce,
were made redundant. Newly-qualified staff found it difficult
to find jobs and big cuts were made to the training budget. The
workforce planning system was not working effectively.
5. We decided to undertake an inquiry in early 2006
when concerns about the boom-bust cycle were beginning to appear.
Evidence sessions began in late spring. Not long afterwards we
became concerned by the deficits, which we decided were a more
urgent priority for the Committee although not a more important
subject. In fact, the vital role of workforce planning became
increasingly evident during our deficits inquiry. The final evidence
sessions were held in December 2006 and January 2007. Our terms
of reference were as follows:
How effectively workforce planning, including clinical
and managerial staff, has been undertaken and how it should be
done in the future.
In considering future demand, how should the effects
of the following be taken into account:
- recent policy announcements,
including Commissioning a patient-led NHS
- technological change
- an ageing population
- the increasing use of private providers of services
How will the ability to meet demands be affected
by:
- financial constraints
- the European Working Time Directive
- increasing international competition for staff
- early retirement
To what extent can and should the demand be met,
for both clinical and managerial staff, by:
- changing the roles and improving
the skills of existing staff
- better retention
- the recruitment of new staff in England
- international recruitment
How should planning be undertaken:
- To what extent should it be
centralised or decentralised?
- How is flexibility to be ensured?
- What examples of good practice can be found in
England and elsewhere?
6. We received memoranda from 99 organisations and
held eight oral evidence sessions, hearing from witnesses such
as the Minister of State for Quality, officials including the
Department of Health's Director General of Workforce, trust chief
executives, academic experts and representatives of 16 professional
and occupational membership groups. We also visited California
in May 2006 where we met academics, legislators and industry experts.
7. Our report considers the issues raised by the
evidence under the following headings:
- Workforce developments since
1999;
- Assessment of the current workforce planning
system;
- The future health service workforce; and
- The future workforce planning system.
8. We would like to thank all those who gave evidence.
We are particularly grateful for the expert assistance we received
from our specialist advisers: Professors James Buchan, Charles
Easmon, Judy Hargadon and Alan Maynard.
1 Health Committee, Third Report of Session 1998-99,
Future NHS Staffing Requirements, HC 38-I Back
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