6 Conclusions
287. In 2000 the Government published an excellent
blueprint for workforce planning entitled A Health Service
of all the talents. Figures were set for a large increase
in the number of staff employed by the NHS in the NHS Plan.
There was also to be a significant expansion in the number of
training places for clinicians. However, the huge growth in funds
provided by the Government, together with the demanding targets
it set, ensured that the increase in staff far exceeded the NHS
Plan. By 2005 there were signs that the NHS was spending too
much. Boom turned to bust. Posts were frozen, there were some,
albeit not many redundancies, but, most worryingly, many newly
qualified staff were unable to find jobs and the training budget
was cut.
288. Although the Government argued for improvements
in productivity, in practice little happened. It was too easy
to throw new staff into the task of meeting targets rather than
consider the most cost-effective way of doing the job. There were
large pay increases but adequate steps were not taken to ensure
increases in productivity in return. There were attempts to create
a more flexible workforce and improve the skills of staff so they
could take on more complex and responsible tasks. The results
of these efforts have been mixed: in some cases there have been
no savings, in others the results have been successful. Unfortunately,
the cuts in the training budget threaten what successes there
have been.
289. In sum, there has been a disastrous failure
of workforce planning. Little if any thought has been given to
long term or strategic planning. There were, and are, too few
people with the ability and skills to do the task. The situation
has been exacerbated by constant re-organisation, including the
establishment and abolition of WDCs within 3 years. In sum, the
health service, including the Department of Health, SHAs, acute
trusts and PCTs, have not made workforce planning a priority,
with the consequences we can now see.
290. Given the pace of change, including technological
developments and the unpredictable consequences of policies such
as Payment by Results, we cannot know precisely what future workforce
will be needed. This means we will need a more flexible workforce.
There are currently many opportunities to increase productivity
and obtain better value for money. There will be more opportunities
in future. It is important that the workforce has the incentives
to take them.
291. To avoid the boom and bust of recent years
and produce a workforce appropriate for the future, there has
to be change. However, we do not support further restructuring.
Persistent reorganisation has caused many of the current problems.
It matters less which organisation does the job than that it is
done well and taken seriously. Therefore, despite their failings
to date, we recommend that workforce planning continue to be undertaken
by SHAs.
292. We propose one key change: workforce planning
must become a priority for the health service. In practice, this
means a number of straightforward but important improvements.
SHAs must recruit as workforce planners people of the highest
calibre and ensure that they are supported by staff with the appropriate
skills. Most human resources staff do not have these skills. Others
organisations, including trusts and the Department of Health,
must improve the quality and accuracy of the information they
produce on a range of matters, including workforce forecasts,
productivity and the cost of new policies. Finally, the Department
of Health must stop micromanaging. In addition to ensuring SHAs
have information of a high quality, the Department should act
in an oversight capacity ensuring that SHAs are giving workforce
planning the priority its importance requires.
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