168.During the inquiry, we heard how crucial effective workforce planning was both to ensure that there are enough staff to do the work, and to improve the morale of existing staff. In her oral evidence, Denise Crouch, a Macmillan Lead Cancer Nurse, set out the pressures on staff who were now facing the backlog of cases created by the focus on the covid-19 pandemic, in an area that was already short-staffed:
How long is it going to take for us to get that work back and get to a level playing field? We were never meeting the 62-day target across the country. If we were not meeting it before the pandemic, what is it going to be like now? Everybody is trying, and everybody is committed to making a difference, but we are going to need more capacity.
169.Chris Hopson, Chief Executive of NHS Providers, was clear that capacity lay at the heart of the problem:
For the last 10 years we have had a mismatch between rapidly rising demand and capacity. Capacity simply has not risen in the same way. The way we tried to close that demand/capacity mismatch was by asking our staff to work harder and harder. The reality is that the demand/capacity mismatch was already showing up before we went into [the pandemic].
170.He warned us that Chief Executives of Trusts were telling him that after this “immediate period” of the pandemic, people would leave the NHS including “those near retirement, junior doctors or people who have come over here from overseas who wanted to train”. He concluded that core workers would leave the NHS because, “effectively, the whole concept of trying to close that gap by asking our staff to work harder and harder is creating an impossible and unsustainable workload for our frontline staff”.
171.Failings in workforce planning are not new. In her oral evidence, Anita Charlesworth told us that a 2013 study by the OECD had identified “a number of weaknesses” in the way that countries did workforce planning, four of which applied in our system:
She concluded that the tendency was for workforce planning in the NHS to be led by available resources, rather than demand.
172.Chris Hopson was clear about the need for better workforce planning. He said that “we absolutely do not have enough people working in the NHS”, and that a “very clear long-term plan” was needed. He added that “one of the really important things” that needed to come out of the pandemic was a “a categoric commitment right the way across Government that we are going to do long-term workforce planning”. The British Medical Association also called for a single national workforce dataset, which included regional staffing levels and consistent vacancy data for all providers, to enable more targeted approaches to recruitment and retention.
173.Sir Simon Stevens, Chief Executive of NHS England, appeared to agree that workforce planning needed to change. He told our joint inquiry on Coronavirus: lessons learnt, that there was a “paradox” in the approach to workforce planning in so far as the health service had “a medium-term outlook for its revenue funding” but a short-term outlook for “workforce training” and “capital investment in infrastructure.” He highlighted that both areas had a “much longer” planning horizon and said he would welcome anything that would bring “predictability” to those decisions.
174.When Prerana Issar, NHS Chief People Officer. gave evidence in October 2020, we questioned her on the availability of workforce projections that would deliver the NHS ten-year Long Term Plan. She stated that NHS England had “made recommendations” to HM Treasury for the comprehensive spending review. She said that she could not make public those recommendations, but that they were based on “what staffing is required to deliver the long-term plan”. Furthermore, she declined to commit to publishing any figures after the Spending Review had been completed.
175.Anita Charlesworth told the Committee that there was “a debate to be had” about whether an independent body should be tasked with workforce planning in health and social care and noted that there was “no power” or “no requirement” for Health Education England to publish long-term forecasts that had been overseen and quality assured by a chief analyst. She believed that one option could be to strengthen the independence and responsibilities of HEE in that regard. In her view, there may be legislative opportunities (in the Government’s proposed Health and Care Bill) to “strengthen the quality, the frequency, the rigour and the transparency” of workforce projections, covering both the NHS and social care.
176.The Department’s White Paper, Integration and Innovation: working together to improve health and social care for all published in February 2021, includes a proposed duty on the Secretary of State to publish a document, once every 5 years, which sets out roles and responsibilities for workforce planning and supply in England. Our witnesses for that inquiry were underwhelmed by that proposal, and argued that the duty should be to produce more detailed work projections and more regularly. In supplementary evidence to that inquiry, the King’s Fund, the Health Foundation and the Nuffield Trust set out the form that annual workforce projections should take. They recommended:
a)Placing a duty on Health Education England to publish annual, independently verified, projections of the future supply of the health care workforce in England and how those projections compare to projected demand for healthcare workforce in England for a 15 year period consistent with the long-term projections of health care spending produced by the Office for Budget Responsibility (OBR).
b)Placing a duty on the Secretary of State for Health and Social Care to ensure that annual independently verified projections of the future supply of social care workforce in England are published, setting out how those projections compare to projected demand for social care workforce in England for a 15 year period, consistent with the long-term projections of adult social care spending produced by the OBR.
c)Requiring the publication of the assumptions underpinning the projections for the workforce flows from and to the other UK countries; and immigration and out-migration of the registered professions in health care. Those projections should be set out in headcount and full-time equivalent. At the England level, the projections should individually cover all the regulated professions (social workers, registered nurses, doctors, allied health professionals).
d)Requiring the process for independent verification and a fixed annual date for publication to be published in advance.
e)Ensuring that the Independent verification of the projections meet the relevant standards set out in the National Statistics Authority’s code for official statistics for collecting, preparing, analysing and publishing government statistics.
177.The Academy of Medical Royal Colleges, NHS Confederation and BMA Council also wrote to the Secretary of State with its proposals for more detailed projections that would include:
178.As we noted in our Report, The Government’s White Paper proposals for the reform of Health and Social Care the Secretary of State appeared sceptical of making such provisions in the Bill. He argued that “Even if it may sound easy to say, “Let’s have an independent target for this. Let’s have some independent people set out the numbers on a spreadsheet,” that does not make it any truer than the best judgment of a Minister.”
179.However, the Prime Minister was more encouraging when asked at the Liaison Committee whether he would consider asking a body like the ONS, or an independent body, to make projections about the future need for doctors and nurses:
Yes, I think that is the kind of thing that we should be looking at […] We are looking at making sure we have the right measures for the long term, to recruit, to encourage, to retain and to make sure that we train people in the right way[…]
180.Our report concluded that the duty to publish an update on the roles and responsibilities once every five years was not an adequate response to workforce shortages that are endemic in the NHS and that we were “very sympathetic to the detailed joint proposal from the Kings Fund, Health Foundation and Nuffield Trust to place a duty in the Bill to produce annual workforce projections”. We also welcomed similar proposals submitted by the Academy of Medical Royal Colleges and Royal College of Nursing which contained the necessary detail to ensure that the Department and NHS England are able to “develop strategies to adequately staff health and social care in the short, medium and longer term”.
181.We are not persuaded that a combination of ministerial judgements and haggling between government departments is a satisfactory substitute for objective long-term workforce planning for the NHS and care system. We therefore recommended that:
The Government include in the Bill, provisions to require Health Education England to publish objective, transparent and independent annual reports on workforce shortages and future staffing requirements that cover the next five, ten and twenty years including an assessment of whether sufficient numbers are being trained. We further recommend that such workforce projections cover social care as well as the NHS given the close links between the two systems.
Workforce reports be undertaken in consultation with the Devolved Administrations to ensure that a clear picture is given on the health and care workforce throughout the United Kingdom.
182.The emergency that workforce burnout has become will not be solved without a total overhaul of the way the NHS does workforce planning. After the pandemic, which revealed so many critical staff shortages, the least we can do for staff is to show there is a long term solution to those shortages, ultimately the biggest driver of burnout. We may not be able to solve the issues around burnout overnight but we can at least give staff confidence that a long term solution is in place.
184.It is clear that workforce planning has been led by the funding envelope available to health and social care rather than by demand and the capacity required to service that demand. Furthermore, there is no accurate, public projection of what health and social care require in the workforce for the next five to ten years in each specialism. Without that level of detail, the shortages in the health and care workforce will endure, to the detriment of both the service provision and the staff who currently work in the sector. Annual, independent workforce projections would provide the NHS, social care and Government with the clarity required for long-term workforce planning.
185.We recommend again, that Health Education England publish objective, transparent and independently-audited annual reports on workforce projections that cover the next five, ten and twenty years including an assessment of whether sufficient numbers are being trained. We further recommend that such workforce projections cover social care as well as the NHS given the close links between the two systems.
242 , Denise Crouch, Macmillan Lead Cancer Nurse
243 , Chris Hopson, Chief Executive, NHS Providers
244 , Anita Charlesworth, Director of Research and REAL Centre, The Health Foundation
245 , Anita Charlesworth, Director of Research and REAL Centre, The Health Foundation
246 , Chris Hopson, Chief Executive, NHS Providers
247 British Medical Association ()
248 Oral evidence taken on 26 January 2021, HC (2019–21) 877, [Sir Simon Stevens].
249 , Prerana Issar, NHS Chief People Officer, NHS England and NHS Improvement
250 , Prerana Issar, NHS Chief People Officer, NHS England and NHS Improvement
251 , Anita Charlesworth, Director of Research and REAL Centre, The Health Foundation
252 , Anita Charlesworth, Director of Research and REAL Centre, The Health Foundation
253 Department of Health and Social Care, , accessed 6 May 2021
254 The King’s Fund, Health Foundation and Nuffield Trust, , accessed 29 April 2021
255 Academy of Medical Royal Colleges, accessed 6 May 2021
256 Oral evidence taken on 16 March 2021, HC (2019–21) 1274, [Matt Hancock, Secretary of State, Department of Health and Social Care]
257 Oral evidence taken on 16 March 2021, HC (2019–21) 1274, [Matt Hancock, Secretary of State, Department of Health and Social Care]
258 Oral evidence taken before the Liaison Committee on 13 January 2021, HC (2019–21) 1144, [Rt Hon Boris Johnson MP, Prime Minister]
259 House of Commons Health and Social Care Committee, , HC 20, para 86
260 House of Commons Health and Social Care Committee, , HC 20, para 87
261 House of Commons Health and Social Care Committee, , HC 20, para 88