Ignoring the needs of our future workforce could have disastrous consequences for the UK NHS and its patients.

Article by: Mireia Jofre-Bonet

Ignoring the needs of our future workforce could have disastrous consequences for the UK NHS and its patients. In economics, we have a pretty complicated name (hyperbolic discounting) for a very common human inclination, that is to consider that today matters much more than tomorrow. However, the UK NHS is facing the consequences of the workforce being planned mostly for the short term as if tomorrow doesn’t quite count.

In the aftermath of COVID-19, more ordinary concerns are recapturing our attention. We are slowly leaving behind a constant state of emergency and, at times, unavoidable improvisation. 

Sadly, after the heroic effort of the NHS staff during the pandemic, the future of the NHS looks increasingly bleak: in 2021, at least 20% of its staff were considering early retirement or switching careers. Being overworked by clinical and escalating administrative tasks and the lack of incentives and rewards explain the looming NHS staff exodus.  Focusing on the lack of incentives for retention, the below graph reveals how medical staff have suffered real wage losses in the last decade.

The resulting number of vacancies is astonishingly high. NHS England alone had 110,192 vacancies, equivalent to an 8.3 % vacancy rate at the end of 2021. GPs are experiencing a similar situation, and certain medical specialities are under higher pressure than others (i.e., anaesthetists or radiologists). There is no sign that these vacancies are going to be filled in the near future. Welcome, but insufficient, piecemeal governmental efforts to increase nurses, doctors and GP recruitment and the partial restitution of the nurses’ and medical bursaries are not considered enough to address the present and future staffing problems.

The UK NHS workforce shortages issue is not new; it has been brewing for years and is largely the result of the lack of workforce long-term planning during the last decade, which the COVID-19 crisis compounded.

Safe and efficient levels of staffing tomorrow require adjusting medical staff training and education many years in advance. In an effort to take a step in the right direction, the government merged Health Education with NHS England and NHS Improvement, but this has yet to result in a long-term plan by which the latter can inform the training needs to be implemented by the former.

The looming NHS workforce cataclysm has caused a compelling outcry from a broad range of experts and analysts, such as The Kings Fund, The Health Foundation, and Nuffield Trust, to name only a few. It is also the object of attention of numerous news outlets (the British Medical Journal, Health Services Journal, The Economist, The Times, The Guardian, The Independent, etc.). Furthermore, an amendment to the Health and Care Bill calling for an objective and independent mechanism to predict the future right staffing of the NHS received the support of over 100 organisations,  but it failed to be incorporated in the approved Act.

In conclusion, COVID-19 has made it more evident than ever that a health care system must be resilient as well as sustainable. These two objectives might clash at times, but this is escalated when the budget is guided by short-term objectives that do not take into consideration the needs of tomorrow. Given the eternal budgetary constraints faced by the NHS, understanding the health care system workforce’s upcoming requirements are more vital than ever.  Carefully orchestrated integration and coordination solutions could alleviate today and tomorrow’s blockages. It is time that decision-makers realise the benefits of behaving maturely, stop ignoring the future, and leave behind the current short-sighted approach to NHS workforce planning.

Mireia Jofre-Bonet  |  Vice President of Research  |  OHE

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