This report has flagged that, by most indicators, workforce trends are going in a negative direction in the NHS in England. With projections of continued growth in demand for services, there is no evidence of recent substantial staffing growth in the main professions, with the exception of medical workforce numbers. And in primary care – a policy priority because of the growth in demand related to an ageing population – there are clear signs of real reductions in the availability of staff.

No one involved in shaping and supporting the NHS workforce in England sets out to create staff shortages, exacerbate their impact, or respond to them inefficiently. However, many of the indicators we have assessed in this report point to a worsening situation: increased demand, but flatlining or reduced professional staff numbers; likely reductions in the numbers of student nurses entering the profession; and reduced stability of NHS staff. The absence of a sustained and nationally focused approach to workforce policy and planning, compounded by the ongoing disconnect between identified staffing needs and funding decisions, prevents effective and coordinated policy interventions.

In the absence of policy coherence, there has been a series of isolated and often reactive responses to the highest-profile staffing concern of the moment. Examples include:

  • despite well-known underlying challenges with placements and capacity, it was only at the last minute that an announcement was made of additional support for student health professional intakes in August 2017
  • the announcement of 1,500 additional medical student places without full consideration of the overall impact on training budgets or future staff costs and mix
  • the upward revision of targets for international GP recruitment, when current targets already appear overly ambitious
  • the very ambitious targets for growth in the mental health workforce, with limited information about budgets or how roles will interface with current staff
  • the recently reported delay, by at least 1 year, to full implementation of the nurse apprenticeship scheme – less than 50 apprentices were reported to be due to begin university courses in September 2017, well short of the 1,000 a year predicted by the government once the scheme was fully established. (The reported reason for the delay is that employers ‘are struggling to support new training routes designed to ease workforce shortages’.)

To effectively address the major internal and external challenges facing the NHS workforce in England there needs to be collective action, led by government, to sustain a strategic process that can adapt to external shocks, such as Brexit, and can shape and drive internal policy change.

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