NHS: Policy “Not Fit For Purpose”

The Government’s NHS policy and plans are “not fit for purpose” and a drop in trainee nurses and high staff turnover mean performance figures are moving further away from their targets, according to a new Health Foundation study. The report found  “increasing cause for concern” that NHS policy isn’t achievable and could cut corners, leaving new staff without the skills they require.

Unstable, Unstaffed

Research into the rising pressures facing the NHS workforce has found two key stresses on staff: policy and stability.

While NHS policy has concentrated on trying to gain and retain staff in priority areas – especially in light of Brexit – trends show that workforce stability has in fact fallen since 2010.

Stability is measured by the percentage of staff who stay in an NHS trust in the year and that fell from 89% in 2010-11 to 85% in 2016-17.

The study also found that the range of stability between different NHS trusts increased – some trusts had an annual staff leaving rate as high as 30%. “This points to a worsening picture of overall workforce stability, with the likelihood of added costs being incurred at a time when the NHS cannot afford them,” it concluded. Instability increases costs where the Government hopes to reduce them and interrupts care for patients.

The overall staffing picture sounds positive – the NHS workforce actually increased by 2% from April 2016-17 – but the study says this “masks critical variations”. The overall gain in staff represents a loss in front-line staff but an increase in management and consultants.

The Government has for instance pledged to add 5000 more GPs by 2020 but instead numbers have fallen by 0.7% during 2016-17. And despite community and mental health nursing being key factors in the Tories’ NHS Five Year Forward plan, nurse numbers have fallen by 0.2% since 2016.

In 2017, 1,220 fewer students began undergraduate nursing degrees in England, with the largest drop in older students. That means an overall reduction in life experience and critical “soft skills” while the pressures to recruit quickly leave many doubting whether staff will have the necessary training and experience, especially for working in mental health.

Mental Health Muddle

The Government promised to create 21,000 new mental health posts and employ 19,000 extra members of staff by 2020.

The Health Foundation is uncertain about whether this could really be done in that time frame and it’s not alone: the British Medical Journal questioned if this target was “simply an example of ambitious headline grabbing on the part of England’s Health Secretary, Jeremy Hunt” (above). Mental health staff aren’t reassured by the poor progress of the GP recruitment plan.

The Government hoped to recruit 2,000 overseas GPs in the next three years but the BMJ has revealed that just 38 were recruited in the first six months of 2017.

Kate Lovett, dean at the Royal College of Psychiatrists, feels that the targets aren’t going to be reached without radical action and Brexit fears aren’t helping.

“In psychiatry we rely on overseas doctors more than any other medical specialty, so clearly we’re worried about the potential to lose from our existing workforce,” she said.

Lovett insisted that there was no chance of achieving Hunt’s ambitious goals without Government and NHS policy supporting those vital workers.

“What we need to be thinking about in the short term is boosting the supply and removing all barriers for doctors coming to work here. It absolutely needs government policy to influence that.”

Critical But Clueless

The Health Foundation study also felt the Government’s plans weren’t properly informed. “At this early stage,” it warned, “it appears that this may be another example where the approach to NHS workforce policy has been driven by the short-term and reactive approach that quotes targets and gains headlines but gives insufficient attention to implementation challenges and costs.”

Anita Charlesworth, research and economics director at the Health Foundation, said the past year had been “beset by unrealistic timescales and no overall strategy.”

“There is a growing gap between rhetoric about the Government’s ambitions to grow the NHS workforce and the reality of falling numbers of nurses and GPs. With winter approaching and staffing numbers in critical areas once again declining, the NHS will be relying on the efforts of its staff to meet the inevitable rising pressures. But in the long-term, both the people working for and the people using the NHS deserve better.”

 

by Jo Davey

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