Workforce: NHS plan is doomed unless staff shortage is solved

James Buchan likens the NHS Long Term Plan to an overly ambitious new year’s resolution

James Buchan likens the NHS Long Term Plan to an overly ambitious new year’s resolution

Picture: PA

New year, new plan?

The NHS has just published its Long Term Plan. Think of it as a long list of very ambitious new year’s resolutions.

These include expansion of the diabetes prevention programme, better treatment for respiratory conditions, more information and training for NHS staff to support people with learning disabilities, and an extra £4.5 billion investment in out-of-hospital care, including digital GP consultations.

But with the NHS currently running with more than 40,000 nursing vacancies, if there is no improvement in staffing there will be no scope for sustained improvement in service delivery.

Put simply: no nurses, no plan.

Only halfway there

The Long Term Plan, which is for ten years, is patchy on the detail of how staff shortages will be solved. Various commitments scattered in the text include increasing the number of undergraduate nursing degree places, reducing student attrition, improving retention, increasing funding for continuing professional development and clinical placements, and recognising that the NHS will have to continue to recruit several thousand international nurses every year.

The ‘what’ is a substantial list, but the ‘how’ is currently very sketchy. Much is being vested in a new ‘workforce implementation plan’ to be published later this year and the establishment of a new national workforce group overseen by NHS England, NHS Improvement and Health Education England.

We have the service delivery plan but await the workforce plan, so we are only halfway there.

Lack of focus

Anyone who has been involved in NHS nursing workforce policy in recent years will be aware of examples of delayed, disconnected or inadequate implementation. This is often caused by underfunding, but in some cases has also been compromised by lack of capacity and of sustained national-level focus.

A new planning structure may help address this, but without adequate long-term funding and policy commitment, with a focus on respect for nurses and other NHS staff and their value and contributions, shortages will persist.

Sustained change over the long term is required. But it is worth noting that not many of us manage to keep our new year’s resolutions for one year, let alone ten.

Main aims of the NHS Long Term Plan

  • Cancer Whole-genome sequencing for children with cancer and young people with rare genetic disorders, in addition to adults with certain rare conditions or specific cancers. Early diagnosis will have improved from half to three quarters of cancers by 2028, saving 55,000 lives a year
  • Diabetes Expansion of the Diabetes Prevention Programme. From April, tens of thousands of people with type 1 diabetes will receive a wearable sensor known as the FreeStyle Libre on prescription
  • Emergency medicine Every hospital with a major emergency department will offer ‘same day emergency care’ for patients to be treated and discharged with the right package of support, without needing an overnight stay
  • Learning disability Children and young people with a learning disability who are inpatients or at risk of being admitted to hospital will have a key worker, while NHS staff will receive information and training on supporting individuals who have a learning disability
  • Mental health Expanding community-based services in schools to 345,000 more children and young people, with new waiting time targets for people experiencing difficulties. An around-the-clock mental health helpline will be established
  • Primary care An extra £4.5 billion to go to out-of-hospital care; '24/7 rapid response teams' made up of nurses and others will provide patients with urgent care and support in the community as an alternative to hospital; digital GP consultations
  • Public health Specialist alcohol care teams to be set up in 50 hospitals. Nurses and doctors to talk to drinkers and smokers about their habits and how to quit
  • Respiratory Investment in earlier detection of and better treatment for respiratory conditions to prevent 80,000 hospital admissions. Use of 'smart inhalers' that track, monitor and prompt asthma medication use via smartphones

James Buchan is professor in the faculty of health and social sciences at Queen Margaret University, Edinburgh



Further information

NHS Long Term Plan

More from James Buchan

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