The world changes, but the NHS stays the same

‘In many parts of the NHS, managers are experiencing nursing manpower [sic] difficulties of varying degrees of intensity. These difficulties are characterised by relatively high turnover rates, increasing recruitment difficulties and shortages in some specialties.’

The words above are not mine, but those of a report commissioned by the NHS from management consultants Price Waterhouse. It went on: ‘These problems are now widely recognised and there is general acceptance that action needs to be taken to improve the position. There are many areas of dissatisfaction that consistently have an adverse effect on retention and recruitment. These concerns, in order of priority, are pay, standard of service, pressure of work, volume of work and management’s approach.’

If this does not sound like news to you, then it is because these words were not penned last week or even last month, but in April 1988. Yes, for almost 30 years those responsible for running our health service have been commissioning reports from consultants and other experts, who come up with reams of recommendations for improving workforce planning and staff productivity. We all then stand back and see little or nothing done about it.

The latest such reports were published last week. The National Audit Office bemoaned the lack of foresight around ensuring we have the right staff in the right places at the right time to ensure patients receive appropriate care. Lord Carter, a Labour peer, issued a report setting out a myriad of ways the NHS could save money through better procurement and use of resources.

His principal assumption is that the NHS could save millions of pounds a year if all hospitals adopted the most efficient practices already in place at the best. In relation to staffing, there is a danger that this will be a race to the bottom, with the organisations with the fewest nurses and weakest skill mix being held up as examples for others to follow. But as RCN general secretary Janet Davies put it, the focus on efficiencies must not be at the expense of safe care.