Expert advice

Workforce: The political risks of implementing 7-day working

The leaking last month of the Department of Health ‘risk register’ on the NHS 7-day working plan was no accident, says James Buchan. 

The leaking of the Department of Health ‘risk register’ on the NHS 7-day working plan was no accident, says James Buchan

A document detailing official concerns over a '7-day NHS' was released to the Guardian in August, revealing the precarious state of NHS finances in England.

A ‘secret’ internal document, the risk register sets out civil servant assessments of the political danger in trying to implement the new working pattern throughout the NHS.

13 major risks

It makes worrying reading. And that is the point.

The civil servants reportedly uncovered 13 major risks, with one concern cited as ‘workforce overload’, or a shortage of skilled staff.

The scale of the shift to 7-day working means the NHS cannot currently ‘fill all roles […] with sufficiently skilled/trained staff to agreed timescales, meaning the full service cannot be delivered’, the document says.

Brexit burden

As if this isn't bad enough, the register highlights concerns around Brexit. The vote to leave the European Union, it says, may exacerbate workforce shortages, given the reliance on 55,000 EU staff to deliver services.

The risk register also notes that NHS staff have not been persuaded by the ‘case for change’. In other words, the workforce that has to deliver 7-day working is not committed to making it happen.

This has been most evident in the junior doctor strikes in England – a muddled escapade triggered by the government attempting to impose the new contract, which it has now done.

On paper, 7-day working makes a lot of sense, but this is an ambitious change which could be undone by funding and staffing problems.

The 'leaked' risk register makes this point abundantly clear, to politicians and the Treasury.

About the author 

James Buchan

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


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