The Ward Round: The workforce plan is still unfunded and uncosted

The Public Accounts Committee issued a strong warning to MPs in its latest report on access to emergency care about the ongoing failure to confirm how the long-term workforce plan will be funded. Ministers stressed how a lack of costing could see the plan “fail for patients” if nothing is done.

The 15-year “once in a generation” plan, which was finally published over the summer, committed an investment of £2.4bn over five years, but contained no detail about when and how this money would be released, nor how the last 10 years of the plan would be funded.

This was emphasised in no uncertain terms by the PAC: “The plan does not include any estimate of total additional running costs for the significant increase in workers it has identified, such as salaries for an extra 260,000 to 360,000 staff. There is no information available on either the scale or source of how staff costs in future years will be met.” 

Slow money

The committee also warned that this “unfunded and uncosted long-term workforce plan risks building in unsustainable financial pressures” and recommended NHS England should provide an update on the full cost of implementing the plan over the next 15 years, including staff costs, training, recruitment costs and “wider enablers”, such as technology, social care and infrastructure.

Although the PAC’s request is aimed at NHSE, the request may also help keep the Treasury in the spotlight for stumping up the cash. To try to ram the point home, both NHS Providers and the NHS Confederation issued comments stressing that fully funding the plan is “critical”, and highlighting the 125,000 current NHS vacancies. 

The LTWP itself acknowledged the “boost to labour productivity” it hopes to achieve will require “continued and sustained investment in the NHS infrastructure… [and] a significant increase in funding for technology and innovation”. Without this, loads more staff would be required to meet forecast demand. 

There are hopes, Ward Round understands, that NHS technology, estates and capital may be addressed in the government’s autumn statement on 22 November.

However, it seems unlikely to resolve other questions relating to how the vast increase in training places kicking in during the next parliament – including doubling medical school places and adult nurse trainees – will be covered.

The plan was clear that “inaction” could leave the NHS with a shortfall of between 260,000 and 360,000 staff by 2036-37. For real work to get started, funding will need to follow fast.

Missing money

Speaking at the Independent Healthcare Providers Network conference this week, health and social care secretary Steve Barclay triumphantly announced 160 community diagnostic centres would be open a year early by March 2024.

The “one stop shops” for diagnostic tests are based in a variety of different settings, including in a former glass works and football stadium (great for a press release) and have received almost £30m investment.

The announcement could only be followed, however, by the all-too-common refrain of “but who will staff them?”.

Dean Rogers, director of industrial strategy for the Society of Radiographers, said the CDCs were “only ahead of schedule when it comes to constructing the centres and buying the equipment”.

“[Government] still has not taken any action to ensure that there will be enough radiographers to staff these new centres and deliver patient care,” Mr Rogers warned, pointing to a 12.7 per cent national vacancy rate for the profession.

Of course, radiographers are not the only staff group needed, as CDCs involve a huge MDT. And while £2.3bn has been allocated for CDC capital, the workforce plan funding — as described above — remains opaque.

Since it is unclear when dedicated CDC staff can be recruited, an integrated care board chair told me this week, many are planning to rotate staff from other parts of provider trusts. The danger is this could ignite a whole new workforce crisis for hospital imaging departments as staff decide they want to stay and work in the less chaotic CDCs.

Because this is the last regular Ward Round, as I move on to cover the mental health beat, I reminded myself of the first edition written in January 2019.

“It’s the workforce, stupid” is as relevant now as it was then. The investment in CDCs could make strides towards reducing health inequalities, improving access and outcomes, but the workforce should have been at the centre of them, not an afterthought. Without them, who will keep the lights on?