Exclusive: Leak reveals government fears over 50,000 nurses plan

The email from the Department of Health and Social Care’s workforce director to NHS England and Improvement’s chief people officer set out “particular concerns” about the “retention delivery plan” for the target.

Retaining more nurses who are already in the service was due to contribute 18,500 of the total 50,000 net growth in nurses promised in the Conservative election manifesto, under the party’s plan.

The concerns are over ongoing work for ministers on detailed plans for delivering “Nurse 50k” — sources close to discussions told HSJ the DHSC had ramped up its involvement in the NHS’ staffing plans in recent weeks. It is separate but closely linked to work on an “NHS people plan”.

NHSE told HSJ retention had increased and it was working on “feasible and practical” plans for “further gains”.

In the leaked comments sent last week, Gavin Larner told Prerana Issar that a delivery plan on retention, which NHSE has submitted to the DHSC, did not contain “trajectories or milestones”, unlike other plans received.

Mr Larner’s email to Ms Issar also said ministers would expect a “clearer model of change in the delivery plan” on “culture” and “how you see the publication of a staff offer translating into national work that changes employer behaviour”. A “staff offer” is being developed as part of the NHS people plan.

He said: “The cause and effect is largely implied and unclear at the moment and this needs to be much clearer for the delivery plan to give confidence to ministers that national action over the next three or four years will in a sustained way deliver the improvements to culture and retention which will retain at least the 12,500 more nurses promised in the interim plan.” The gap between 12,500 nurses retained as per NHS planning — and the 18,500 which the Tories based their proposal on — is not explained or discussed in the email.

Mr Larner also said in the email that proposals on how “related work” such as pay, pensions and leadership would improve retention were “weak”.

He added: “The team would be happy to meet with you urgently, or provide direct support, to help ensure that we have a more robust delivery plan this week.”

Meanwhile, referring to “stretch target dates for delivery of 50k more nurses”, he said the “main lever” for “early delivery” would be international recruitment, but also asks for proposals to boost other recruitment or retention “if additional measures, including legislation, or resources, not included in the interim plan, were taken into account”. It is not clear what type of legislation is envisaged, although DHSC has indicated it is looking to relax professional training requirements.

An NHSE/I spokesman said: “Trusts’ retention rates have improved over the past year partly as a result of improved staff satisfaction with pay and working conditions as reported in yesterday’s annual staff survey, and partly as a result of NHS Improvement’s retention collaboratives.

“Further gains are possible, and the People Plan which will follow the Budget will set out the path to 50,000 extra nurses, based on evidence of what is — and is not — feasible and practical, including on retention.”

A DHSC spokeswoman said: “We are working closely with the NHS to deliver on our commitment for 50,000 more nurses by 2025, including quality assuring plans.

“The upcoming NHS People Plan will set out further actions to boost recruitment and retention.”