The NHS lags behind international peers on workforce

If you got a choice between having more money for the NHS and more staff for the NHS, which would you choose? A new comparison of health statistics by the Organisation for Economic Co-operation and Development tells us that at 9.8 per cent of gross domestic product, health spending in the UK is above average for developed countries.

But when it comes to numbers of healthcare professionals we have in post, we are below average. And that matters.

According to the OECD database, the UK has about 2.8 doctors and 7.8 nurses to look after every 1000 people. But the average number of health professionals across the developed countries of the OECD is significantly higher: 3.5 doctors and 8.8 nurses for every 1000 people in these countries.

Greece has around double the number of doctors, and Finland nearly double the number of nurses we do. So what’s going on?

It’s not just the numbers

There are different views about how many doctors and nurses a health service ought to have, and the appropriate skill mix. It’s not just about the number but also their roles within the health system.

Nevertheless, the lower-than-average number of UK healthcare staff is not a strategic decision.

It’s due to empty posts across the country. We hear about inadequate numbers of health professionals in low-income countries, but in fact there is currently a shortage of more than 100,000 staff across the NHS.

That’s one in every eleven posts across the whole health service. In the next 10 years, the vacancies are set to triple.

There is currently a shortage of more than 100,000 staff across the NHS

This is due to a combination of problems, such as workforce planning, reduced funds available for training places, restrictive immigration policies and Brexit uncertainties, and more doctors and nurses leaving their professions.

The projected increase is also due to increased demand. Successfully delivering the government’s vision for the NHS will need more staff, not fewer. Yet the NHS Confederation’s recent survey of frontline NHS leaders found workforce was their top concern.

Two-thirds of respondents doubt their local health systems can meet that increased demand, especially in general practice and mental health.

Beyond money

The World Health Organisation considers the health workforce to be central to improving health services and population health outcomes. Internationally, inadequate health worker numbers have been associated with declines in quality of care, patient safety, and patient outcomes.

International research tells us that even the addition of one extra inpatient to a nurse’s workload increases the likelihood of patients dying, and of poorer quality care.

And yet the United Nation’s High-Level Commission on Health Employment and Economic Growth anticipates a global shortfall of healthcare staff of 18 million by 2030.

It says: “Failure to invest in and reform the global supply of qualified health workers to meet both current and projected needs will result in the continuation of inefficiencies in healthcare.” The UK risks being a part of this trend.

Other countries are looking to the NHS to learn from how we resolve these challenges. We can also learn from looking overseas. For example, we recently heard from Spain and Poland about their efforts to develop attractive packages to retain and regain their nursing staff.

Failure to invest in and reform the global supply of qualified health workers will result in the continuation of inefficiencies

These approaches go beyond money to focus on other factors that matter to their staff, such as opportunities for training and research, childcare, and helping them settle into the local community – extending to support for finding accommodation and schools.

To make the NHS long-term plan a reality, the new prime minister will need to prioritise investment in key areas that lie outside the £20bn NHS funding settlement – most notably training and education budgets, capital investment, public health, and social care.

The People Plan and its aspirations announced earlier this year were a step forward, but more detailed plans are needed, including from employers: in particular, more investment in training and better alignment with social care to make sure any steps the NHS takes to strengthen its workforce does not weaken the social care workforce.