The Ward Round: Moving from hope to commitment

“For the first time we have looked more than five years ahead in planning our workforce — through to 2027…” 

That is a line from Health Education England’s 2017 “Facing the facts, shaping the future” draft workforce report.

The need to plan ahead when it comes to the workforce should not have been a novel idea. In February, former health secretary Jeremy Hunt branded the government’s failure to publish precise workforce figures for the future “a joke” (although, long-term projections were not published during his tenure as health secretary either).

And, of course, the recent government white paper contained a new requirement for the health secretary to publish a report every Parliament setting out “greater clarity” around workforce planning responsibilities.

Workforce experts are calling for long-term NHS workforce forecasts to be published (with the Health Foundation’s Anita Charlesworth recently suggesting this should be a legal requirement of HEE). But Sir Simon Stevens, although agreeing long-term projections would have merit, has warned “the future has already been set for decisions we have made in the past”.

It is true some things, such as the number of medical school places available in any given year, are set. But workforce planning has been blinkered for too long.

The Health Foundation has recently set out how numerous Parliamentary inquiries have highlighted the short-termism in central government policy.

They argue policymakers are drawn to “near-term issues” and are limited by “structural short-sightedness” — for example, year-to-year funding. They argue this results in politicians becoming incentivised to prioritise current interests and ignore issues that are beyond the horizon.

This encapsulates problems with workforce planning — the lack of a long-term funding settlement for education and training, or a fully-costed people plan has clipped the wings of any ambition for long-term supply and demand modelling.

Mark Britnell, the former NHS bigwig turned consultant and author, has also discussed the impact of short-term thinking. In one of his books, Mr Britnell says that, faced with ever increasing patient demand, some healthcare systems take the workforce for granted and have been “blithely assuming that someone will always be there to cope with the work”.

Mr Britnell is clear workforce planning must not be treated separately to clinical or financial planning and argues it needs to respond “flexibly” to different supply factors over time.

In the wake of the covid pandemic, the need to flexibly think about workforce planning is absolutely essential. This week, HSJ reported on warnings from community nursing leaders that, without enough staff, key community care targets in the long-term plan and the white paper could be at risk.

The Queen’s Nursing Institute has predicted 1,500 district nurses will be needed, three times the current number funded by HEE. It is unclear whether this funding shortfall will be met, but it emphasises again the lack of slack in the system.

So circling back to the white paper; could a report from the health secretary in each Parliament ensure long-term workforce planning commitments are made and met? Without proper funding, it’s hard to see how. 

A quote from Peter Drucker, the prolific management thinker and author, summarises it quite well: “Unless commitment is made, there are only promises and hopes; but no plans.”