The Ward Round: What the NHS reforms mean for the workforce

Most of the reforms set out in the government’s white paper last week have been long expected — turning integrated care systems into statutory agencies, merging NHS England and Improvement and abolishing clinical commissioning groups.

But some of the proposals are more controversial — most significantly, the sweeping new formal powers given to the health secretary. If the bill is passed, which it probably will be, Matt Hancock or his successor will be able to transfer functions easily between arm’s-length bodies and even abolish them without needing a vote in the Commons.

It will also become the secretary of state’s responsibility to publish a report every parliament, which will “support greater clarity around workforce planning responsibilities”.

This feels a bit of a throwaway remark and poses new questions. How would this report interact with the People Plan? How would it make workforce planning any clearer?

But with key drivers of recruitment, such as immigration policy, deeply political, perhaps it makes sense for these to be directly addressed by a minister.

This white paper was unlikely to set out workforce modelling expectations and reform — we are still waiting for the crucial second part of the People Plan to do this — but some of the proposals within it could have serious implications on education, training, and regulation.

In recent years, there has been a question over Health Education England’s independent future. At the end of 2018, it was thought the organisation would become accountable to NHSE.

However, upon starting as its new chair in 2019, Sir David Behan stressed the advantage of having HEE as an independent statutory body with its own budget. With new leadership in place, the future of HEE has seemed brighter.

Yet the prospect of HEE being enveloped within NHSE may have reared its head again following the proposals set out in the white paper. Losing an organisation whose sole responsibility is for workforce planning could risk this important area of policy becoming diluted and funding diverted elsewhere.

As part of the Department of Health and Social Care’s “bureaucracy busting” ambitions, the white paper also set out plans to abolish local education training boards from statute to give HEE “more flexibility” to adapt its regional operating model.

HEE’s new chief executive Navina Evans said the organisation supports this and said it would “encourage more flexible local working arrangements that allows different parts of the country to focus on their own priorities”.

There is no detail on when or how this will happen, or how regions will be supported in workforce planning. If LETBs were to be abolished, medical training in particular will still need to be organised regionally — and bodies would be created with the same aims and responsibilities — LETBs rebadged or reinvented.

The gaps left by LETBs will arguably see the formation of regional people boards becoming increasingly important within local areas, when it comes to workforce planning, in the absence of a robust national plan.

Regulatory changes

The white paper also proposed some important changes to regulation. It suggested a reduction in regulatory bodies is needed — there are currently nine — and said this would deliver public protection in a more consistent way, while also delivering “financial and efficiency savings”.

It also discussed the need to look at whether the professions protected by the law are the right ones (this sounds an awful lot like deregulation, despite protestations to the contrary).

This could make some feel nervous, but the proposals for one regulator are not new. The Office of the Health Professions Adjudicator was shelved 10 years ago, in the bonfire of the quangos. After speaking with experts in the field, the consensus seemed to be, if done well, consolidation could improve the experience of regulation and set all on a level playing field. But it depends very much how it is done.

A question also remains as to what is in store for regulation of senior health service managers. Jon Restell, Managers in Partnership chief executive, said it is not clear if the government is signalling an intention to use existing powers under section 60 of the Health Act 1999, which would suggest a “full-blown [General Medical Council] model”.

He added: “Either way, there is still mileage left in the response to the Kark review before considering statutory regulation.

“Whatever system is adopted the fundamental questions about regulating senior managers don’t change: who, why, what and how? The critical issues for MiP are clarity about professional duties, independent oversight and fair process.”

The white paper provides more questions than answers for workforce. And it has made the absence of a long-term, fully-funding workforce strategy been felt even more acutely.

With more responsibility likely sitting with the health secretary, the government can only expect to face harder questions about sky-high staff vacancies and poor retention rates.