A total of 65% of NHS leaders in England are either ‘not very’ or ‘not at all’ confident that their local health systems are able to meet the increased demand for staff outlined in the long-term plan, an NHS Confederation survey found - with many citing a lack of time, resources and funding as key obstacles.
The NHS long-term plan, published in January, pledged ‘a net increase of 5,000 GPs as soon as possible’ and to retain the equivalent of ‘12,400 additional nurses’. This was followed by the new five-year GP contract, in which NHS England committed to recruiting an ‘army’ of 20,000 primary care staff - including pharmacists, physios, paramedics, physician associates and social prescribing link workers - to help GP practices.
However, the NHS Confederation findings, coupled with analysis from the Health Foundation, have prompted warnings that the NHS long-term plan will be ‘extremely challenging’ to deliver without urgent government action on wider health funding, including ‘additional investment in education and training to train and build the workforce’.
The NHS Confederation report, titled ‘Unfinished business: The need to invest in the whole health and care system’, reads: ‘With a significant shortage of more than 100,000 staff, the case for greater investment in education and training, both of our existing health and care workforce, and the new entrants that will be needed to plug the gap, could not be more compelling.
‘The survey results reveal that the level of concern about this issue among system leaders remains very high. Without enough people we cannot deliver the services that people expect. Additional investment in education and training is needed urgently.’
Meanwhile, the Health Foundation’s ‘Investing in the NHS long-term plan’ report notes: ‘Although the government has committed additional funds to NHS front-line services, it is clear that delivering the ambitions to improve services set out in the NHS long-term plan will be a major challenge… Staffing is the make-or-break issue for the NHS in England and workforce shortages are already having a direct impact on patient care and staff experience.'
The long-term plan makes it clear that 'the NHS will need more staff, working in rewarding jobs and a more supportive culture', and the Health Foundation states: 'It is spending in these areas that will determine if there are enough staff in training, and if they have sufficient levels of investment in their development.’
However, spending on the education, training and development of staff sits outside NHS England’s £20.5bn long-term plan budget, falling instead with Health Education England, whose budget has been cut by 24% since 2013/14 - from £5.3bn to £4.2bn in 2019/20.
‘Without investing more in both current staff and the training pipeline of new staff, the NHS’s staffing shortages will worsen,’ the authors add. ‘As outlined in our recent analysis with The King's Fund and the Nuffield Trust, investing £900m in Health Education England’s budget would allow national investment in workforce development to return to previous levels, and would allow nurses to be given additional financial support to improve their retention and engagement.’
Other areas of health spending that must be addressed in order to achieve the ambitions set out in the long-term plan include the public health, funding for which has been cut by 15% (£850m) since 2015/16, and social care.
Dr Jennifer Dixon, chief executive at the Health Foundation, said: ‘Policymakers need to face the fact that there is urgent unfinished business if the NHS is to deliver its vision to improve patient care. There are mounting workforce shortages, the social care system is starved of funding, capital investment is going backwards, and public health funds cut. This all piles demand on the NHS and risks swallowing up the extra money and leaving far less to modernise care, reduce waiting times, and prevent illness in the first place. The NHS is being seriously hampered in efforts to move forward.
‘The new government needs to honour last year’s promises to set out long-term funding for public health, capital investment, workforce training and social care, and ensure they receive sufficient funding to support the long term plan ambitions.’
Niall Dickson, chief executive of NHS Confederation said: ‘[NHS leaders] face crippling staff vacancies, rising demand for care, lack of investment in buildings and equipment, and the drastic cuts to social care and public health that are fuelling extra demand on A&E and other front-line NHS services.
‘Failure to address this in the next spending review will put the ambitions of the NHS plan in jeopardy, and patients will not feel the full benefits of the extra £20bn of funding. This may look like a bounty when compared with other public services, but it will not be enough unless there is investment in those other neglected areas.’
The NHS Confederation survey received 64 responses from leaders representing all English regions and the commissioner, acute, mental health, community, primary care, independent and voluntary sectors, as well as those leading integrated care systems and STPs.