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NHS long-term workforce plan - what are the key enablers?

With the NHS's long-term workforce plan finally being released at the end of June, we look into what is required to make a success of it - from retention, recruitment and investment to regular monitoring against the targets.
Published on
August 8, 2023

The NHS’s long-awaited long-term workforce plan was finally released at the end of June, after many false dawns. But how can it be realised to achieve its full potential and really make a difference?

What was announced?

The long-term workforce plan covered a wide range of areas, but the most eye-catching announcements were:

  • A £2.4bn investment in training and apprenticeships over the next five years.
  • 130,000 fewer staff leaving the NHS over the next 15 years by improving  culture, leadership and wellbeing, to help increase retention.
  • The NHS Plan could mean the health service has at least an extra 60,000 doctors, 170,000 more nurses and 71,000 more allied health professionals in place by 2036/37.
  • The number of medical school places will double by 2031 from 7,500 today to 15,000, while GP and adult nursing training places will also increase substantially by 2031.

How can the plan be a success?

Firstly, we should start off by saying that the plan is a welcome and much-needed piece of work, and we applaud its comprehensiveness. It’s also important to note that it’s not a silver bullet that will solve all of the NHS’s problems overnight – nothing can solve everything in one fell swoop in a complex system such as healthcare.

There’s also a need to acknowledge the length of time that the workforce plan will take to bear fruit. With this in mind, there is an absolute need to continue operational grip and delivery against targets. The foot needs to be kept on the pedal continuously, with regular monitoring and measuring being crucial to stay on track.

We believe there are five main areas of focus to ensure the service can meet its workforce ambitions.

  • Firstly, while the significant investment in training and apprenticeships is brilliant and welcome, it won’t on its own address the problem of recruitment and retention.
  • Secondly, while the focus on retention is welcome, the plan doesn’t really go into enough detail on how this will be achieved. Retention was only mentioned in vague terms in the plan despite its huge importance
  • Thirdly, despite the plan’s focus on retention and recruitment, there is not a clear enough strategy on how to retain staff and the close the current 1 in 10 vacancy rate in the NHS.
  • Fourthly, it was promising to see the plan mention an increase in investment in education, tech and physical infrastructure, but there will need to be more details about how this will be achieved in practice.
  • Lastly, as well as training, retention, closing the vacancy rate and investment in infrastructure, the fifth key enabler, as we see it, is improving productivity by 1.5%-2% – as without a productive workforce, positive change will be hard to come by.

It’s our opinion that the above five key enablers are needed to ensure the workforce plan is a success, and that all of the above regularly needs to be measured and monitored to achieve progress.

We must also take a moment to look at what was missing in the plan. For example, solutions to the problems in social care, which still requires a strong, robust review, otherwise the challenges in the NHS will merely continue. A flawed social care system means people stay in hospital longer than they need to, putting extra pressure on bed spaces. By contrast, a properly functioning system can help keep people well for longer and enable faster, safer discharges home, which would all reduce strain on the NHS and improve its capacity.

There wasn’t much on the pay and reward challenge, either. While it’s no surprise that it wasn’t mentioned in the plan – it’s something that ultimately sits in the hands of the government – it will need to be adequately resolved if recruitment and retention are to be true successes.

There is still an impasse with many health workers despite the recent pay offer made by government (in line with the recommendations made by the independent pay review bodies), and Rishi Sunak has said the only way these pay rewards will be made possible is by making more efficiency savings elsewhere in the NHS.

If you add that to the already expected productivity improvements, that is putting great pressure on a challenged system with no real clarity on how this is going to be achieved.

For recruitment and retention to be effective long-term, the current pay and reward challenges will need to be overcome.

Mental health parity and new challenges

While there were positive mentions of recruiting and training more mental health professionals, we’re not convinced that there was parity with physical health in the long-term workforce plan.

Lastly, there is a need to look at things more holistically and to understand how interconnected many aspects of society are. Amanda Pritchard, CEO of NHS England, appeared on Sunday with Laura Kuenssberg at the beginning of July, shortly after the workforce plan had been released, and made an interesting point that the NHS has to deal with the ills and challenges of society, which are now very different to 75 years ago.

Gambling, for example, is now 24/7 online and everywhere you look, from social media to the shirts of major football teams. Then there is vaping, whose harms may still remain somewhat of a mystery. There is a duty to try and address these issues that adversely affect people’s health, to once again reduce the strain on the NHS.

In summary, then, while we welcome the NHS’s long-term workforce plan, there are a number of essential steps to ensure it is successful and the need for a more rounded approach that factors in improved pay, social care, society’s changing challenges and a focus on retention.

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