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No coherent attempt to assess headcount implications of 7-day NHS

11 May 2016

The Public Accounts Committee report calls for an urgent review of NHS clinical staffing in England, raising serious concerns about supply, budgeting, agency costs and leadership.

Report findings

The Committee concludes "national bodies need to get a better grip on the supply of clinical staff in order to address current and future workforce pressures".

In particular, the Committee warns "no coherent attempt" has been made to assess the headcount implications of major policy initiatives such as the 7-day NHS.

Commenting on the Government's commitment to provide an extra £10 billion in funding for the NHS by 2020, the Committee concludes this funding is a pot the Department of Health "seems to expect will cover everything—despite not having separately costed 7-day services and other initiatives".

It adds: "We are therefore far from convinced that the Department has any assurance that the increase in funding will be sufficient to meet all of its policy objectives."

"Unrealistic" efficiency targets

The Committee finds NHS trusts and NHS foundation trusts have been set unrealistic efficiency targets, leading to "overly optimistic and aggressive staffing profiles" which have in turn led to staffing shortfalls.

The Committee warns efforts to retain clinical staff "are not well managed, which may further increase shortfalls" and highlights that the shortage of nurses is expected to continue for the next three years.

Inaccurate headcount planning is largely responsible for a "significant increase" in agency costs, says the Committee.

The Report states: "NHS England told us that some agencies had taken advantage of trusts' need for staff to charge "rip-off" fees. In fact, the rise in spending is mostly the result of trusts needing to use more agency staff, often to cover vacancies."

The Committee urges the Department of Health, NHS Improvement and Health Education England to provide "greater national leadership and co-ordinated support to help trusts reconcile financial, workforce and quality expectations".

It recommends that "all major health policy initiatives should explicitly consider the workforce implications" and calls on the Department to report back by December 2016 with a summary of these implications in relation to the 7-day NHS.

By the same date, NHS Improvement should review trends in clinical staff leaving the NHS and provide the Committee with a plan "on how it will support trusts to retain staff better".

Chair's comments

Meg Hillier MP, Chair of the PAC, said:

"There are serious flaws in the Government's approach to staffing the NHS and without urgent action the public will pay for it on multiple fronts.

Frontline staff such as doctors and nurses are the lifeblood of the service, yet the supply of these staff in England is not keeping pace with demand. 
This poor workforce planning means patients face the possibility of longer waiting times and a greater cost to the public purse.

It is unacceptable for the Government to blame staffing agencies for the growth in spending in this area when its own mismanagement is a major contributor to the size of the bills.

At the same time, taxpayers are being asked to accept uncosted plans for a 7-day NHS—plans which therefore present a further serious risk to public money.

It beggars belief that such a major policy should be advanced with so flimsy a notion of how it will be funded—namely from money earmarked to cover all additional spending in the NHS to the end of the decade.

Taxpayers are entitled to ask questions about the financial security of the NHS and the level of service it is able to provide both now and in the future.

If the Government hopes to reassure the public it has credible plans for staffing and service delivery we urge it to demonstrate leadership in addressing the pressing concerns detailed in our Report."

Report summary

Over 800,000 clinical staff work in the NHS. Managing the supply of these staff effectively is vitally important as it involves frontline staff—doctors, nurses and others directly involved in treating and caring for patients.

However, the extent of staffing gaps in the NHS indicates that the supply of staff is not meeting demand.

In 2014, there was an overall shortfall of around 5.9% between the number of clinical staff that healthcare providers said they needed and the number of staff in post, equating to a gap of around 50,000 staff.

Undersupply could lead to longer waits

This undersupply of staff inhibits trusts' ability to provide services efficiently and effectively, and could lead to longer waiting times for treatment and shortcomings in the quality of care.

In recent years, NHS trusts and NHS foundation trusts have focused on reducing staff costs in order to meet efficiency targets. This has led to them consistently understating how many staff they will need and resulted in gaps in staffing.

At the same time, trusts had to ensure they had enough nurses in light of the failings in care at Mid Staffordshire NHS Foundation Trust and the publication of safe staffing guidelines. Trusts met their need for more staff, in part, by using more costly agency staff; thereby increasing the financial pressure on the NHS.

Department has provided ineffective leadership

The Department of Health and its arm's-length bodies have provided ineffective leadership and support, giving trusts conflicting messages about how to balance safe staffing with the need to make efficiency savings.

In addition, overseas recruitment and return-to-practice initiatives, which could help address current shortfalls, have been poorly coordinated.

The national bodies need to get a better grip on the supply of clinical staff in order to address current and future workforce pressures.

Further information

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