Recruiting more staff ‘is not enough’, says NHS workforce plan

New healthcare people strategy highlights importance of better culture and retention, but experts warn managers need to ‘start with their own behaviour’ to enact change 

Recruiting more staff ‘is not enough’, says NHS workforce plan

The NHS needs to rapidly become a better place to work, as well as address growing staff shortages, according to a new government people plan launched in a bid to address the health service’s workforce challenges.

The interim NHS people plan – developed collaboratively across the NHS with partners including the British Medical Association (BMA), the Royal College of Nursing (RCN), NHS managers and staff unions – argues that more needs to be done to improve retention of existing healthcare staff and transform ways of working, in addition to recruiting new workers. 

The plan, which follows the wider NHS Long Term Plan published in January, focuses on three key areas – recruiting more staff; making the NHS a better place to work; and equipping it to meet the future challenges – and sets out a long-term strategy to achieve this, as well as a number of immediate actions.

Health secretary Matt Hancock said there was “no question” the NHS needs more staff and a more supportive culture to make the NHS Long Term Plan, which sets out the 10-year vision for healthcare in the UK, a reality. 

“The NHS will take immediate action over the coming year to lay the foundations to grow a future workforce that can truly deliver the highest-quality care to patients from the cradle to grave. We must make the NHS an employer to be proud of,” Hancock said. 

“The success of the health service is rooted in the incredible people who dedicate themselves around the clock, and we must show our staff the NHS values them as much as they value their patients.”

Baroness Dido Harding, chair of NHS Improvement, said the plan acknowledges the workforce challenges the NHS faces, and they are determined to address the concerns frontline staff had expressed about the pressures they face at work. 

She said: “We need to change the way people work in the NHS to recognise the changing needs of patients and to create a modern, caring and exciting workplace that should be the best place to work in England.”

The interim plan suggested multiple ways for the NHS to quickly drive recruitment in the healthcare sector. One such action is to rapidly increase the number of NHS staff, starting with the nursing workforce “where the current vacancy pressure is the greatest”. 

The NHS employs more than 1.3 million people but had almost 108,000 vacancies at the end of June 2018. The interim report revealed there are approximately 40,000 substantive nursing vacancies in hospitals and health services across the UK, with a majority (80 per cent) of these shifts currently covered by agency staff.

The interim plan suggested one immediate course of action to address the shortage was to increase the number of undergraduates studying nursing by offering universities extra hospital and community placements for student nurses. 

Harding said NHS trusts had already identified over 5,500 extra clinical places for undergraduate nurses, which would put them on track to expand nurse undergraduate places by 25 per cent in September.

The plan acknowledged that the NHS will need to increase international recruitment for nurses and doctors to secure rapid increases in the short to medium term given the existing vacancy rates. The NHS will develop a new procurement framework of approved international recruitment agencies for “lead recruiters” in the service to draw on, “ensuring consistent operational and ethical standards”, to support increased overseas recruitment. 

It also set out plans to address current concerns from frontline NHS staff on the work pressures they face, improve retention rates and better workplace culture. The report acknowledged that healthcare jobs have become increasingly demanding as the NHS has struggled to recruit and retain staff.

The NHS said it will conduct a major staff engagement exercise this summer to create an “explicit offer to staff covering issues they say matter to them” like access to flexible working, career development and support from line managers. 

The 2018 NHS Staff Survey revealed poor workplace culture has already negatively impacted by workers feeling overstretched, with many reporting bullying, harassment and abuse in the workplace in the last year. 

The report ensured the NHS will develop a new offer with their staff setting out the support they can expect from their employer. This will be framed around broad themes of creating a healthy, inclusive and compassionate culture, as well as enabling career development.

But Nigel Edwards, chief executive for independent health think tank the Nuffield Trust, said a big difference in workplace culture will only happen “as long as national leaders start with their own behaviour”. 

"A good culture won’t make much headway when staff are seeing unsafe shortages every day,” Edwards said, adding that key measures “simply won’t happen” unless they are backed up by funding in the government’s upcoming spending review. 

"A good plan is a good start, but for this to be more than a piece of paper, it needs to be backed up with money and people.”