Nhs Staffing Shortages: Why Do Politicians Struggle To Give The NHS The Staff It Needs?

16th January 2023

This article is from the Kings Fund.
https://www.kingsfund.org.uk/

The workforce crisis has been a prominent issue for years, but there has been little concerted action from governments to tackle the challenge.

For almost two decades now there has been no clear plan to address the crisis and the staffing gaps have continued to worsen, because, for whatever reason, the UK political system seems unable to respond properly to this very real public concern. Given this long-running gap in solutions from national politicians, The King's Fund and Engage Britain commissioned Bill Morgan, a former Conservative special adviser, to explore what can get in the way of ministers taking meaningful, long-term action to address NHS workforce shortages.

The resulting report, NHS staffing shortages; why can't politicians give the NHS the staff it needs?, focuses on the role of politicians in workforce planning and delivery. It sets out the scale of the workforce crisis and the impact that it has, and the causes - identified in the report as difficulties in workforce forecasting, a tendency to train too few staff in the UK, and the insufficiently strategic use of international migration to compensate. It also considers the political reasons around why it has historically been so hard to fix and considers three factors that could contribute to tackling the current shortages:

transparency in workforce forecasts.

the establishment of an independent workforce-planning organisation.

accepting the NHS's historical reliance on recruitment from outside the UK as explicit future policy and planning accordingly.

The accompanying long read from Sally Warren, Director of Policy at The King's Fund, looks to place Morgan's report in a wider policy context to briefly consider the range of actions that the long and often-promised comprehensive workforce plan for health and care needs to cover. For those leading on workforce away from national policy, the long read provides an overview of the key factors to keep in mind to act comprehensively across the range of levers to grow and support the workforce.

About this report
This report was funded by The King's Fund and Engage Britain. It was independently developed, researched and written by the author and all views are the author's own. The author undertook this project between May and October 2022.

Author's foreword
On 26 April 2022, the UK government defeated an attempt during the passage of the Health and Care Act to force it to publish independent assessments of the number of health care staff that the NHS will need in the future (Hansard (House of Lords) 2022). The defeat came despite a cross-party campaign that more than 100
health organisations, including The King's Fund, endorsed.
The government's hostility to the campaign seemed bewildering. The NHS's longstanding lack of staff has been one of its greatest - ever-present - challenges, and those supporting the campaign argued that independent forecasts would help ensure we train enough staff in future.

The government’s position was even more unfathomable given that the challenges facing the NHS workforce are one of the public’s greatest concerns. Engage Britain, through its People’s Panel, has identified the failure to recruit, train and retain sufficient health and care staff as the public’s top priority.

The NHS workforce shortage is therefore one of those nationally important issues that has been around for decades, but has never been resolved - because, for whatever reason, the UK political system seems unable to respond properly to this very real public concern.

Why is this? What is stopping it from being sorted out? And can anything be done?
To answer these questions, The King’s Fund and Engage Britain commissioned this paper on the politics of the workforce challenge. It is intended for all those with an interest in health and social care, particularly for those who are in or aspire to enter government.
The paper aims to identify why ministers are unlikely to take meaningful, long-term action to address NHS workforce shortages - even when doing so would be in their interests - and why there is a risk that even when they announce their intention to do so their plans may be derailed. It seeks to shine a light on the cross-government dynamics that impede a sustainable solution, and to help politicians understand why – although it would seem evidently popular for them to train more NHS staff – they find it problematic to do so.

NHS staffing shortages
Although the conclusions of this paper are the author’s own, it is the product of the input of many individuals who have given their time to contribute to it, some of whom are willing to be acknowledged, and some of whom would rather not. Those who are happy to be acknowledged are Mike Barnard, David Behan, Derek Bosworth, James Buchan, Andy Coulson, Richard Douglas, Paul Doyle, Andrew Foster, Shaun Gallagher, Sara Gorton, Dido Harding, David Hare, Fiona Hill, James Kanagasooriam, Andrew Lansley, Jo Lenaghan, David Metcalf, Alan Milburn, David Nicholson, Ben Nunn, Mike Richards, Nick Seddon, Richard Sloggett, Hugh Taylor, Nick Timothy, Claire Warnes and Rebecca Wilde.

The paper could also not have been produced without the expertise and insight of those at The King’s Fund, Engage Britain and the Institute for Government – including Siva Anandaciva, Suzie Bailey, Alex Baylis, Alasdair de Costa, Nick Davies, Nick Downes, Francis Elliott, Miriam Levin, Julian McCrae, Richard Murray, Emma Norris, Jill Rutter, Nihar Shembavnekar, Nick Timmins, Sally Warren and Joachim Wehner – nor without the members of Engage Britain’s People’s Panel.

Read the full report HERE
Pdf 33 pages

Note
The report focuses on the position in England but similar problems exist in Scotland.