The government has published its long-awaited, £2.4bn NHS workforce plan, and at first glance, it’s not short on ambition. The prime minister wants to train more than 300,000 additional doctors, nurses and other health workers in England over the next 15 years. This would represent the largest recruitment drive in the history of the health service. Yet there are some important (and unfunded) caveats.
Before we go any further, a side note. This is about recruitment for the NHS in England. Despite doubling as a national institution, there are in fact four health systems in the UK, for England, Scotland, Wales and Northern Ireland. Blame – or thank – devolution, depending on your view of the Barnett formula.
First of all, the plan itself. The government intends to:
- Double the number of medical school training places
- Increase the number of GP training places by 50 per cent
- Introduce medical degree apprenticeships for up to 2,000 students
- Expand dentistry training places by 40 per cent
- Train more NHS staff domestically, taking the percentage of overseas recruitment from nearly a quarter today to 10 per cent
Retention is also vital. Medical professionals are sought-after the world over. They can, and indeed are, leaving the NHS for better pay and conditions. And every doctor or nurse that leaves has to be replaced. The government says it has a plan for this too, but without more money for salaries, it is operating with one arm tied behind its back.
The other problem for the government is, if you were to plan a massive NHS recruitment drive, you wouldn’t want to start from here. There are at present 112,000 vacancies in the NHS in England. And as a result of demographic change (a polite way of saying you are getting older), doing nothing would lead to a shortfall of up to 360,000 by 2037.
Already, chronic staff shortages are contributing to record-high waiting lists, which hit 7.4m at the end of April. This backlog not only blights lives, it also has a knock-on effect on the economy. More people on long-term sick leave contributes to a tight labour market, further fuelling inflation.
Partly, this is a reflection of the pandemic. People got sick, either from Covid itself or from other normally treatable conditions for which they did not seek treatment, following the advice to ‘protect the NHS’. But the problems go back further than 2020.
The NHS has faced a spending squeeze since 2010. Not as tight as other departments (see local government), but still a huge change from the past. The Nuffield Trust calculates that health spending per capita, adjusted for demographic changes looks like this:
- 1979 to 1997 (Conservative government): +2.03 per cent
- 1997 and 2010 (Labour): +5.67 per cent
- 2010-2015 (Con-Lib Dem): -0.07 per cent
- 2015-2021 (Con): -0.03 per cent
This is why the post-pandemic backlog isn’t really a Covid phenomenon. Take one statistic that the Standard’s health reporter, Daniel Keane, pointed me towards. Sure, the government plans to increase training places for district nurses by 41 per cent. Yet the number of district nurses in England has fallen by half since 2010.
Given those demographic pressures referred to earlier – the number of people aged over 85 is estimated to grow 55 per cent by 2037 – we don’t simply need to return to the NHS of 2010. We must go further. And this isn’t just about staffing.
A recent report by the King’s Fund comparing the NHS with other healthcare systems found that the UK lags behind other nations on capital investment – for example, we have substantially fewer machines such as CT and MRI scanners, as well as basic equipment like hospital beds.
One final point because it’s a Friday and we all have somewhere to be: there is no social care workforce plan being published alongside this one. And a lack of social care packages, the dreadful pay and difficult conditions are a big reason for the backlog because hospitals cannot discharge patients. Indeed, the NHS simply stealing care workers risks making things even worse.
Voltaire once quipped that, while some states have an army, Prussia was an army that had a state. To that end, Britain is on the path to becoming a health service with a state attached. There are worse things to be, of course. But to make it work, it has to be funded, equipped and staffed properly. That will cost money, and it is why, no matter the promises made at the next election, taxes will rise to pay for it.
In the comment pages, Emily Sheffield pays tribute to the late Margaret McDonagh, the woman who helped women (and Tony Blair) get to power. El Hunt says that as a lesbian, she backs trans rights, and that we ought to ignore those who try to divide us. While Simon English suggests that though other utilities have their flaws, at least they’re not pumping sewage into our rivers.
And finally, from parades and concerts to where to party, Isobel Van Dyke reveals how to make the most of Pride in London.
Have a lovely weekend.
