Addressing the skills gap: Why the NHS Workforce Plan doesn’t do enough

Tania Bowers, global public policy director at APSCo looks at ways to solve NHS staffing issues

As the NHS celebrates 75 years, the focus for many of those in the profession remains squarely on one key issue: the significant resourcing pressures facing the sector. The unrest across the workforce that has resulted in multiple strikes since last year is, in my view, a symptom of much wider problems within healthcare, with how resources are being recruited for and the lack of continuity across Trusts just a few examples of where improvements can be made in processes.
Before I delve into how the recruitment crisis in healthcare can be resolved, though, it’s important to take a step back and look at the current situation. There’s been a growing skills gap in the sector for many years now, and the additional pressure of the pandemic and the patient backlog that this created has certainly exacerbated the issue of excessive workloads and not enough trained staff.
There’s a wealth of data to demonstrate the extent of the crisis. According to NHS Digital, 15,000 nurses resigned from the health service between March 2021 and March 2022 with a lack of work-life balance one of the drivers of these higher-than-expected staff turnover rates.
A recent report by MPs also revealed that England is failing to meet the demand for professionals, citing a shortage of 12,000 hospital doctors and 50,000 nurses and midwives. Our own study, produced in conjunction with the world’s largest network of job boards, Broadbean Technology, showed a continued fall in people applying for healthcare positions. In fact, the number of applications in healthcare fell 53 per cent between March and April of this year.
Hospitals and Trusts are facing significant resourcing difficulties that are showing no signs of easing. While there has been some movement in pay negotiations, the damage to the healthcare labour market that has already been done will be difficult to reverse, suggesting that struggles will only continue. However, there are some steps that can alleviate these challenges – and unfortunately, not all are covered by the NHS Workforce Plan.

Supporting the short-term crisis
The long-awaited plan announced by the Government at the end of June certainly showed some promise. The commitment to speeding up the training process and rethinking apprenticeships to help people learn on the job will have a positive impact. But it will take time to see the results, with the Prime Minister suggesting it could be 15 years before the real benefits are felt. But the healthcare sector is in crisis now and it needs an approach to the skills agenda that has a more immediate effect.
In this instance, a flexible and global workforce needs to be the focus. One aim of the reform is to reduce NHS providers’ reliance on agency workers which are currently critical to fill resourcing gaps. Speaking to many suppliers of talent in the healthcare sector, it is apparent that much of these gaps are being created by staff choosing to leave the service and work as locums or to reduce their permanent hours to supplement pay through better-paid agency work, a necessity for them due to the surging cost of living.
What this means is that rather than the agencies driving the demand as some commentators have suggested, it is candidates choosing to work this way, reducing the access the NHS providers have to staff directly. In any workforce as complex as the NHS there will always be a need for agency workers and the Government must not only recognise this, but also actively engage with the suppliers of these workers to ensure a well-managed solution is developed.
International talent will also play a key role in helping get the country out of the current staffing crisis. Reducing the reliance on globally trained healthcare professionals during a staffing shortage simply isn’t a viable option and while I agree that on a longer-term basis the UK needs its own sustainable source of trained doctors, nurses and GPs, until that has been created, global skills will be required.
There’s also a fundamental problem that is being overlooked in much of the plan. Increasing training and diversifying routes into healthcare employment will only be effective if people choose to practice their profession in the NHS and build a career within it. The NHS is struggling with extreme worker dissatisfaction, as evidenced by strike action and demotivation, not helped by recent OECD data evidencing that the UK has the lowest ratio of practising doctors per 1,000 people.
The reputational damage that has already taken hold in the sector is certainly not going to support the attraction of talent into the profession – whether that’s encouraging new trainees to choose this career or encouraging international healthcare workers to move to the UK for work.

Continuity needed
Clear leadership and ownership are also needed by government and NHS employers to cut the red tape when it comes to recruiting in the sector, which would deliver immediate results.  One such example is the lack of conformity around pre-hiring compliance and safety checks of permanent and agency staff which is contributing to the increased costs and delays of getting nurses and doctors in front of patients. A specialist, compliant to work for a Trust hospital under one CCG, may not necessarily be so at another hospital or primary care centre that operates under the same group, meaning there is minimal agility or responsiveness in workforce management.
Having consistency and conformity of compliance requirements in the healthcare sector will broaden the scope of resources for some hospitals and Trusts that are struggling. But transparency will be a necessity in achieving this. In fact, we are working closely with them - to help standardise the compliance checks across healthcare to ensure continuity across frameworks and reduce inefficiencies in the recruitment process. We will continue to work with them on this issue, but believe that the Government should play a more active role in supporting initiatives such as this which will only aid hiring in skills-short sectors.
The NHS Workforce Plan is long overdue but will take years to have an impact. There are shorter-term steps that government must consider, including standardised compliance checks and onboarding processes across Trusts, primary care and social care, to facilitate efficient, free movement between care settings.  Greater reform of the apprenticeship levy to allow reskilling and upskilling of existing staff through flexible, modular training that is supplemented by improving working conditions, pay and benefits will also have a more immediate impact and should be pursued with greater investment in my opinion.