Navigating the challenges of the NHS Long Term Workforce Plan

It felt timely that the NHS long-awaited Long Term Workforce Plan was published ahead of its 75th birthday celebrations last week. But for many working in and for the NHS, the plan didn’t have the substance or nuance which would lead us to believe the system will have a clean bill of health ready for its next big anniversary.

While it is commendable that the plan addresses staffing shortages head-on (by its own estimates acknowledging that, without intervention, the NHS workforce shortfall will reach nearly 360,000 by the middle of the next decade), those of us involved in NHS staffing can see it lacks in several key areas.?

I raise these points not to be a contrarian but to explore potential solutions that would better serve the needs of the NHS workforce and the patients they care for. I truly believe collaboration is key, and together we can collectively work toward a stronger NHS workforce that meets the evolving healthcare needs of our nation.

Delayed implementation

The NHS Long Term Workforce Plan is long overdue, and with a possible general election next May, there is uncertainty over the Government's ability to implement the plan fully.

While the NHS Long Term Workforce Plan carries positive intentions, it lacks the necessary detail on how the proposed measures will be implemented. Detailed strategies and clear timelines are essential to ensure successful execution and mitigate potential setbacks or delays. It has a firm stance on the what, just not the how.

Furthermore, the impact of additional staff may only be felt in 2030-31. This raises concerns about the lack of an interim plan to retain existing staff, especially considering the NHS ageing workforce and the rising number of younger healthcare professionals leaving the system.

Misconceptions over agency supply

After two decades working in staffing, I find the sustained political narrative that all agency supply represents poor value frustrating.

Providers need to undertake a cost evaluation of their agency suppliers. By recognising the return-on-investment reputable agencies bring, the NHS can leverage their expertise in managing workforce needs efficiently and cost-effectively. Not only does this optimise the system, but it represents better value for taxpayer money.

For me, there’s no doubt that a lack of alignment between government departments regarding the value and cost of flexible staffing solutions exacerbates the anti-agency rhetoric. Some departments have embraced more mature and valuable agency staffing models, including Managed Service Provisions, which provide economies of scale and cater to the workforce’s desire for flexible working.

In contrast, the Department of Health and Social Care (DHSC) and NHS England (NHSE) continue to hold agency suppliers at arm's length, treating their services as transactional with little value. The staffing industry has often been made a scapegoat for NHS expenditure, disregarding the substantial benefits they bring, particularly supporting greater flexibility for the skilled healthcare professionals it relies on.

It feels like the narrative concerning the role and value of agencies in the NHS is at the behest of those who write the political agenda. After all, it wasn’t all that long ago that the secretary of state wrote to all agency suppliers thanking us for the meaningful contribution we and our workforce made in bolstering the NHS COVID-19 response.???

Staff banks vs agency staffing and the employee experience

The plan suggests NHS staff banks as an alternative to agency staffing. However, the costs associated with staff banks can exceed those of agency assignments they replace. I have seen numerous examples of where staff bank shifts are offered to agency doctors at enhanced rates in an effort to convert them from agency to bank. This is clearly an arbitrary tick-box exercise resulting in greater cost exposure to the NHS.??

A comprehensive evaluation of the costs and benefits of staff banks compared to agency staffing is crucial to ensure efficient resource allocation. If bank staff are positioned as the replacement model for temporary staffing arrangements, the question is, will this work for the healthcare professionals on the front line? Outstanding concerns among temporary healthcare workers around flexibility and pay rates may act as a barrier to transition, underlining the importance of understanding worker sentiment.

The workforce experience gap exists when there is dissonance between what workers expect from an employer and how effectively they meet those expectations. This is something I talk about at length in my article introducing Acacium Group’s viewpoint programme. This is a technology-led candidate experience management programme we’ve created to collect employee experience data at scale, analyse it and create actionable insights to support healthcare providers in making positive change. A holistic view of the employee experience is necessary to addressing the workforce's concerns to improve retention rates long term.

Funding and pay rise challenges

Like several events in recent years, the recent spate of NHS strikes has been repeatedly described as ‘unprecedented’. NHS pay is a topic that never strays far away from the headlines, and therefore, I found the plan's ambiguity around funding models particularly unhelpful.?

While the NHS Long Term Workforce Plan outlines the need for more staff, there is a glaring absence of strategies to address funding for pay rises during the training period. There needs to be more emphasis on retaining those we stood in the street applauding every Thursday. How will we support the existing workforce now?

Without these crucial elements, there is a risk that we will continue to haemorrhage the current workforce, and new staff will be trained only to find that the battle has been lost by the time they enter the workforce. The Government must allocate adequate resources to fund pay raises and support healthcare professionals throughout their training journey.

Preserving the attractiveness of the NHS

I welcome the plan’s commitment to additional local training spaces, and yet I think it’s worth noting that the NHS workforce staffing challenge requires a multifaceted response. In addition to reinvigorating training and development support at home, the NHS must remain an attractive choice to healthcare professionals worldwide.

The plan needs to consider the impact on migrant workers, whom we have increasingly relied upon to fulfil staffing shortfalls in recent years. It is crucial not to make the NHS less attractive to these valuable professionals, especially as employment opportunities in other global healthcare markets become more appealing. Retaining a competitive employee value proposition is vital to securing a diverse and skilled workforce.

In conclusion

While the NHS Long Term Workforce Plan should be commended for its positive intent and purpose, it is essential to acknowledge the challenging years ahead between now and 2031 - there is no silver bullet solution.

Navigating this period requires greater collaboration and cooperation across all levels of the healthcare system, including ICBs, NHS trusts, banks, and agency suppliers. By working together, we can find innovative and sustainable solutions to address the workforce challenges the NHS faces.

I wholeheartedly support the Recruitment & Employment Confederation (REC) in their call for a market review by the Public Accounts Committee. Such a review would help address the misconceptions surrounding agency staffing costs and highlight that, overall, temporary agency workers are more cost-effective than in-house NHS staffing banks. By exposing this truth, we can benefit taxpayers, patients, and their families.

I also echo the REC's call for the DHSC to engage with its membership on workforce planning and orchestration. The REC and its members stand ready to serve and contribute to the development and implementation of effective workforce strategies.

Furthermore, I urge the Government to extend its commitment and provide a similar plan for addressing the workforce challenges in the social care sector. By investing in and supporting the social care workforce, we can create a more cohesive and resilient healthcare system as a whole.

While the NHS Long Term Workforce Plan is a significant step forward, we must still be proactive in our efforts to collaborate, address misconceptions, and advocate for comprehensive workforce planning across healthcare and social care. Together, we can build a stronger, more sustainable future for our workforce, benefitting both professionals and the patients they care for.