The NHS Workforce: in Crisis?

10 January 2019
By Dr Nick Scriven FRCP (London)
Consultant Physician
President
Society for Acute Medicine
Dr Nick Scriven FRCP (London), Consultant Physician, President, Society for Acute Medicine

As the NHS enters another period of crisis, some would say the 18th month of a perpetual winter crisis, my concerns focus around staffing and workforce. This is of utmost importance as in my view the people who work within the NHS is its vital lifeblood and without them there would be no NHS.

The workforce can be broken down in two main ways, the current ‘team’ and how to retain them and then the everyday worrying gaps in those numbers for both medical and non-medical staff.

Staff retention is a relatively unrecognised issue that is hard to quantify. From the Royal College of Physicians (RCP) 2018 census of consultants and trainee doctors it was noted that 33 per cent of consultants currently in post will reach retirement age in the next 10 years and in the age group currently aged over 60 nearly 50 per cent have reduced their hours significantly in the last 12 months. Replacing a consultant is not quick or easy – at present 45 per cent of advertised consultant posts are unfilled due to a lack of suitable applicants and it takes on average 14 years from entering medical school to becoming a consultant.

Gaps in the workforce cause significant issues with 53 per cent of consultants saying rota gaps occurred frequently/often, with significant patient safety issues in 20 per cent of these despite on average working 10 per cent above contracted hours. Worryingly a third of trainee physicians said that if they could start again, they would take a medical job outside the NHS or a job outside medicine quoting rota gaps as the major factor.

Nursing workforce issues have long been widely reported - official NHS Workforce statistics data confirms the total number of nurses in the NHS as 285,500 which is only 7,000 more than in 2009 and this is despite the massive rise in need in the NHS. Hidden in this is the over 10 per cent reduction in community nurses and the staggering 40 per cent reduction in nurses specialising in learning difficulties/disabilities over this timeframe. Ian Dalton was quoted in the summer acknowledging that there are over 40,000 unfilled nursing posts in the NHS (at 11.6 per cent vacancy rate). The currently unknown effect of Brexit is looming with one think tank, the Cavendish Coalition, forecasting possible further 5,000-10,000 nursing vacancies (on top of existing ones) by 2021.

In efforts to make the service safe trusts are forced into using expensive bank and locum staff – 13,000 doctors and 64,000 nurses were employed in this fashion costing the NHS an incredible £207 million in September 2018. There are massive variations in reported spends with one hospital (Bart’s Health NHS Trust) showing a spend of nearly £10 million with others (e.g. King's College Hospital NHS Foundation Trust) spending under £100,000 in the same period.

In conclusion, as the NHS faces ever mounting pressures from demand, the internal pressures created by staffing gaps are of equally high importance not only for care but also finance and any long-term plans must address this so that working in the NHS again becomes a career people will choose.

As the NHS faces ever mounting pressures from demand, the internal pressures created by staffing gaps are of equally high importance