NHS workforce crisis remains urgent as Spending Review fails to deliver long-term investment


Last week’s Spending Review failed to deliver the long-term funding that the NHS and the wider healthcare sector had hoped for in terms of training, education and professional development of the workforce. 

The reasons for this are understandable – the unprecedented burden the pandemic has placed on the economy and the ongoing response to COVID-19 have derailed other policy and funding commitments as we are told to expect the largest fall in output for more than 300 years with the highest recorded level of borrowing in our peacetime history. It is a situation that the Chancellor, Rishi Sunak, described as “an economic emergency.”

Responding to the Spending Review, Sally Warren, Director of Policy at The King’s Fund, acknowledges that any investment in health and social care is welcome, considering the wider financial situation. However, she adds, the funding is unlikely to be enough to address the pressures faced by services across the country. The lack of commitment to a long-term workforce strategy is particularly disappointing, and “will make it difficult for the government to fulfil its manifesto commitments, such as the promised 50,000 extra nurses.”

In an open letter to the Chancellor ahead of the Spending Review, the Chief Executive of The King’s Fund, Richard Murray, outlined why health and care services need the stability of a multi-year funding deal and urged Rishi Sunak to deliver a multi-year settlement for NHS training, education and development.

“There has been no national NHS workforce strategy since 2003. The key change needed is to shift beyond short-term initiatives and take a more strategic approach, as the Public Accounts Committee (PAC) and many other bodies, including ourselves, have recommended. The government has introduced some welcome measures to address staff shortages including the introduction of maintenance grants for student nurses, increased funding for nurse apprenticeships and changes to visa rules for NHS staff. However, the NHS People Plan 2020/21 does not constitute a strategic workforce plan and it is not clear that the initiatives announced so far will add up to the sustained balance of inter-linked policy, funding and leadership actions that our research showed is needed.

“The decision to undertake a one-year Spending Review, rather than the comprehensive, multi-year approach originally planned, is a pragmatic response to the economic uncertainty created by the COVID-19 pandemic. However, it risks reinforcing the short-termism in health and care workforce planning that has been so strongly criticised by the PAC and others, and jeopardising delivery of the government’s manifesto commitments. Funding for professional education, training and national workforce functions sits outside the NHS budget and has therefore not been agreed beyond the current year. Agreeing a funding settlement for the remaining years of this parliament – as has been done for NHS funding – would be both a practical enabler and a powerful statement of intent for a strategic, sustained approach to NHS workforce planning.

“Public appreciation of health and care staff and concern for their wellbeing have never been higher, yet the workforce crisis remains urgent. To develop and support the health and care workforce will require long-term effort underpinned by clarity about the funding available over multiple years.”

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