The NHS is battling a long spell of ill-health. It has been suffering from a chronic shortage of nurses, doctors, general practitioners, beds and investment as well as a growing dependency on agency workers; as such, the NHS workforce is diminishing as the British public’s demand for healthcare rises.
“More people are leaving nursing than joining – deterred by low pay, relentless pressure and new training costs. For the sake of patient safety, the Chancellor must scrap the cap and help to fill the tens of thousands of vacant nurse jobs.”
This assessment from Janet Davies, Head of the Royal College of Nursing, encapsulates the multi-faceted challenges presented not just to the nursing contingent of the workforce, but other divisions of the NHS. The 1% public sector pay cap, Brexit uncertainty, staff shortages and under funding are creating an environment that has led to NHS vacancies rising by more than 10% in the last year, projections of £15bn financial shortfalls by 2020, missed A&E treatment targets for consecutive years and an influx of private healthcare providers competing for NHS contracts.
Open Forum Events is collaborating with NHS stakeholders, healthcare professionals and medical associations to present Frontline Services: Putting the NHS Workforce at the Heart of Healthcare; an event that will provide comprehensive assessment, actionable discussion and deliver solutions to the problems posed to the 1.3 million-strong National Health Service workforce.
The conference will emphasise a shift from reactive to proactive measures of equipping the NHS workforce to cope with the demands of contemporary healthcare service through improved domestic training, an expansion in international recruitment, upskilling of existing NHS staff, increased investment and an overhaul of the sector’s managerial practices.
According to official figures, in March 2017 there were 30,613 vacant full-time positions within the NHS; a 15.8% increase from the previous year. Overall, in the first quarter of 2017, 86,035 positions were advertised; many of which were looking for multiple new employees as part of recruitment programmes, meaning the true figure is likely even higher. Nearly 40% of the advertised vacancies were for nursing and midwifery roles, averaging a worryingly thin three applications per-role. This is a little less surprising when taken into account that nursing pay has fallen by 14% in real terms since 2010, now worth £3,000 each year.
In April 2017, one month after the previous vacancy figures were taken, a further 1,274 nurses left the NHS.
For the first time in history, nurses are threatening to strike over staff shortages and low pay, which has been subject to the government’s 1% public sector pay freeze since 2010. In 2016, the Royal College of Midwives published a survey that found 80% of midwives who were considering leaving the NHS would be persuaded to stay if they had a fair pay rise.
To further compound the sense of loss, NHS mental health services lose around 10,000 members of staff each year.
The figures don’t make for good reading.
The Department for Health has pledged to train an extra 1,500 doctors per year by 2020 – boosting the current number of student doctors by 25%. Additionally, 10,000 extra places will be made available for trainee nurses, midwives and allied health professionals. A spokesperson from the Department of Health commented on the staffing issues within the NHS, purporting a drastically more optimistic outlook: “Staffing is a priority – that’s why we have invested in frontline and there are almost 32,000 more professionally qualified clinical staff including almost 11,800 more doctors and over 12,500 more nurses on our wards since 2010.”
Jeremy Hunt, Secretary of State for Health has promised there will be 21,000 more nurses, therapists and consultants working in mental health services in England by 2021 to the tune of £1billion. However, medical professionals have expressed concern with the government’s training initiatives on several fronts as the new students that will benefit from these training places could take up to ten years to train and become senior doctors; therefore, this initiative will not address the immediate shortage of doctors.
Additionally, the £1billion that will fund the 21,000 new positions is not new money from HM Treasury but is instead coming from existing NHS budgets.
Phillipa Hentsch, head of analysis at NHS Providers commented on the difficulties posed to potential international recruits by contemporary Britain: “Tough language tests, and the uncertainty that Brexit has created for current and potential EU staff has contributed to the issue. We are also seeing the impact of pay cap, prompting staff to seek work elsewhere. Trusts will do all they can to ensure safe care for patients, but where they cannot recruit to roles they may be forced to rely on expensive agency staff, or stop services altogether. Both options are unsustainable in the long run.”
However, as recently as June 2017, the number of practising GP’s has fallen since 2015 from 29,862 to 29,423; a drop-off of 439. Opposition to the government have used these figures to demonstrate a failure to deliver on its promises and those voices are strengthened by members of the medical community commenting on the shortages. Dr. Krishna Kasaraneni, GP workforce lead for the British Medical Association: “The government needs a long-term plan that addresses the fundamental pressures on general practice from rising patient demand, stagnating budgets and widespread shortages. Even considering recent announcements, the government is still going to be well short of its target if recruiting 5,000 new GPs by 2020.”
NHS services in the devolved nations are also under increased strain. According to a survey carried out in Scotland by The Royal College of Nursing, half of the 3,300 nurses surveyed reported that patient care was compromised on their most recent shift due to staffing shortages; one quarter believe there are not enough support workers, nearly half voiced concerns about the skills mix on wards and one-in-eight nurses on the wards are not NHS staff but expensive outsourced agency workers.
In line with the increasing and expensive use of locum and agency staff is an permeating all four devolved NHS institutions, NHS Scotland has increased its use of agency staff in 2016/17 up £8.4million.
With the assistance and expertise of some of the healthcare sector’s industry-leaders and influencers, Open Forum Events presents Frontline Services: Putting the NHS Workforce at the Heart of Healthcare to provide NHS stakeholders, staff and users with actionable guidance in guaranteeing the prosperous future of the UK’s world-renowned national healthcare system.
Setting out the challenges posed to the NHS workforce by the public sector pay cap, pressurised work environments, constrained budgets and declining staff numbers. The Chairs Opening Address will be a short evaluation of the problems facing the sector as well as welcoming delegates to the conference.
The keynote address will set the tone for the rest of the conference, outlining in further detail the workforce crisis and the potential solutions; both government recommended and independently suggested, that could provide relief to the immediate workforce challenges.
The Department of Health claims to have substantially invested in frontline NHS services, creating 32,000 more professionally qualified clinical staff since 2010 and committing to training an extra 1,500 doctors a year by 2020; subsequently increasing the number of student doctors by 25%. Additionally, 10,000 extra places for trainee nurses, midwives and medical specialists will be made available. Unquestionably, the training and employment of more medical professionals is incredibly important to the sector, however, given the duration of medical training and courses, additional training will not provide reprieve to the immediate NHS workforce crisis and, by extension, the patient care that is suffering as a result.
What can stakeholders and decision makers do to ensure that the waning-current NHS workforce remains committed to delivering high quality patient care?
Following on from the keynote address, plenary sessions will scrutinise challenges in more detail; beginning with the controversial public sector pay cap. The 1% public sector pay cap, first introduced in 2010 as part of the Conservative government’s austerity policy programme, has understandably been the subject of much scrutiny from within the public sector and growing scepticism from back-bench MPs and front-bench ministers.
Justified by supporters of austerity as a necessary method of preventing a Greek-style economic collapse, the cap on public service pay is, in the words of Christine McAnea, Head of Health at Unison:
“A derisory amount in the face of soaring fuel bills, rising food prices and increasing transport costs. The government’s insistence on the 1% pay cap has tied the PRB’s hands. As the PRB itself admits, it can no longer prevent health employees’ pay falling way behind wages in almost every other part of the economy. Without the cash to hold on to experienced employees, the NHS staffing crisis will worsen as people leave for less stressful, better rewarded jobs elsewhere. This can only be bad news for patients.”
Now, eight years on from the introduction of the cap, is it time to re-evaluate public sector pay?
Dominic Cummings, Chief of the Leave Campaign penned a blog for the Spectator in which he called the now infamous pledge to deliver an extra £350million of funding per week to the NHS as ‘the most effective argument in the entire Brexit campaign’ and ‘necessary to win’. Britain’s annual net contribution to the European Union is estimated to be around £7.1billion; equating to roughly £137million per week. Even if the post-referendum government gave every penny of the UK’s weekly EU contribution to the NHS, it would still be a far-cry from the £350million injection promised by some of the prominent members of the Vote Leave campaign.
If this was a campaign technique, not a realistic pledge, the question arises; what the real impact of Brexit on the NHS be?
Immigration will likely play a crucial role in how the NHS functions post-Brexit, as it has done since its inception. International medical professionals have always been an integral to the NHS, but with potentially tighter border-controls, visa restrictions and changes to the quasi-home status of EU students looking to study at the UK’s world leading medical institutions; how will the NHS cope in the post-Brexit landscape?
The UK is fiercely proud of its National Health Service, and rightly so. Founded in 1948 under the principle that healthcare should be available to all, regardless of wealth, the NHS provides care for one million UK citizens every 36 hours. Given budget constraints and a pressurised workforce, the world’s oldest single-payer healthcare system is struggling to provide the world-class patient care it established a reputation on.
This session will scrutinise the four proposed methods of inflating the NHS workforce and outline how they might improve the standard of patient care within the sector. They are;
Successive governments have contributed to the further integration of private sector influence in the National Health Service; awarding lucrative contracts to companies that allows them to provide healthcare services within the NHS. The driving philosophy behind the increased private sector presence in the NHS is that a competitive environment will incentivise companies to deliver the highest-quality healthcare or risk losing the contract to better providers; but is incorporating free market ideology into the National Health Service generating best-practise or forcing the UK down the avenue of a USA-style private, expensive healthcare system?
Is the influx of private sector capital a necessary immediate measure or a drawn-out assault on the constitutional right of British citizens entitled to healthcare free at the point of use?
The Department of Health has pledged to invest £1.3billion in mental health services to bring psychiatric treatment into line with physical health; the initiative looks to facilitate seven days a week, 24 hours a day mental health services as well as integrating physical and mental wellbeing. Health Secretary Jeremy Hunt has championed the new funding plans, saying: “As we embark on one of the biggest expansions of mental health services in Europe it is crucial that we have the right people in post – that’s why we’re supporting those already in the profession to stay and giving incentives to those considering a career in mental health.’
However, ‘those already in the profession’ have voiced concerns about the consistent lack of funding mental health services in the UK have received. In a report by NHS Providers, 37 chief executives and chairs of the 53 specialist mental health trusts in England voiced concerns that services are so overwhelmed by soaring demand and plummeting staff that patients are facing dangerously long delays and inadequate patient-care:
Recent figures revealed that the London Metropolitan Police Force received a phone call relating to mental health issues every five minutes last year, a result of NHS services being unable to cope with large demands. Inspector Mike Brown, mental health coordinator for the College of Policing said: “We know there is more demand on NHS mental health services and their funding has been cut. We know that there has been a 60% increase in referrals to NHS mental health crisis teams but these services have had cuts to their funding. Most people in contact with police about mental health issues don’t need the police, they need a mental health professional.”
How can the NHS meet the growing number of mental health concerns that have driven people suffering from psychiatric illnesses to extreme lengths just to be treated?
According to the Department of Health, 45,000 students applied for nurse training places in 2017. Unfortunately, despite having the required grades, thousands will be rejected as there are only 23,000 available places. To counteract this deficit, the government will create an extra 10,000 places for trainee nurses, midwives and allied health professionals; opening the avenue into NHS work to social groups that are underrepresented in the sector such as lower-income domestic students. This plan should see the number of doctors graduating each year increase by 25% to 7,500.
Phillip Dunne MP, Health Minister said the plans were: “the biggest ever expansion to the number of doctor training places, but is also the most inclusive; ensuring everyone has the chance to study medicine regardless of their background, and ensuring the NHS is equipped for the future.”
Whilst health professionals welcome the increased training opportunities, how can institutions guarantee that they will train the new influx of future NHS workers to appropriately cater to the surging demands of contemporary healthcare?
The funding of healthcare qualifications has also come into question; as from August 2017, anyone who wants to train as a midwife, nurse, or other allied healthcare professions such as hearing or physiotherapy in England will have to pay tuition fees and can no longer access NHS bursaries to cover living costs whilst studying. The Department of Health claims that the £800million saved by replacing bursaries with loans will help create the targeted additional training places by 2020. However, experts such as Janet Davies, Head of the Royal College of Nursing have said: “It’s time for ministers to face facts; they will struggle to build a strong and resilient workforce unless they lift the cap on pay and reinstate student funding.”
To close the conference out, attendees will have the chance to field questions to a panel of medical profession experts, consolidating the information they’ve accrued during the event and presenting delegates with the opportunity to raise any issues they (or other stakeholders) might have regarding the NHS workforce.
The panel will be held in a Question Time style, with delegates posing their questions to the panellists in an orderly fashion; the events Chair will serve as the arbitrator and the session will last roughly an hour before the Chair makes his/her closing remarks and the Event Close.
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Construction of The Bridgewater Hall commenced on 22 March 1993, but the idea of a new concert hall for Manchester dates back to the reconstruction of the Free Trade Hall in the 1950s after wartime bomb damage. The Free Trade Hall was home to the city’s famous Hallé orchestra and also hosted rock and pop concerts. However, despite holding great public affection, the 1850s Free Trade Hall was ill-equipped to respond to the rising standards of service and acoustic excellence demanded by performers and audiences.