Following the result of last month’s general election, the Conservative party has formed a Cabinet and Jeremy Hunt has been confirmed as the Secretary of State for Health. In the second part of their review of what this means for the NHS workforce, Nicola Green and Victoria Watson from Capsticks explore some of the changes which are likely to take place in the NHS over the next five years.
NHS England has highlighted the need for a modern workforce in the NHS. With that in mind the Conservatives have made a commitment to recruit 9,500 doctors and 6,900 nurses which, as the Five Year Forward View (FYFV) identifies, means that increased funding will be required to recruit additional staff members. However, another problem with this recruitment drive is the shortage of candidates for existing vacancies. Some NHS organisations use overseas recruitment agencies as the solution to candidate shortages and it may be that more employers become reliant on this source of workers to meet the recruitment commitment made in the manifesto.
The FYFV states that it is essential that the NHS becomes a better employer. It suggests that this can be achieved by supporting the health and wellbeing of frontline staff, providing non-discriminatory opportunities, and supporting staff to raise concerns.
With regard to health and wellbeing, the FYFV lists a number of initiatives to which NHS leaders have committed including:
• Cutting access to unhealthy food on NHS sites
• Implementing food standards and providing healthy options for night staff; and
• Measuring staff health and wellbeing.
NHS organisations should be considering the steps they currently take to ensure the wellbeing of their staff and comparing them with the initiatives set out in the FYFV. Issues such as staff engagement and staff satisfaction, which are already a priority for most NHS employers, are likely to continue to be at the forefront of workforce strategies.
There is also a clear emphasis on supporting staff to raise concerns. This is already on the agenda for most NHS organisations following the Freedom to Speak Up Review. The previous government started a consultation on the recommendations made by Sir Robert Francis QC in his report, which closes in June 2015. The recommendations include the introduction of Freedom to Speak Up Guardians; someone to whom staff can go, who is recognised as independent and who has dedicated time to perform this key role. NHS employers should bear in mind that the results of the consultation are likely to result in requirements for them to take steps to ensure that listening to staff raising concerns is a priority.
Whilst the FYFV only briefly refers to this point, one of the headline commitments in the Conservative manifesto was that they would make the NHS more convenient for the public. Most notably, this includes making the NHS a full seven-days-a-week service.
Not only have the Conservatives said that they want everyone to be able to access their GP seven days a week between 8am and 8pm by 2020, they have also committed to staffing hospitals so that the quality of care is the same, seven days a week. A seven-day-a-week NHS is a commendable aspiration. However, achieving it is far from simple.
As readers will be aware, with regard to NHS employed doctors, NHS Employers had been in negotiations about amendments to the terms and conditions for both doctors in training and consultants. An important issue being explored as part of those discussions was how the consultant contract could facilitate the provision of seven-day services for the benefit of patients. Unfortunately, negotiations broke down in October last year. There is no sign that negotiations about the contract are to be recommenced in the near future and, for example, the BMA has been heavily critical of the government’s approach to this issue. This is an obstacle that Mr Hunt will need to address if he intends to progress the vision of a seven-day-a-week health service.
Even with doctors in post with terms and conditions that enable seven-day working, there are many who argue that the Conservative vision of a truly consistent service will require unrealistic levels of additional financial investment and further recruitment. With a workforce that is already stretched and a significant number of NHS organisations ending the last financial year with a deficit, some may argue that a move to a seven-day service will reduce the quality of care being provided across the week, rather than extending it. NHS organisations will need to examine the true cost and benefit of moving to a seven-day service, so that they are able to plan effectively for this change.
In addition to the issues impacting on acute, community and mental health providers, there is currently a shortage of GPs in the UK. The FYFV acknowledges that more needs to be done to increase the numbers of medical students who are training and being recruited as GPs and to improve retention, for example when GPs take maternity leave. Primary care commissioners would be well advised to start considering the seven-day week issue as soon as possible in order to establish whether it is possible to meet this level of service with current staffing levels or whether funding for recruitment will be necessary.
Nicola Green and Victoria Watson