News / PAC blasts NHS staff planning

The committee’s report – Managing the supply of NHS clinical staff in England – raised particular concerns about the lack of any ‘coherent attempt’ to assess the headcount implications of major policy initiatives such as the seven-day NHS or the move to deliver more care outside hospitals. The £10bn of extra funding for the NHS by 2020, announced in the 2015 spending review,  was described as a ‘pot that the Department seems to expect will cover everything – despite not having separately costed seven-day services and other initiatives.’

The MPs’ report, a follow-up to a National Audit Office report published in February, continued: ‘We are therefore far from convinced that the Department has any assurance that the increase in funding will be sufficient to meet all of its policy objectives.’

The report made a number of recommendations. It noted conflicting pressure on trusts. Unrealistic efficiency targets led trusts to understate their staff requirements, while a quality and safety focus following the Mid Staffordshire NHS Foundation Trust inquiry created pressure to increase frontline staffing. The report called on ‘the Department, NHS Improvement and Health Education England to provide greater leadership and co-ordinated support to help trusts reconcile financial, workforce and quality expectations’.

There was further criticism about work to retain existing staff, with data suggesting rising numbers of nurses leaving the profession. NHS Improvement has been asked to review trends in clinical staff leaving the NHS and variations between trusts to produce a plan by the end of the year for supporting trusts to retain more staff.

There has been a focus recently on reducing agency staffing costs by capping the rates paid. But the report insisted the increase in agency costs is mostly due to higher volumes not higher rates – with inaccurate headcount planning to blame both in trusts and at the centre. It has called on the Department and NHS Improvement to address this ’fundamental issue’ and report back on progress.

‘There are serious flaws in the government’s approach to staffing the NHS and without urgent action the public will pay for it on multiple fronts,’ said PAC chair Meg Hillier (pictured below). ‘This poor workforce planning means patients face the possibility of longer waiting times and a greater cost to the public purse. It is unacceptable for the government to blame staffing agencies for the growth in spending in this area when its own mismanagement is a major contributor to the size of the bills.’

On seven-day services, Ms Hillier added that it ‘beggars belief that such a major policy should be advanced with so flimsy a notion of how it will be funded’.

NHS Providers chief executive Chris Hopson said in recent years the approach to workforce planning had been disjointed, particularly in clinical staffing. 'Our approach is unsustainable given we spend two-thirds of the NHS budget on staff, including doctors, nurses and other clinicians. Today’s report from the Public Accounts Committee rightly highlights how the NHS needs a more sustainable approach that addresses current shortages and supports a reduction in use of agency staff,' he added.

'Use of agency staff been a key contributor to the deficits most trusts are now experiencing. Combined with the unrealistic efficiency targets that have been set for trusts in the past, these two factors show the consequence of ineffective workforce planning.'