As an NHS supplier, it is essential that we are up-to-date with the latest industry trends concerning the NHS. Last month, Remedium attended the NHS Executive Strategy Summit, where we heard from leading NHS figures and led a roundtable discussion about the current workforce challenges and possible solutions. Here are our key findings.
Winter Pressures
Following a particularly challenging winter in 2022, with the ‘twindemic’ of Flu and Covid-19 admissions amongst industrial action, the NHS is now bracing for another difficult winter. With the service reeling from the impact of the sustained industrial action seen over the last 12 months, patient care is beginning to suffer with the 65-week wait elimination target effectively having been scrapped. The NHS is already functioning with little spare capacity – how it will cope with the increased demand seen in the winter months remains to be seen.
In addition, funding designated to address winter pressures and help trusts provide more beds and increase capacity has been reallocated to cover some of the deficit left by costly agency and bank cover during periods of industrial action, as well as to account for the loss of productivity during this time. Winter Planning guidance set out by NHS England earlier this year may no longer be achievable in the face of reduced budgets and resource.
There are growing concerns among both NHS leaders and clinicians that the current pressures the NHS is facing are unsustainable – and there is a lack of resource to address them in the short, medium or long term.
Industrial Action
As mentioned, the past 12 months of industrial action have had a devastating impact on the NHS budget. The total cost of the strikes – accounting for wages for cover shifts and a loss of productivity – are estimated to have reached £1 billion. Trusts, already on shoestring budgets, are being asked to cover these expenses within existing budgets. This will mean money previously allocated for other things, like digital improvements and winter planning, will go towards covering strike expenses.
Aside from raiding budgets, industrial action has also led to an increase in the elective care waiting list – which now sits at a record 7.7 million. This has several implications – there are now more patients waiting longer for care, which may mean their condition declines – and ultimately require more complex and costly care, further depleting NHS budgets. Clinicians are feeling the pressure to reduce the backlog and are reporting burnout as a result of a high workload in record numbers.
At the summit, NHS leaders expressed difficulties with keeping staff morale high both during and after strikes and preventing burnout in staff who covered strike rotas. The increased elective backlog, partially as a result of cancelled appointments during strikes, now feels insurmountable.
While the government is in talks with the BMA, industrial action has paused for now, though NHS leaders are concerned about the impact sustained strikes could have on the service over the upcoming winter months.
Financial Pressure
Following the Covid-19 pandemic and industrial action, as well as rising costs of medications and equipment, the NHS is feeling financial pressures at an all time high. With strikes having cost an estimated £1 billion, and government ministers refusing NHS pleas for emergency funding, the service has been left with a gaping budget. Money previously set aside for winter pressure and digital and recruitment initiatives has been redirected. Earlier this week, NHS leaders warned they do not have the financial resource to carry out plans to open extra beds this winter – which proved crucial to care provision last winter. NHS Providers also reported that recruitment to plug workforce gaps has been put on hold as a result of budgetary constraints.
While the NHS budget can only be stretched so far, reducing or pausing recruitment initiatives is a short-sighted policy. We know that one FTE clinician saves an average of £100,000 in agency and locum fees on an annual basis. During a time of financial constraint, it simply does not make sense for managers to rely on agency and bank staff to maintain safe staffing levels.
Investment in the service now will prevent overspend later – and ultimately drive significant savings.
Long Term Workforce Plan
While the NHS England’s Long Term Workforce Plan was welcome when it was published earlier this year, there is a lack of planning and direction for the short and medium terms. The measures set out in the plan, namely the increased training and apprenticeship roles, may be unachievable without a robust senior workforce to take the lead on training and development of early-stage career recruits.
The NHS is feeling the effects of chronic understaffing in the form of expensive agency and locum cover and discontent amongst the workforce which has led to recurrent industrial action. While the plan sets out sensible and achievable goals for the long term, the workforce needs urgent attention.
An increased focus on retention, training and development of existing staff as well as an increase in permanent, FTE clinicians would provide short and medium term relief, drive savings and improve patient care. However, without centralised policy this will be hard for individual Trusts to achieve.
Next Steps
Coming out of the Strategy Summit, it is clear that there is a lot of work to be done to protect both the NHS’s financial resource and its workforce to maintain high quality patient care and support the service throughout the particularly challenging winter months.
The root of the NHS’s current struggles – lack of financial resource, challenges in retention and staff discontent, and a record elective backlog – rest with its workforce. Adequately staffing departments with clinicians on FTE, permanent contracts will both reduce agency and locum expenditure and improve patient care – while also helping balance workloads and reducing staff burnout. This is where focus must lie in the short and medium terms.
Remedium remains available to discuss any of the market conditions mentioned above. Please get in touch with us here, or reach me directly at sebastianevans@remediumpartners.com.
