These are the worst of times for the NHS in England. Public satisfaction is at its lowest level since it started to be measured 40 years ago. Staff morale is shattered, with retention a growing problem. Currently there are more than 112,000 vacancies in a workforce of 1.26 million full-time equivalents. Waiting lists have reached record levels. Against this alarming backdrop – particularly for anyone in need of treatment – the workforce plan launched by the prime minister on Friday is welcome as well as overdue. But it should not be mistaken for a solution.
The plan, which includes a promise to spend £2.4bn over five years, is the fulfilment of a pledge made by Jeremy Hunt when he was the health secretary in 2017. The need for a strategy to train enough staff to care for an ageing population was clear then. But centralised workforce planning does not sit well with a Conservative party that trusts markets over public administrators. Repeatedly, and in the face of a mounting crisis, ministers refused to act.
Mr Sunak’s government has belatedly – but rightly – recognised this as a mistake. Doubling medical school places to 15,000 per year by 2031, and increasing the number of trainee nurses by 92%, makes sense given demographic projections of the rising need for care. A commitment to rely more on staff qualified here, and less on overseas recruits, brings the UK more in line with other countries. The figure of 50% of NHS doctors employed in 2021 who were trained in other countries is too high. The recruitment by high-income countries of healthcare staff from low‑income ones raises ethical issues. Given existing gaps in dental care provision, a proposal to require new dentists to treat NHS patients is sound.
But while a workforce strategy was desperately needed, it cannot make up for past failures. The challenge posed by ageing populations is global. In the UK context, the record in social care policy is particularly poor, and there is a real risk that this plan could worsen it. In particular, the pledge to recruit 204,000 more NHS support workers will alarm care managers, as their staff may be tempted to sign up.
Pay is another hole in the policy. An upcoming five-day strike by junior doctors will further set back plans to tackle a waiting list of 7.4 million people. This week consultants voted to strike for the first time in 50 years. Ministers should accept the recommendation of the independent pay review body of a 6% pay rise, with an extra £1,000 for junior doctors. If they do nothing about pay levels, warm words about retention will be revealed as just that. Consolidation of an increased role for pharmacists is sensible, following the success of the vaccination programme which they helped roll out. Other reform proposals, including an apprenticeship route into medicine, are more questionable.
Mr Sunak’s pledge is a step in the right direction – a fact which should not be lost in a public slanging match with a resigning minister. But the changing nature of illness, including growing numbers with more than one problem, or “multimorbidity”, is a public policy challenge that extends beyond the NHS itself. It includes the impact on people of poverty, inequality, poor housing and unhealthy food. As the NHS reaches its 75th birthday, after 13 years of Conservative government, neither it nor the people it serves are in good health.