18 January 2019
NHS England released its 10-year plan last Monday, building upon 2014’s Five Year Forward View. The main thrust of the document sets out where the proposed £20.5 billion boost in NHS funding will be allocated. We welcome the ambition, providing support in specific areas that will provide much needed sustainability to the NHS.
The plan sets out the priority areas in health and social care over the next decade from maternity to the ageing population. It is an excellent step in the right direction towards a more sustainable health service and a much-needed boost in funding, but there remain many questions about how its vision will be implemented.
The section of the plans with potentially the biggest impact on our members relates to workforce. The plans promise to reduce the unsustainable number of vacancies, hire more staff and create improved development opportunities – important steps towards creating a more sustainable and supported workforce.
The plan commits to raise the number of nurses within the NHS by increasing the number of undergraduate placements by 25%, while clinical placement for an additional 5,000 positions will be funded from 2019/20. By 2020/21 funding will be provided for as many clinical places as universities fill, up to a 50% increase. Meanwhile medical school places will grow from 6,000 to 7,500 per year. It is not clear, however, whether this will be enough given calculations from Nuffield Trust, The King’s Fund and Health Foundation predict that the NHS would have a shortfall of 250,000 staff by 2030 without action.
The Getting It Right First Time (GIRFT) initiative is also recognised within the plans – a piece of work that our members are leading on within rheumatology. GIRFT is highlighted for its work on productivity growth and reducing unwarranted variation and will combine with other clinically-led programmes such as NHS RightCare and an increased investment in Quality Improvement (QI) to accelerate work to end unjustified clinical practice variation.
While the plan sets out specific workforce actions that can have a positive impact now, many of the wider reforms to training and education will not become fully realised until budgets for Health Education England (HEE) are set later in 2019. A workforce implementation plan is also due to be published later in 2019, with NHS Improvement, HEE and NHS England establishing a national workforce group to ensure workforce actions are delivered efficiently.
These commitments are ambitious and needed, but little detail is known of how they will be implemented and received. For now, the plan falls short in addressing current workforce shortages, especially considering the uncertainty posed by Brexit on the workforce in the public sector. This pledge only applies to NHS England’s budget, and not to the Department of Health and Social Care, which funds public health, training for frontline clinicians and capital investment. The true impact on the NHS will not be known until more detailed budgets and implementation plans are in place.