Billions more for the NHS but where are the staff to do the work?

Successive governments have dodged the biggest challenge facing the NHS – and that’s the lack of enough staff to deliver the care patients need. As Rishi Sunak prepares to write another big cheque for the health service this unaddressed question is looming larger than ever.

The new £6bn capital investment to help set up an additional 56 community diagnostic hubs on top of the 44 already in train is the right thing to do to cut the huge waits for CT scans and X-rays.

The NHS waiting list has hit a record level of 5.74 million with thousands of patients waiting more than a year. The challenge is huge and comes on top of existing day-to-day demands. Who will do this extra work?

The Royal College of Radiologists, for example, says the NHS is short of 1,939 consultants just to keep up with pre-Covid levels of scans.

More than half of all radiology leaders say they do not have enough diagnostic and interventional radiologists to keep patients safe.

A lot of this extra work might well go to expensive agency nurses and locum doctors who will be able to demand premium rates. On top of this the NHS will need to do new deals with private healthcare companies.

That will almost certainly be more costly to the NHS and ultimately the Treasury, than if it had invested in a properly funded workforce plan for the NHS a decade ago. Had it done so then we would now be seeing the results of several generations of fully qualified nursing graduates in the NHS for example.

The NHS workforce eats up more than two-thirds of the budget for most NHS hospital trusts – delivering healthcare is labour intensive.

NHS England under Sir Simon Stevens consistently ducked the issue of workforce, trapped as it was by the starvation diet of funding from the Treasury during the austerity years.

In 2012, there were clear warnings of a nursing crisis heading for the NHS as university training numbers were cut by cash-strapped health authorities. Scant action followed, even after the horror of the Mid Staffordshire care scandal which had its roots in a lack of staff and a target-driven culture under New Labour.

Workforce, because of the health service’s vast scale, is extremely expensive and thus has been in the too difficult pile for too long. Even when the NHS secured funding for its long-term plan in 2018, the idea for a corresponding workforce strategy never really got off the ground.

The chancellor can only write cheques. But the risk is that without the meaningful substantive growth in staff to do the work, the only option open to the NHS is to ask existing NHS staff to work harder, for longer, over several years when many have just lived through their worst nightmare.

Some of our most experienced consultants are reducing their hours and leaving the NHS thanks to the Treasury’s punitive pension rules that have seen doctors hit with huge tax bills. Other staff are leaving simply because they are burning out after the last 18 months of pandemic. Nurses are leaving because the strain they are under has broken their mental health.

In response the NHS is recruiting staff, at great cost, from around the world to plug gaps in services. The workforce is actually increasing by thousands of doctors and nurses but it isn’t enough to meet the corresponding increase in patients and the activity now being asked of the health service.

At the weekend, The Independent reported there are empty intensive care beds up and down the country because of a lack of nurses to staff them. This means operations to reduce the NHS waiting list can’t go ahead.

Throwing money at the NHS generates great headlines and boosts the earnings of those able to make the most of the crisis spending we are seeing. But it makes for bad long-term financial management of the NHS and the nation’s wealth if we continue to fail to match workforce numbers with demand.

Former health secretary Jeremy Hunt has admitted he did not do enough to increase staffing levels in the NHS during his tenure. Sajid Javid and Rishi Sunak risk spending billions more to fix the backlog when the structural workforce issues remain unresolved.

NHS England’s new boss Amanda Pritchard should be making clear that the success of the backlog recovery programme and her entire tenure as NHS chief executive will rest on the health service having enough staff, with the right skills, in the long term.