Workforce challenges

Workforce planning is a major priority and challenge for local systems and individual providers. Recruitment and staff retention continue to be severe problems, particularly in adult social care and primary care.

We set out in chapter 2 our concerns about the sustainability of the adult social care workforce and how COVID-19 has magnified these significantly. Urgent action is needed to tackle the staffing issues in adult social care, and the increased pressures and stresses caused by staff shortages.

Similarly we highlighted how in mid-2021 there were fewer FTE GPs in total per 100,000 patients than there were in 2017. A BMA survey in February 2021 found that around 50% of doctors were more likely to reduce their working hours in the following 12 months. One in four were more likely to take early retirement and another fifth were more likely leave the profession.

While there has been an increase in the number of mental health staff working in the NHS recently, there has been little growth over a nine-year period. The Nuffield Trust has reported how average staff numbers have increased by about 1% a year, but the number of mental health nurses have decreased by 3% in total over that period.

As we highlighted in chapter 1, health and care staff have continued to work under immense pressure. As at May 2021, NHS Digital data on NHS sickness absence rates showed that anxiety, stress and depression was the most reported reason for staff absence, accounting for more than 493,000 full-time equivalent days lost and 29% of all sickness absence – not infectious disease or coughs and colds/respiratory (which might suggest COVID-19). Sickness rates were highest among support to ambulance staff. In the NHS Staff Survey 2020, 44% (up from 40% in 2019) of staff reported feeling unwell as a result of work-related stress in the last 12 months.

The House of Commons Health and Social Care Select Committee report on workforce burnout and resilience in the NHS and social care, published in May 2021, set out the extent of the workforce challenge for health and social care. In their evidence to the committee, the Health Foundation stated that that the NHS workforce gap in 2020/21 was 115,000 full-time equivalent (FTE) staff. In adult social care, the Health Foundation and the Institute for Fiscal Studies projected that 458,000 additional FTE staff would be needed in England by 2033/34.

We highlighted the absence of a people plan for social care in last year’s State of Care report. This lack of equivalence was also noted in the Health and Social Care Select Committee report.

In concluding their report, the House of Commons Health and Social Care Select Committee called for “a total overhaul of the way the NHS does workforce planning”. It recommended that the government instigate a requirement for the publishing annual, independent workforce projections to cover both NHS and adult social care. It also advocated for the development of an approach to workforce planning that takes into consideration capacity and demand and makes clear “the opportunity cost of not training, employing and retaining sufficient numbers of staff”.

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