Getting NHS staffing back on track

I'm writing this on the morning of the Prime Minister's big speech at the opening of the political autumn. You know the one: "What an inheritance, so much to do, tough decisions... etc etc."

That's no surprise - anyone who watched the recent election campaign with a careful eye could have seen the fiscal bind a Government of any political colour would be in right now. It's tough.

By historical standards, taxes are relatively high, but public services are obviously struggling with demand. The longer-term answer to this is growth - make the pie bigger, and the tax take grows even if rates start to fall.

A lot of the REC's campaigning effort over the summer has been about putting growth first. That includes their labour market law reforms, where I was pleased to be one of only a few business representatives at the recent summit hosted by Deputy Prime Minister Angela Rayner. There is a lot to be concerned with there - but discussions are going on, and we have made members concerns and ideas clear.

By contrast, discussion about reform in the public sector has so far been light, with the focus more on settling pay disputes. But the British Government spends a lot (about £1.2 trillion pounds, or 45% of GDP), which means spending it well matters to public service outcomes, to maintaining and then lowering taxes, and to growth. It's on all of us to help all Governments get this right.

Take the NHS, for example. That's £178bn, before you even get to the linked costs of systems like care. Years ago, John M Neill , the recently retired Chairman of Unipart (and productivity champion) reviewed NHS design and found savings that could maintain and enhance care while saving staff time and Treasury money. Bad systems beat good people every time, unfortunately, as Sam Freedman has pointed out in his recent book "Failed State". The review didn't change the culture of the system.

As a citizen, and from a parochial Recruitment & Employment Confederation point of view, I can see this every day in how the NHS operates as an employer at trust level.

Often, our members are hung out to dry by politicians when they are surprised to discover that persuading a someone to leave their family at 2pm on a Sunday afternoon to drive 200 miles for a shift cover at a hospital with no notice requires a big wedge of cash.

It does. But the issue isn't the price - it is why you are having to ask the question in the first place. The previous Government's much vaunted "workforce plan" never really seemed to engage with the people of the NHS as employees with their own choices to make. The new Government will need to learn that.

Right now, we continue to see:

• Staff leaving substantive NHS employment for flexibility;
• Trusts telling recruiters that they can't pay a permanent placement fee for available candidates, but being willing to pay more overall for temporary help because it comes from a different budget;
• Cost-controlled on-framework rates frozen at rates that are unsustainable for both agencies to provide and which NHS staff will not take. Those shifts go unfilled - and they become that 2pm call on a Sunday. Even just passing on the substantive staff pay rises to agency staff would help.
• A narrative about agencies and cost that is not rooted in the truth - NHS Banks are regularly at least or more expensive than on-framework agency, and cater to a different demographic of staff anyway;
• Waiting lists lengthening as trusts are forced to do less, to avoid overspending.

This is all eminently fixable. But it is hard and requires a change of approach. A more sustainable agency market offering better value for taxpayers and - frankly - a better customer relationship for agencies is possible. Most importantly, it should also support the NHS to deliver better care, with substantive, bank and agency work operating in a more sustainable way. Work with agencies and unions on this - not against them - and we can deliver big change.

If a reset under this Government on the spending side - from transport to energy to health - is to mean anything, it must be about putting the long-term over the short-term. In health, staffing has saved pennies now - and for at least the last decade - to lose future pounds. This autumn - through the Budget and beyond, the REC will be focusing on reversing that.

Neil

p.s. - We always want Healthcare staffing firms to work with us on a mission for sustainability in the NHS. Do get in touch if you would like to know more.