It looks like all three have some choices to make.

Some choice to make

Let’s start the week with a
• factoid-fest:

• We are experiencing the lowest rates of unemployment since the mid-seventies.
• Vacancy rates across most NHS staff groups are high, despite the overall workforce having grown.
• Leaver rates are climbing.
• There’s a growing dependency on bank and agency.
• The staff survey shows the ‘working experience’… declined.
• Sickness absence rates … higher than before the pandemic.

Any workforce plan will have to take into account the lengthy training periods new intake professional go through.

It is expected the workforce plan, awaiting Treasury approval, will look at a fifteen year time span… and have little immediate impact.

• Due to the cost of living crisis, staff are dropping out of the NHS pension scheme, creating a problem for their future.
• Around 40% of the NHS workforce is over 50yrs.
• Incentives to return, after retirement are poor.

(Readers tell me, repeatedly, the process, frankly, is a pain and many give up.)

• The pay bill, £70 billion, is around 65% of a provider’s expenditure.
• Each additional 1% of pay, for NHS trusts, accounts for around £1 billion, allowing for full system costs.

You can see why a 19% pay rise for nurses is undeliverable. It would add £19bn to the pay bill, recurrent, year on year.

• Over the next 15 years, England’s population is projected to increase by 4.2%.

It is, also, ageing; the number of people over 85 is estimated to grow by just over half… meaning staff skills and profile will have to change.

The NHS financial settlement, agreed with government in the 2021 Spending Review, covered the period up to 2024/25:

• The settlement requires the NHS to deliver efficiency savings of at least 2.2% each year.
• Significantly higher than the circa 1% per year the NHS has historically delivered.
• The NHS budget is estimated to have reduced in real terms by 3.4% in 2022/23…
• … and will increase by only 1.8% in 2023/24 and 2.0% in 2024/25.

NHSE funded the shortfall in the 2022/23 pay award; the PRB awarded 4.75% and HMG paid only 3%.

Making up the difference meant…

• … reducing the funding investment in technology…
• … and new diagnostic capacity.
• NHSE are already looking at what to cut in the 2023/4 window.

We are well into 2023 and the results of the NHS staff survey 2022 are still not available.

Given the importance we are attaching to retention, somebody needs to tell somebody to pull out a finger.

However, we do know, in 2021 we saw staff motivation and engagement drop off a cliff.

• There is a 10% productivity difference between the average of the ‘ten-most’ and ‘ten-least’ engaged acute providers’ and…
• … for those with a combination of high productivity and effectiveness and high engagement, their working practices and workforce models can be quite ‘distinctive’…

… which tells me, ‘distinctive’ means streets ahead and whilst we are in ‘finger-pulling-out-mode’, it looks to me, there are a shedload of dozy Boards that need a clear-out.

• Things are so bad for some NHS staff, NHSE has resorted to providing advice and guidance to staff to help their money go further, including…

• … directing them to Asda, where kids can get a meal for £1 at any time of day in their cafes across the UK.

There have been serious efforts to retain staff by sharing ideas and good practice.

It has had some impact but not for paramedics where the leaver rates are still on the slide and for nurses were there’s only been a tiny change, 0.1%.

• Midwiffery vacancies are nearly 11%.
• Agency spend by the end of 2021/22, was £2.9 billion.

I bet, by now, you want to know the source of all these fascinating factoids!

They’re reliable. You can cut them out, stick them on the fridge and office notice board. Send them to your MP. Throw them at the naysayers. Baffle them in the pub and dazzle them at the bridge-club. They come from…

… NHSE’s evidence to the upcoming Pay Review Body. It’s a cornucopia of the really-interesting and a cuppa-builder’s read.

The unions have said they will not cooperate with the PRBs. Bonkers idea.

Rumour has it that HMG will say they can only afford 2%. Even more bonkers!

I’ll leave the final word to NHSE;

‘… Pay [is] the largest component of NHS costs… pay inflation represents a material cost pressure… [and]…if not supported by additional investment, will result in … trade-offs …

• on staffing numbers, …
• the ability of the NHS to deliver…
• reducing the elective backlog,
• bearing down on [the expense of] … agencies,
• tackling sickness absence…

…and improving staff experience.’

You don’t have to be an economist, a unionist or a politician to see the extremis the NHS faces.

It looks like all three have some choices to make.

News and Comment from Roy Lilley
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Reproduced at by kind permission of Roy Lilley.