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4/1/2007
The Conservative health spokesman
Andrew Lansley has written an open letter to the Secretary
of State for health, Patricia Hewitt
Following a leaked document on workforce
planning that was published in the Health Service Journal
on Jan 4th. It raises major concerns for new and existing
clinicians in the NHS, and we publish the text of the letter
here:
I am writing to you in relation to the Department
of Health’s workforce planning following the leaking
of the third draft of the NHS Pay and Workforce Strategy
to the Health Service Journal on 4 January.
I have two main concerns with the leaked document, which
I shall outline below.
However, I would first like to probe the reasons why the
planning assumptions which are being used to inform the
Comprehensive Spending Review (CSR) 2007 are so different
from those used to inform CSR 2004. The document used to
inform CSR 2004, NHS Workforce Demand and Supply Analysis
to 2008-09 (gateway reference: 3970), assumed that –
by 2008-09 – there would be a shortage of 1,040 consultants
and 5,536 allied health professionals (AHPs) and scientific,
therapeutic and technical (ST&T) staff. The document
leaked to the Health Service Journal now indicates that
you are predicting an excess of 400 consultants and an excess
of 2,900 AHPs and ST&Ts by 2008-09. I would like to
know whether you have identified the reasons why your workforce
planning three years ago was so inaccurate, and –
if so – what action your Department has taken to remedy
these failures.
In a similar vein, I would like to draw your attention to
what you told the Health Select Committee on 21 November
2006, when you blamed the NHS financial crisis on the NHS
employing too many staff: ‘the reality is that the
NHS has spent more of the growth money on additional staffing
than was planned and has taken on…significantly more
nurses and somewhat more GPs than the NHS plan intended’.
I am unsure how this statement is consistent with the conclusions
of the leaked document (which was written on 27 November),
given that it forecasts shortages of 1,200 GPs and 14,000
nurses by 2010-11. I would be grateful for your comments.
My first key concern is the way in which your Department
appears to have lost control of the tools needed to manage
workforce numbers. The leaked document states that, ‘with
decisions on workforce planning now led by Strategic Health
Authorities (SHAs), the levers available to us to ensure
that workforce supply meets demands of the service across
the NHS are now limited’. The document goes on to
express the clear concern of your Department that ‘SHAs
[need] to take a strategic view and restore the recent reductions
in nurse training commissions’. I was under the impression
that the reason for devolving workforce planning to SHAs
was [ostensibly] to ensure that the supply of staff more
adequately matched demand. It seems now that your Department
has lost confidence in the ability of SHAs to perform this
task. If SHAs do not respond to the need for the, ‘clear
strategic direction for workforce development’ desired
by your Department, do you anticipate taking back control
of their education and training budgets?
As an aside, I was slightly bemused that your rationale
for restoring nurse training commissions was a fear that
nursing wages would otherwise rise beyond what was affordable
in the future, as opposed to any genuine desire to improve
care for patients. This only reinforces my belief that your
Department is now so fixated on restoring its credibility
in financial matters to the detriment of everything else
that it has lost sight of its overriding aim: improving
and protecting the health of the nation.
The document is, of course, correct to say, ‘failure
to invest [in workforce training] now produces welcome short-term
savings but shortages in the longer-term’. I have
estimated that there are almost 16,000 newly qualified nurses,
speech and language therapists and physiotherapists who
are unable to find jobs in the NHS. These people, who could
be making a beneficial contribution towards patient care,
have been trained at a cost to the taxpayer of almost £600
million. Given that your own workforce planning anticipates
a shortage of 14,000 nurses by 2010-11, I would be grateful
to learn what current plans you have to harness this unrealised
potential for the benefit of tomorrow’s NHS –
before these expensively-trained clinicians become demoralised
and seek work either in other sectors or even abroad.
To balance my criticisms, I should like to say that I was
encouraged by the statement in the leaked document that
your Department is considering giving undertakings on students
leaving training – presumably similar to the One Year
Job Guarantee which exists in Scotland – which I and
my colleagues have called for on a number of occasions,
although somewhat less encouraged to learn that you are
planning to use this as a bargaining chip to secure a below-inflation
pay award for NHS staff.
My second key concern is what has been accurately described
by the Royal College of Nursing as your ‘yo-yo’
attitude to workforce planning. I have next to no idea –
beyond your political and personal need to return the NHS
to balance by March – why the NHS workforce needs
to contract by 2.7 per cent this year, given that this document
assumes that it will expand by 7.1 per cent the year after.
The NHS will be spending at least £325 million this
year making staff compulsorily redundant, but you appear
to be anticipating reemploying many of them in 2007-08.
This shambolic waste of taxpayers’ money is neither
‘prudent’ nor ‘sensible’; words
which your Department has used in vain to describe the leaked
document. A prudent and sensible approach to workforce planning
would not have a ‘sharp’ contraction in one
year followed by a major expansion in the next.
I look forward to hearing from you. In the light of the
interest surrounding these issues, I am making this letter
publicly available.
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