The NHS 10 Year Health Plan: The good, the bad and the flat out wrong.

On 15 October 1987 during a televised weather forecast, BBC weatherman Michael Fish said, "Earlier on today, apparently, a woman rang the BBC and said she heard there was a hurricane on the way. Well, if you're watching, don't worry, there isn't!"

Later that evening, Southeast England was hit by the worst storm it had seen in over 300 years, with the weather causing record damage and killing 19 people.

Wes Streeting the Health and Social Care Secretary seems as out of touch with the reality of NHS staffing needs and Mr Fish was about the day's forecast, as demonstrated in the NHS’ 10 Year Health Plan for England.

Streeting continues to demonstrate a fundamental, and almost wilful, misunderstanding of how staffing in the NHS needs to be managed, with his new plan again billing the end of agency work as the cure all to the complications of getting the right workforce plan in place. It's also worth noting that the 10 year plan is not the end of the discussion on NHS staffing, and the NHS is expected to publish a further workforce specific plan in the next few weeks. We will keep members informed of any further developments set out in this

But for now, what does the 10 year plan actually say, and what does it mean for recruiters operating in the sector?

Ban on Agency Staff

Hidden deep in chapter 7 of the plan, the government states clearly its intention to “eliminate agency staffing in the NHS by the end of this parliament” and transition agency workers to staff banks, which the document claims are “better value”. As a statement on value, we know this is objectively wrong and have data to prove this. As a policy, this represents a wildly unrealistic view of how staffing can be managed.

Case studies from REC members repeatedly show that bank staffing costs more per hour than equivalent agency staff. One REC member based in London has previously shared the example of a locum Senior House Officer with a base pay rate of £36.14 an hour who was being supplied to a trust in London for a total hourly rate of £46.55 (including holiday pay, national insurance and agency fees,). Via the NHS bank, this same worker would have had a total hourly cost to the Trust of £58.91. Over the course of a year this would add up to an additional £30,850 to the Trust. This pattern repeats time and again across the NHS and is reflected in the total costs being paid for different types of supply. In 2023/24 the total cost of agency staffing dropped from £3.5bn (in 22/23) to £3.0bn but in the same period bank costs rose from £5.8bn to £6.7bn. Moving agency workers over to banks doesn't necessarily save NHS money but the facts here just get in the way of the political point scoring Streeting is pre-occupied by.

The plan also sets out a commitment to allowing Trusts greater flexibility and authority over how they deploy their staff. But not so much flexibility that they would be allowed to use agency staff in circumstances where they are needed to help deliver for patients and reduce backlogs. Even with a perfectly staffed and resourced NHS, there are always going to be occasions where additional external support is needed at short notice. If the staff themselves get sick, or there is a sudden surge in illness that needs a rapid response, agency workers will still be needed to fill gaps. Others agree that more needs to be done on getting the right staffing strategy in place. The British Medical Association, in their response to the plan, have stressed that “The limited workforce, who are already feeling undervalued must not be moved around like pieces on a chess board or made to work even harder”.

There is also plenty in the plan around cutting red tape, allowing doctors and nurses to get into work more quickly. However, in many cases there is a need for external talent to support the NHS with these processes. NHS trusts are not able to run their own procurement processes as effectively as agencies can, leading to inefficiency and increased costs when it comes to attracting and hiring new talent. In some instances, it can take weeks or months for Trusts to make recruitment decisions. Last year, one REC member did some analysis for an Integrated Care Board (ICB) regarding their hiring practices. On average the ICB was taking:

• 56 days to respond to every CV they received,
• Another 30 days to respond to a candidate after interview,
• A total of 137 days to onboard a new starter

This is a far cry from the efficient and effective workforce the plan is seeking to create. In a scenario like this, partnering with an external recruitment expert is actually the sensible and cost-effective thing to do, but no-one in the government is prepared to accept this reality.

What else does it say?

The New NHS (Neighbourhood Health Service)

As part of the drive to modernise the NHS, the government intends to move away from healthcare being centralised around hospitals, with plans to create a "Neighbourhood Health Service". This is designed to bring healthcare into local communities in a way that is convenient and accessible to all people. The ultimate goal of this is for every community to have a neighbourhood health centre, "with multi-disciplinary teams working together, under one roof", including GPs, dentists and social care professionals.

The Neighbourhood Health Service will also work alongside businesses and charity partners to help with preventative health measures - services like debt advice, employment support and smoking cessation or weight management services.

AI driven NHS

Technology and AI play a key role in the government’s plans with, with AI being mentioned 79 times throughout the document. The government anticipates using AI for everything from taking notes to accelerating drug development, and from conducting remote assessments to sequencing genomes. As far as the plan is concerned, AI is the key to unlocking the potential of the NHS and driving the government's plan to transition to an NHS that is genuinely preventative. The intention is that AI advancements will make diagnosis quicker, free-up doctors and nurses to do the patient focused work and will completely reform the entire clinical pathway. The support of AI is also intended to help reduce the overall headcount in the NHS by removing or reducing the need for many of the existing supporting roles.

However, even the most staunchly pro-AI advocates might recognise that the current capabilities of AI aren't quite at the level being envisioned in this plan. That begs the question of how the NHS will operate in the transition period over the next few years whilst these technologies are developed and integrated. This once again brings us back to staffing, and ensuring sufficient staff are retained to manage the transition. Cutting staff numbers too aggressively, before the technology is ready and fit for purpose, could leave the NHS further weakened.

The government is also committed to revitalising the NHS App. In his launch speech, Sir Kier Starmer wanted the app to be like “a doctor in your pocket”, giving millions of people direct access to non-urgent medical advice, the ability to book tests and appointments, and access to their new shared patient record. The app is planned to be a “world-leading tool” that helps to drive the government’s commitment to creating a fully digitally enabled NHS over the 10-years of this plan.

What is REC doing?

The REC has already responded directly to the proposals set out in this plan in our own comment to the media. We will continue to engage with the government and NHS where possible, and endeavour to compel the government to reconsider and reverse its position on agency staffing in particular.

We appreciate circumstances in the health sector remain perilous for many members. Next week on 9th July at 1pm we are hosting our next Health Care Sector Webinar heavily focussed on business advice. We will offer strategic practical advice on how to manage a healthcare agency during these difficult times.