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Audit finds ‘weaknesses’ in modelling used for NHS workforce plan

A government-commissioned report has found “significant weaknesses” in the data projections used in NHS England’s long-term workforce plan.

In a highly critical report, independent auditors concluded that some of the modelling assumptions used in the plan, a key plank of NHS England’s workforce policy, “may be optimistic” in terms of forecasts.

In other instances, they found they “could not replicate” the workforce numbers that featured in the plan due to technical weaknesses in they way they had originally been calculated.

The National Audit Office (NAO) today presented the findings of its report into the plan, which was published last year, after concerns by government ministers were raised over the figures presented in it.

“Realising the [Long Term Workforce Plan] in full will also depend on additional funding”

Saffron Cordery

The NHS Long Term Workforce Plan set targets for the domestic recruitment and training of nurses, doctors and other clinical staff, as well as a significant reduction in international recruitment.

This included increasing the number of nursing training places by 80% (53,858 per year) by 2031-32 and the number of primary care nurses by 5,000 by 2036-37.

After the plan was published, some health leaders and politicians aired concerns over its achievability and the NAO was asked to independently assess the data modelling used to reach the specific targets set.

The NAO’s report found that the plan was overly optimistic in places, and said NHS England must make improvements and adjustments to its data modelling to reflect realistic goals for the workforce.

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It said “manual adjustments” the NHS England’s data modellers made to figures meant that some of the figures published in the plan were not replicable.

The NAO wrote, highlighting in particular a planned doubling of undergraduate medical school places that “some of the assumptions used in the modelling may be optimistic”.

“The NHS needs to address these issues in order for the modelling to be a reasonable basis for regular strategic workforce planning,” it said.

The NAO also noted that the NHS had assumed, in its modelling, that the health service’s productivity would increase “above the long-term historical average”.

In addition, it criticised the “complex design” of the modelling to reach the published numbers in the plan.

It recommended that NHS England change its modelling to remove any manual data processing, improve the quality assurance of its data modelling and “improve its documentation of assumptions” about the future of the workforce to better reflect uncertainties.

More on the NHS Long Term Workforce Plan:

NAO lead Gareth Davies added: “The creation of the modelling that underpins the long term workforce plan has been a significant undertaking.

“However, NHS England must strengthen its workforce modelling next time around to make better-informed decisions about the NHS’s future workforce.”

Meg Hillier, chair of the Commons’ Public Accounts Comittee, called on NHS England to “address the weaknesses” the NAO had identified, so its decisions about the future NHS workforce were “better informed and we know what money will need to be spent on it”.

In response to the NAO’s report, NHS England chief workforce officer Dr Navina Evans said the body would “implement any necessary changes” in future iterations of the NHS Long Term Workforce Plan.

Navina Evans

She added: “Expanding domestic education, training and recruitment, to ensure we have more healthcare professionals in the NHS to meet the changing needs of the population, remains the right course of action for patients and staff.

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“We have already made significant progress with a 25% increase in medical places and record numbers of staff working in the NHS, and we are fully committed and remain on track to delivering the vital actions set out in the plan.”

Union leaders welcomed the NAO’s recommendations, and reiterated their original concerns about how realistic the NHS Long Term Workforce Plan’s targets were.

Unison head of health Helga Pile described the original figures as “wishful thinking” and said that improved nurse pay was needed to meet the ambitious nursing recruitment and targets in the plan.

Similarly, Patricia Marquis, Royal College of Nursing (RCN) director for England, said: “This credible intervention asks the government and NHS to ‘revisit’ their ill-founded optimism.

“Since the workforce plan was published less than a year ago, student nurse numbers have already dropped twice – taking England’s NHS further from safe staffing levels.

“For the budget this month, we called on the government to take the nursing workforce crisis seriously and bring forward investment to increase the numbers of domestic nurses being trained.

“Today’s NAO report shows just how wrong ministers were to ignore those calls, but there is time to correct this grave mistake,” she said.

Ms Marquis added that “serious interventions” would be needed for the workforce figures in plan to become a reality.

Those representing health service employers also acknowledged the need to adapt the workforce plan following the NAO’s report.

Saffron Cordery, deputy chief executive at NHS Providers, said she was concerned about the report’s findings, and echoed the union leaders’ calls for more funding to achieve the goals of the workforce plan.

Saffron Cordery

“Trust leaders want – and need – the NHS Long Term Workforce Plan to be a success,” she said.

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“It is, therefore, deeply concerning that ‘significant weaknesses’ in its modelling have been identified. Realising the plan in full will also depend on additional funding.

“The report recognises the challenging productivity ask of trust leaders and their teams, who are already are doing everything they can to boost productivity.

“Overstretched staff are working flat out to treat patients with increasingly complex conditions within existing resources and in the face of relentless demand,” she said. “We need to see more capital investment in NHS infrastructure to support productivity efforts.”

She added: “More widely, trust leaders know that for the NHS long-term workforce plan to succeed – and help ensure the sustainability of the health service – there must be more support for social care. Social care needs a fully funded long-term workforce plan, too.”

Danny Mortimer, NHS Employers chief executive, pointed to the health service’s existing “commitment to regularly refresh” the plan, and said the NAO would assist in the first changes.

“We have always known that meeting the ambitions of the NHS Long Term Workforce Plan will be no easy feat due to the scale of the challenge in filling existing gaps and boosting staff numbers to meet future demand, and the significant delay in commissioning the plan,” said Mr Mortimer.

“The NAO have given advice to how future iterations can be improved, building on the huge expertise and practical understanding already held in the NHS England team,” he said.

“Health leaders have always known that the plan needed to be flexible and regularly updated in order to stay relevant in the face of technological, economic and demographic factors.

He added: “There are also opportunities to allow trust and system leaders greater influence on the plan’s priorities and choices.”

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