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Perhaps the dominant news has been the historic decision of nurses to strike following a ballot by the Royal College of Nursing (RCN) overpay settlements; savaged in parts of the media it is important to place the issue of NHS pay in a broader historical context. In its analysis entitled NHS Staff Pay since 2016, the Nuffield Trust points out that “NHS staff pay has remained lower in real terms in 2021-22 than it was in 2010-11.”

The nurses (RCN) commenced strike action in December 2022 and whilst the separate December 9 ballot of midwives’ votes didn’t result in the favour of strike action, the British Medical Association (BMA) due to ballot junior doctors in early January.

NHS receives only half the funding it needs

The issue of sufficient budgets to meet ‘pay’ aspirations is likely to remain a feature in coming years despite the higher-than-expected funding settlement for the NHS (and social care) announced in the Autumn Statement delivered by the Chancellor, Jeremy Hunt, on 17th November; in cash terms, the NHS would receive £3.3bn in 2023-24 and 2024-25.

Yet, according to Nigel Edwards, CEO of the Nuffield Trust, “…this is only around half of what the NHS had warned last month would likely be needed.”

It is also instructive to note that the Chancellor’s cash boost (in age-adjusted healthcare terms) amounts to less than 1% real terms increase in the NHS budget over the next two years, according to Nuffield Trust analysis. This should be compared to the 2.6% real terms average increase received between 1979-80 to 2020-21 on age-adjusted basis.

Finally in order to place the above in a broader context it is to be noted that, according to the Health Foundation, “…over the last decade the UK spent around a fifth less on average than the EU14 on day-to-day health care costs per person.”


Under the Health and Care Act, in July 2022, the Integrated Care Systems (ICS) were placed on a statutory footing focusing on comments and government intervention.

The Health Service Journal’s Henry Anderson reported in December 2022, ICSs were set for a combined deficit, likely to exceed £1 billion this financial year. This despite the expectation from NHS England that all ICS must break even in 2022-23.

It was also announced in the Autumn Statement that Patricia Hewitt (former Secretary of State) is to conduct a review of the ICS’s role and power. One of the ostensible aims is to afford greater autonomy to ICS.

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The state of care

Elsewhere, the CQC published its “State of Care” report in October 2022 reflected the various challenges facing the sector. This included references to the system being in gridlock for some patients trying to access care and the shocking statistic of 500,000 people waiting for a social care assessment. In its analysis of the CQC Report, the NHS Confederation was candid: “The Report’s findings are an indictment of years of underfunding and political neglect of the health and social care system.”

There have also been some prominent healthcare appointments over the last two months.

The Government, for example, announced a new task force to consider how the NHS can leverage the private sector better. The Task force would be chaired by junior health minister Will Quince and is likely to include David Hare, CEO at IHPN and NHS England’s Sir Jim Mackey, Health Service Journal reported.

In addition, in November it was announced that Bill Morgan will become the Prime Minister’s Health Advisor. A former advisor to Andrew Lansley, it will be interesting to see the impact of Mr Morgan on workforce policy particularly considering his recent paper, “NHS Staff Shortages: Why Do Politicians Struggle to give the NHS the staff it needs?”


Staff shortages and seeking solutions remains an ever-present theme in policy and practice.

The NHS Confederation in its analysis of the CQC State of Care Report highlights that the latter confirms that health and care staff “…are working under increasingly intolerable conditions leading to record vacancies, standards slipping nationally and patients not always receiving the care they need.”

The scale of vacancies remains over 100,000 in the NHS and 165,000 within social care. To add insult to injury, many clinicians are leaving the sector. The Nuffield Trust (“A Spotlight on Nurse Leaver Rates in the UK) stated that in the year to June 2022 over 40,000 NHS nurses in England left active service (equating to 1 in 9 of all NHS nurses).

The issue of staff shortages has been a perennial (if not permanent) issue. As part of the solution, it is instructive that there now appears to be policy consensus to properly consider projections of future staffing needs. The forthcoming NHS workforce plan would have to include regular updates of such statistics, NHS England CEO, Amanda Pritchard in November stated (speaking at the NHS Providers annual conference).

Indeed, in the Autumn Statement the Chancellor committed to not only publish a comprehensive workforce plan but one that included independently verified workforce forecasts.

The staff shortages and need for creative solutions to enable the workforce of the future were also prominent themes in the recent Voices of Care podcast series launched in November 2022 by Newcross Healthcare, featuring the likes of Sir David Nicholson, Sir Jim Mackey, Dr. Jane Townson, and Roisin Fallon Williams. The increased use of international recruitment, in the short term at least, one of the key solutions discussed by guests in the series.

Staffing – a ticking time bomb?

The wider issue of “retention” across global healthcare workforces is likely to mean that an accurate projection of workforce needs will become ever more important. The World Health Organisation – Health, and Care Workforce in Europe: Time to Act, highlighted that 40% of doctors are close to retirement age in one-third of the countries covered in the report added a stark warning: “…without immediate action, health and care workforce gaps in the European Region could spell disaster”, stated in September 2022 report.

The issue of global workforce well-being and mental health has also remained prominent as we head further into the winter.

The Commonwealth Fund published a report in November 2022 (“Stressed Out and Burned Out: The Global Primary Care Crisis”) confirming that most primary care doctors in the US and other high-income countries say they are burned out and stressed. Furthermore, according to the report, nearly 50% of older physicians in most of the countries say, they intend to leave the workforce soon.

Need for an honest vision

As we enter 2023, the transformation of the NHS landscape via ICS systems will be reviewed as the Government call for more balanced budgets encounters the reality of inexorable demand and continued workforce shortages.

This is also a time when the NHS is facing unprecedented falls in public satisfaction rates; the 2021 British Social Attitudes Survey, for example, found overall satisfaction with the NHS fell to 36% (a fall of 17% from 2020-21) the lowest satisfaction level recorded since 1997.

The promised NHS workforce plan will therefore have many expectations. One feels the wisdom of the call in October 2022 from the NHS Confederation (“A Renewed Vision for the NHS”) that, any discussion of the future of the NHS reflects the reality it faces above and that it “…. set out an honest vision for what the NHS should seek to achieve over the remainder of this decade and how it will be supported to do so amid the severe pressures local services are experiencing.”