The healthmatters blog; commentary, observation and review
HIV charities from Liverpool (Sahir Trust) to Leicestershire (LASS) to London have come together with health professional bodies, British Association for Sexual Health and HIV (BASHH), and British HIV Association to launch a new national campaign opposing cuts to HIV services across the country -‘Support people with HIV: Stop the cuts’.
Increasing numbers of local authorities are pulling funding from HIV support services.
The campaign has written to Secretary of State for Health, Rt Hon Jeremy Hunt. calling for a meeting to discuss the impact of these cuts, demand effective commissioning, adequate funding, and access to support services for all people living with HIV.
HIV services in both Berkshire and Oxfordshire, run by Thames Valley Support and Terrence Higgins Trust respectively, have been cut by over £100,000 between them. In Berkshire this equates to a loss of a third of funding, and will directly affect 300 people living with HIV in both Slough and Bracknell.
In David Cameron’s back yard, Oxfordshire County Council has cut Terrence Higgins Trust’s £50,000 funding, which is forcing the closure of its local centre. The reality is that there are will be no HIV Prevention and Support service in the whole county after April 2016, with almost 500 people left with no alternative support service.
In Portsmouth the HIV support service, provided by Positive Action, has been cut by approximately £26,000 by Portsmouth City Council. Its Hampshire service has been granted an interim support payment of £30,000, less than half of the amount it historically received.
In Bexley and Bromley, equality and diversity charity, METRO is facing cuts to HIV support services of over £80,000.
Public Heath England’s national HIV figures show that in 2014 alone over 6,000 people were diagnosed with HIV, while People Living with HIV Stigma Index UK– found that stigma had prevented 15 per cent of people surveyed from accessing their GP in the last year, and 66 per cent had avoided dental care.
14 per cent had received negative comments from healthcare workers. Despite the obvious roles specialist HIV support services play in combatting this they are being reduced to almost ineffective levels, or cut completely, in a short term cash save measure.
Alex Sparrowhawk, Membership and Involvement Officer Terrence Higgins Trust said:
“As a person living with HIV, I can prove to Jeremy Hunt that HIV support services are vital to dealing with your diagnosis and managing this health condition. The national campaign is about sounding the alarm to policy makers, councils, and the public – these essential services are under serious threat and we need your help.
“At a time when rates of HIV are increasing, stigma is as apparent as ever, we are seeing the start of a disturbing trend of local authorities across the country scrapping HIV services.
Yusef Azad, Director of Strategy National Aids Trust:
“HIV remains a stigmatised and misunderstood condition. It’s not the same as other health issues where people can rely of support and sympathy from friends and colleagues.
“HIV support services can be the only place where people are open about their status, the only places they can find advice and support, the only place they can talk to other people with HIV.
“They are an essential component of the long-term care of people with HIV. To remove them would leave a lot of vulnerable people stranded.”
Dr Greg Ussher, METRO Charity CEO, said:
“People living with HIV can be some of the most vulnerable members of our communities.
“Proposed cuts of up to 100 per cent to HIV support services will decimate vital provision for people that cannot speak out against their local authority’s plans for fear of the stigma publicly disclosing their HIV status might bring.”
The Treasury last year announced it was cutting public health budgets in-year by £200 million with reductions in the funding for public health set to continue this year. The feasibility of the Chancellor’s plan to allow local authorities to income generate to fund social care services will be tested in poorer areas of the country – those areas that also see the highest rates of HIV.
‘Support people with HIV: Stop the cuts’ is also appealing to members of the public to take an e-action to show their support – write to their local council leader and ask what the council is doing to support local people living with HIV.
New case study highlights need to rebalance prevention vs. treatment strategies
A new case study entitled Confronting Obesity in the UK: The need for greater coherence has been published today by the Economist Intelligence Unit (EIU), with experts calling for a coherent strategy to tackle obesity1.
The study explores the UK’s approach to obesity management and interviews experts, highlighting that the fragmentation of the NHS’s obesity treatment may be negatively impacting patients1. Today’s disjointed system is associated with a lack of investment in treatment services1. According to the study, over 94% of the UK’s obesity management budget is spent on prevention strategies1, leaving just 6% of the budget to treat the majority of the population who are already overweight or obese1. The case study reveals that the continued structural reform of the UK healthcare system has led to confusion over accountability, creating huge differences in access to treatment1. Nearly half of the obesity services across the UK do not have access to higher levels of treatment1.
“The UK has excellent evidence based guidelines from National Institute of Health and Care Excellence detailing strategies for the prevention and management of obesity in children and adults. We now need to ensure that these are implemented” said Professor Rachel Batterham, Head of the UCLH Bariatric Centre for Weight Management and Metabolic Surgery and the UCL Centre for Obesity Research. “We know that for some patients, especially those with type 2 diabetes, that bariatric surgery leads to unrivalled health benefits and cost-saving for the NHS. Unfortunately, less than 1% of the patients who could benefit from this surgery currently receive surgery. This represents a major missed opportunity in terms of improving health and economic savings”.
Obesity is a rising concern in the UK with 62% of the population now overweight or obese2. Yet, according to the study, the shortage of obesity services is negatively impacting patients; as people with severe obesity are forced to wait longer to be assessed, have their associated medical problems treated and receive weight-loss advice1. The study states that better access to the UK’s tiered obesity management programme could help the country to treat those patients for whom preventative measures are too late or ineffective1.
Obesity is a major public health concern across Europe and the UK is no exception. Due to its association with serious chronic diseases such as type 2 diabetes, cardiovascular disease and some cancers3, obesity places a huge burden on both the UK’s health and economy. The study highlights that the one quarter of the population that is obese cost the NHS £6bn–8bn alone in 20154. By 2025 the NHS cost of all weight related disease is predicted to reach £21.5 billion per year4, over 20% of the current NHS budget.
The study, which was commissioned by the Johnson and Johnson subsidiary, Ethicon, follows the release of an EIU report entitled, Confronting Obesity in Europe: Taking action to change the default setting. The report highlights the need for European policymakers to address the impending health crisis and stresses that national approaches to obesity need to take into account two distinct populations: those of a healthy weight and those who are obese5.
“The study suggests that a more holistic and cost effective strategy is needed to tackle obesity, and we believe that bariatric surgery could play an important role here” said Silvia De Dominicis, Vice President of Ethicon EMEA. “At Ethicon, we pride ourselves on value-based healthcare and we’re committed to supporting patients in the UK. We hope that this case study helps to open up an urgently needed discussion with policymakers and shape the future of the obesity strategies. It’s time to act.”
A full copy of the EIU case study, is available here:
23rd February, 2016:
The financial situation of the NHS is getting worse. The latest quarterly monitoring report from the King’s Fund shows that NHS trusts are forecasting an end-of-year net deficit of around £2.3 billion. The estimate, based on survey responses from 83 trusts, comes as NHS national bodies are imposing stringent financial controls in an effort to reduce the deficit to £1.8 billion by the end of the financial year. There is a risk that the Department of Health will breach parliamentary protocol by overspending its budget.
Key findings from this quarter’s survey include:
- More than two thirds of trusts (67 per cent) and 9 out of 10 (89 per cent) acute hospitals are forecasting a deficit at the end of 2015/16
- More than half of trusts (53 per cent) are concerned that they will not be able to meet nationally-imposed caps on their agency staff spending, while a fifth (22 per cent) say the caps may impact on their ability to recruit the staff they need to provide safe care
- Nearly two-thirds (64 per cent) of trusts are reliant on extra financial support from the Department of Health or drawing down their reserves
- More than half of trust finance directors (53 per cent) are concerned about meeting productivity targets – the highest level of concern at this time of year since our survey began
- CCGs are in a better financial position, although nearly one-fifth (18 per cent) are forecasting a deficit and nearly a third (29 per cent) are concerned about meeting their productivity targets.
Responding to the King’s Fund quarterly report, Paul Healy, Senior Policy Advisor on Economics and Regulation, NHS Confederation said: “NHS leaders know the status quo isn’t sustainable and are working hard to join up across the health and care system, so as to be more efficient, deliver better value and offer a more individual service for the public. This survey shows up many of the challenges facing the service at this particular point in time and highlights a broader signal from leaders on the need to overcome these through a process of transformation”.
“A new approach to value needs to be stitched into the fabric of the health and care system, which moves away from a technical focus on reducing the costs of current services to a coordinated attempt to get more out of resources within a defined budget. What this means in practical terms is less reliance on cutting the prices paid to hospitals, which has impacted on the bottom line of providers, and more emphasis on transformation across the system through new models of care and effective commissioning”.
“While this is an enormous challenge, it is achievable if national bodies keep working to support strong local leadership and enable them to build on the significant savings delivered in the last five years to ensure the NHS is sustainable and continues to deliver good value for taxpayer funding.”
In January Monitor and the NHS Trust Development Authority issued a financial “control total” to every trust in England for 2016-17, which they had to accept to secure their share of the £1.8bn “sustainability and transformation fund”. This fund was promised as immediate cash flow by after Simon Stevens’ put pressure on the government. According to the HSJ two-thirds accepted the deal in their draft plans for the coming financial year, many only with conditions attached.
A common reason for not accepting the target was that the control totals were based on trusts’ financial positions at the end of October, so trusts which had experienced deterioration after October had not seen this reflected in their offer. Another was that one-off income had not been discounted, so trusts that received large amounts of non-recurrent funding in 2015-16 effectively had a tougher target next year.
One anonymous respondent to the HSJ story said: “some Trusts have accepted figures they stand absolutely no chance of achieving, solely because of the perceived consequences of not accepting. This is against a backdrop of declining financial performance (suggesting almost all of them are going the wrong way in reality, declining target attainment, rapidly rising mortality (causal effect not yet established) and the single biggest decline in public satisfaction. On top of that, the collapse in primary care, summer of junior discontent and the consultant contract ‘negotiations’ still to come…”
Satisfaction with the NHS has increased, with 65% saying they are satisfied, up from 60% in 2013. This increase in satisfaction was greatest – no less than 11 percentage points – among Labour supporters.
Satisfaction with A&E services has also increased, from 53% to 58%. On the other hand, satisfaction with GP services has declined from 77% in 2010 to 71% in 2014, though this is still the most popular of the NHS services.
A funding crisis?
The public believe, almost universally (92%), that the NHS is facing a funding problem. But how should this problem be addressed?
A majority (58%) say they would not be happy for the government to curb spending in other areas to maintain the current NHS service. Support for increasing taxes to spend more on health, education and social benefits still remains relatively low (37%). Only around a quarter back charging for services such as a GP appointment or hospital meals.
Alternatives to universal NHS care?
Most people are opposed to the idea of a system only for those on lower incomes, while only a minority would prefer to be treated by a private service.
Nearly 7 in 10 (68%) oppose the idea that the NHS should be available only to those on lower incomes. However, 45% think that the NHS will not still be a free universal service in ten years’ time. More (39%) say they would prefer to be treated by a NHS service than a private one (16%) though 43% have no preference.
This is an important set of results for the health and care sector and shows that the public continues to value the NHS very highly. Public perception on NHS funding, staffing and wait times are however driving lower satisfaction. What the public and health service now needs is a strong clear narrative from politicians of all parties on the future of the NHS.
The most important set of results are those on social care. We have said consistently that the NHS and social care system cannot be seen in isolation from each other. A further fall in satisfaction of 5 percentage points to just 26 per cent is deeply concerning. This reflects the pressure social care services are facing and these must be addressed if we are to sustain effective care for vulnerable people. Current resourcing levels in social care will, we believe, be insufficient in the short term to make this a reality.
Rob Webster, Chief Executive, NHS Confederation
Health systems in the United Kingdom have, for many years, made the quality of care a highly visible priority, internationally pioneering many tools and policies to assure and improve the quality of care. A key challenge, however, is to understand why, despite being a global leader in quality monitoring and improvement, the United Kingdom does not consistently demonstrate strong performance on international benchmarks of quality.
This report reviews the quality of health care in the England, Scotland, Wales and Northern Ireland, seeking to highlight best practices, and provides a series of targeted assessments and recommendations for further quality gains in health care. To secure continued quality gains, the four health systems will need to balance top-down approaches to quality management and bottom-up approaches to quality improvement; publish more quality and outcomes data disaggregated by country; and, establish a forum where the key officials and clinical leaders from the four health systems responsible for quality of care can meet on a regular basis to learn from each other’s innovations.
This report rightly acknowledges that our members across the UK have a clear and consistent commitment to improving the quality of care for patients. While all four nations share this common goal, the different systems in each country have been designed to best suit the needs and challenges of their own populations.
The OECD’s investigations have confirmed that it is not possible to look across the health systems in Northern Ireland, Wales, England and Scotland and identify one system to be better than another.
Instead what comes out strongly for England in particular is how our members need support from central government and regulators to drive up standards across the health service but that this must be balanced with empowering local leaders, and staff to drive and lead change for the benefit of patients.
Our members should be enabled to make radical change driven by the needs of local people. By delivering proactive, joined up care closer to people’s homes, we can help people to stay well, and allow hospitals to focus on treating the people that need to be there.”
Dr Johnny Marshall, Director of Policy, NHS Confederation
It had to come sooner or later, and it has come sooner. Christopher Smallwood, chair of St. George’s University Hospitals NHS Foundation Trust, writing in the Guardian on Monday February 8th, claimed that the “free at the point of use” mantra has had its day. It is time to allow insurance to play a part in funding the NHS, he said. This is no dodgy dossier from a right-wing think-tank, picked up briefly by the Tory press. It is a serious view from a senior NHS figure, published in a centre-left newspaper and included in a Guardian-sponsored public debate. And it dovetails with the call made by Alan Milburn, Stephen Dorrell and Norman Lamb for a cross-party commission to examine how a national health and care service should be organised and funded. A new common sense is struggling into being, in which the continuation of the National Health Service as we use it depends on a transformation in the way we pay for it.
Christopher Smallwood’s argument is that the junior doctors’ dispute is driven by the funding shortfall in the hospital sector, engineered by the present government. No argument there. In his view this shortfall can only be put right by a substantial and sustained increase in taxation, or by moving to a European-style comprehensive insurance system. He favours the latter as a way of mobilising money that citizens are seemingly reluctant to pay as tax but are presumably willing to pay out for individual or family gain.
The shift to an insurance based funding mechanism for health services has been an ambition amongst Conservatives since the Carlton Club conference of 1983, which saw an expanded National Insurance as the likely insurance vehicle. The conference anticipated a slow change, preceded by full costing of the health service and the creation of an internal market – a thirty year strategy of attrition, in other words.
The Carlton Club scenario now looks like this. The English NHS is squeezed financially and services begin to fail. The government does some fire-fighting to prevent hospitals from collapsing, but will not relent on the overall budget. Conflicts between NHS management and professionals escalate, and working relationships are damaged profoundly. A series of junior doctor strikes are followed by similar actions by consultants, also aggrieved by contract changes. General practitioners begin a work to rule, launch a fierce attack on the Care Quality Commission, and threaten mass resignation. Recruitment of nurses is harmed by daunting student fees, and retention of nurses worsens, whilst migration controls limit recruitment from outside England. Other professional bodies express their concern about the deterioration of services, waiting lists and times grow, and the right-wing press exaggerates where it does not distort. All parties proclaim their blamelessness and project all faults onto their opponents. As the 2020 general election approaches the new conservative leader, listening to worried leading figures from the medical Royal Colleges, opens the debate about “ditching ideology” (Smallwood’s words) and rebuilding the NHS around an insurance base, in order to save it.
Interestingly, the photograph accompanying Christopher Smallwood’s article shows masked junior doctors with a home-made placard saying “Patients before Politics”. The slogan ‘Patients before Politics’ has form. It was the headline of a document, published in the BMJ on April 3rd 1976, which stated the BMA’s absolute opposition to the then Labour government’s plan to eliminate private practice from the NHS, and to licence private hospitals. The slogan became the rallying cry of the Campaign for Independence in Medicine, a BMA front organisation. The 1976 BMA statement ended: “The Government’s proposals will take away a freedom enjoyed by patients and by doctors, and will damage the National Health Service, already in a parlous state” (my emphasis).
“Already in a parlous state” gives it away, I think. NHS politics is manipulative and populist when it is not scheming and bureaucratic. The Right and the Left share a common political culture. The NHS is always gripped by crisis and in need of saving (or reforming), freedoms are constantly being endangered, safety is repeatedly compromised, shrouds are waved endlessly, catastrophism mushrooms. In another piece of BMA-inspired common sense, what is good for the doctor is good for the patient, allowing any professional grievance to be pursued as if it were in the public interest. In 1976 “Patients before politics” was a warning to the state not to mess with the medical profession, and the message is the same today.
The message has been heard, but the Carlton Club strategy is paying off and Conservative politicians are prepared to take risks. All that is needed is for the professions to believe that the present funding system cannot bring them more money and resources. The move to an insurance-based system will occur when the medical profession gives up on a tax-based NHS. The public – which trusts doctors more than politicians – will follow.
On the Right, politicians watch and wait calmly for their moment, quietly anticipating the end of ideology. Their focus is shifting. Christopher Smallwood’s article prompts them to think of how best to manage the demise of the old NHS and assist in the birth of the new. On the Left, Labour and the trades unions are mesmerised by the ebb and flow of contracting out, and are looking in the opposite direction. Will they turn in time?
Responding to the cancer waiting times statistics for December 2015 released today by NHS England[i], Dr Fran Woodard, Director of Policy and Impact at Macmillan Cancer Support, says:
“It is encouraging to see that cancer waiting times targets, which outline the time it should take for people with cancer to begin treatment following an urgent GP referral, have been met in December 2015, for the first time in 20 months. But this is not yet a cause for celebration. Analysis by Macmillan Cancer Support shows that more than 20,000[ii] cancer patients were hit by distressing delays during 2015.
“Keeping a person with cancer waiting for access to life saving treatment can leave them feeling anxious and alone at an extremely difficult time. It’s simply not right to leave people in the lurch like this.
“While we know that healthcare professionals are working hard to support people when they have been diagnosed with cancer, there is clearly a problem in people starting their treatment swiftly. It’s possible that the NHS is struggling to assess people with complex needs, such as the estimated 70%[iii] of people with cancer who also have another condition like heart disease or mental health problems; this can result in delays.
“While today’s figures are an improvement on previous months, targets were only just met – with more than 1 in 3 (36%) hospital trusts still missing the 62-day target[iv] and a quarter (25%) of people with lung cancer having to wait more than two months to start treatment. We need to see greater improvements consistently over the following months if the NHS has any hope of handling increasing pressures and giving people affected by cancer the best possible support.”
 NHS England. Provider based cancer waiting times. 11 February 2016. https://www.england.nhs.uk/statistics/provider-based-cancer-waiting-times-for-december-2015/
iiA wait of more than 62 days to begin their first definitive treatment following an urgent referral for suspected cancer from their GP.
iii An estimated 70% of people with cancer are living with at least one other LTC, compared to 55% of the general population of a similar age profile. Research undertaken by Monitor Deloitte, commissioned by Macmillan Cancer Support.
iv Based on provider organisations who gave first treatment to at least five people with cancer during December 2015.
Sir Michael Marmot in conversation with Professors Richard Wilkinson & Kate Pickett
Introduced by Christina McAnea (UNISON, Head of Health)
Tuesday 1 March, 6.15pm – 8pm
UNISON Centre, 130 Euston Road, London, NW1 2AY
In every country in the world, the higher you are on the social scale, the longer and healthier your life will be. In Britain, the average person would have eight extra years of healthy life if they had the same opportunities as the richest in our society. This social gradient is not inevitable, so what can governments do to address these dramatic and unjust health inequalities?
At this Equality Trust event, hosted by UNISON, Sir Michael Marmot will discuss the evidence from his latest book, The Health Gap: The Challenge of an Unequal World, with Spirit Level authors Professors Kate Pickett and Richard Wilkinson. Together they will explore the political and policy implications of the research, and take questions from the audience.
Please arrive to register at 6.15, for a prompt 6.30 start. The event is free, but Michael Marmot’s book will be on sale so do bring cash if you are considering a purchase. Please note this is not a catered event.
Getting to the venue
The UNISON Centre is situated on the north side of Euston Road between Euston and King’s Cross station. Euston tube station is on the Northern and Victoria lines, and King’s Cross station is on the Victoria, Piccadilly, Northern (City branch), Circle, Hammersmith & City and Metropolitan lines. Click here to check London travel, including bus routes. The event will be accessible, held on the ground floor.
The NHS has had an unhappy history in its relationships with information technologies. Undeterred, Health secretary Jeremy Hunt has announced a £4.2 billion investment in IT in the National Health Service (NHS), as part of the relaunched ‘digital transformation plan’.<
Examples of planned investments include:
- £1.8 billion to create a paper-free NHS and remove outdated technology like fax machines
- £1 billion on cyber security and data consent
- At least 10% of patients accessing GP services online and through apps by March 2017
Google, Apple and Microsoft will team up with the NHS to ensure the apps are fully supported across mobile platforms.
There is a sense that the government is pushing on an open door with its IT plans. A new Pricewaterhouse Cooper study of the UK’s healthcare market has found that almost four in 10 people would be willing to receive advice from their GP through their smartphones and tablets, while six in 10 would be happy to see a GP at a retail store during their shopping trips. Two thousand UK consumers, patients and clinicians were polled as part of PwC’s “Capture the Growth” study, which found that increasingly IT- savvy consumers are willing to have their care delivered in non-traditional settings, from non-traditional players.
The healthcare apps and wearables sectors are expected to be worth £460m and £375m respectively by 2020 ( vs £100m and £125m in 2015), PwC predicts. The wellness and fitness market, which includes gym memberships, studios, nutrition and sports drinks, alternative medicines, sports equipment, wearables and apps was estimated to be worth almost £20bn in 2015 and is predicted to grow to almost £23bn by 2020. Potential beneficiaries in the IT industry are enthusiastic but also cautious.
Gordon Morrison, Director of Government Relations at Intel Security said: “This investment sends a clear signal that the government is serious about transforming the NHS and making it fit for the digital age. However, the journey towards digitised records and services brings with it challenges around cyber security, privacy and protection of patient data.
That’s why it’s vital that the digital NHS plan is underpinned with a dedicated cyber strategy that can enable secure transformation that protects data from outsider threats. This approach will mean doctors, nurses and patients can enjoy world class digital health services and operate with genuine confidence in the increasingly connected online world.”
John Smith, principal solution architect at Veracode, added: “These proposals for a more connected, app-enabled NHS will certainly offer patients and health professionals more efficient digital services which are long overdue. But whilst patients will benefit from mobile access to records, data and online bookings, the sharp rise in healthcare apps could cause headaches for the government. That’s why it’s vital that all applications which access confidential data are fully tested and protected from vulnerabilities which could be an easy target for cyber criminals wishing to damage the NHS or profit from the wealth of sensitive data it holds.
Veracode’s research has shown that the healthcare industry has a poor track record in terms of creating secure code – with 69% of apps tested failing to meet basic security standards, and only 43% of identified flaws being fixed. Healthcare apps were also found to have a particularly high prevalence of Cryptographic Flaws which is rather worrying given that Encryption is one of the key technologies needed to protect sensitive data.”
Ensuring there are enough clinical staff with the right skills to meet the demand for high-quality, safe healthcare is essential to the operation of the NHS. However, the current arrangements for managing the supply of clinical staff are fragmented and do not represent value for money, according to a report from the National Audit Office published on February 5th. www.nao.org.uk/report/managing-the-supply-of-nhs-clinical-staff-in-england/
The arrangements for managing the supply of clinical staff involve the Department of Health, various arm’s-length bodies and healthcare commissioners and providers. Available data on vacancies are poor but, in 2014, there was a reported overall staffing shortfall of around 6% which equates to a gap of around 50,000 clinical staff. The extent of the shortfall varied between different staff groups and regions.
The creation of Health Education England means that, for the first time, there is a national body specifically tasked with making strategic decisions about planning the future workforce, working collaboratively with local healthcare providers. The national workforce plan is developed from plans prepared by local providers, which means it should be based on a detailed understanding of local circumstances. According to the NAO, however, the process for developing the national long-term workforce plan could be made more robust and Health Education England should be more proactive in addressing the variations in workforce pressures in different parts of the country.
Healthcare providers are responsible for employing clinical staff to deliver healthcare. Hospital trusts’ use of temporary staff has increased significantly, putting pressure on their financial position, and the NAO concludes that there is room for trusts to reduce spending on temporary staff. Temporary staffing gives trusts the flexibility to address short-term workforce pressures, but high levels of temporary staff are an inefficient use of resources. Spending on agency staff increased from £2.2 billion in 2009-10 to £3.3 billion in 2014-15. The Secretary of State for Health announced a cap in October 2015 on how much trusts can pay per shift to help control spending on agency staff; however, the NAO notes that these measures are unlikely to address fully the underlying causes of the increased demand for temporary staff.
At the same time as the use of temporary staff has increased, the NHS has made much less use of overseas recruitment and return-to-practice initiatives to address staffing shortfalls. The number of overseas nurses has fallen, particularly from outside the European Economic Area (EEA), where the number of entrants decreased from 11,359 in 2004-05 to just 699 in 2014-15. Some of the decline may have been due to tighter immigration rules for nurses between 2009 and 2015. The decrease was partly offset by a large rise in recruits from within the EEA. The NAO found that a more coordinated and proactive approach to managing the supply of staff could result in efficiencies for the NHS as a whole.
In response to the NAO report on managing clinical workforce supply, Danny Mortimer, Chief Executive, NHS Employers said: “The NAO report is a helpful analysis of the challenges that employers across the country are facing. Attracting and retaining the best staff is important for the NHS, and we need to get it right to build a sustainable workforce. Work is already happening with our recent survey showing that over 99 per cent of providers recognised the need to invest and retain their nursing workforce. We need to move away from a model of short-term fixes through agency staff to investing in attracting the best talent to work in the NHS – both from within and outside of the EU. Many NHS Trusts are currently facing a stifling shortage of nurses so we continue to lobby for nurses to be added to the shortage occupation list so that NHS Trusts can ensure safe staffing for patients.”