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NHS Elective Recovery Plan: Having enough staff to meet demand

RCP president Andrew Goddard discusses the NHS Elective Recovery Plan.

Yesterday, the Delivery Plan for Tackling the COVID-19 Backlog of Elective Care was published with a clear recognition that ‘to succeed we have to grow and support our workforce’. While the number of patients waiting for care has risen to 6 million, we mustn’t forget that this figure was an eye-watering 4.4 million before the pandemic had even begun. We in the NHS have long known that staffing numbers have been the limiting factor in keeping up with ever growing patient need and demand. 

The NHS’s own estimates suggest we have 100,000 vacancies, including about 8,000 medical and 40,000 nursing professionals. The RCP has been reporting that almost half of advertised consultant vacancies go unfilled for years, with the rate of unfilled posts in 2020 at its highest level in almost a decade

Earlier this week, the Secretary of State for Health and Social Care said there are more doctors and nurses in the NHS than ever before. In the simplest terms, this is true, but must be put into context by explaining that there are also many more people in need of care. More people working in the NHS is always welcome, but what we really need are independent assessments of how many clinicians we need now and in future, based on projected patient demand

A ‘finished consultant episode’ is the time someone spends being cared for by a particular doctor. From 2008/9 to 2018/19, the number of episodes rose from just under 16.25 million to over 20.75 million, an increase of 28%. But the number involving people aged 65 and over rose by 50%, from almost 6 million to just under 9 million. The older people are, the more they need the NHS – and the number of people aged 70 and older grew by 25% between 2009 and 2019.  

Government is right in simple terms that we have 5,000 more doctors than last year: in October 2020 there were almost 131,000 doctors and in October 2021 almost 136,000. Of that 1.5% increase, most were consultants and SAS doctors – and we can’t be sure how many of them returned to the register solely to help with the pandemic. The number of trainees grew by just 144 - less than a quarter of one percent. 

The focus that the Recovery Plan gives us for the next three years is welcome, as is its recognition that staff are central to successful elective recovery. But we must remember that the pressure the service is currently under has become the norm. The plan will only be successful if it is implemented alongside recovery of urgent and emergency care, as the two are intimately entwined both with respect to workforce and estate. 

We will also need to build on it with a full plan for recruiting enough new staff to meet patient demand and the steps we’ll take to retain existing staff, including flexible and remote working for those returning to practice. Targets help patients to understand what they can expect from the health service – but they cannot be met without a supply of clinicians that is sufficient to meet the demand for care.