Wages for nurses and other NHS staff will need to become ‘more generous’ in order to grow staffing levels in line with the NHS Long Term Workforce Plan, new research has suggested.
A new paper from the Institute for Fiscal Studies (IFS) also warned that the long-awaited workforce plan had failed to consider the ‘medium-term’ cost implications for the NHS and would mean ‘difficult fiscal decisions’ at future government spending reviews.
If the NHS Long Term Workforce Plan, published in May, was to be fully implemented, the IFS estimates it would require the total NHS workforce increasing to include 9% of all workers in the UK and almost half (49%) of public sector workers.
The IFS argue that this significant workforce expansion would also lead to a change in staff mix, with roles such as nursing associates and advanced practitioners seeing the largest increases.
Based on the workforce plan’s ambitions, the IFS estimate that the number of advanced practitioners will need to increase 370% by 2036/37, while the number of nursing associates will increase 1,100% during the same time.
However, in order to meet these targets, the report’s authors claim a strategy will be needed that ‘is almost certain to require real-terms wage increases, and highly likely to require pay increases that match – or perhaps even exceed – economy-wide earnings growth’.
The report’s authors note that economy-wide nominal wages will grow 3.3% year on year, according to Office for Budget Responsibility forecasts, or 1.2% per year accounting for expected inflation.
Using this scenario as a guide, the IFS estimates that the total real-terms wage bill for the NHS will need to increase around 4.4% per year to meet the plan’s ambitions.
Responding to the research, Royal College of Nursing (RCN) chief executive and general secretary Pat Cullen, said: ‘These independent experts are laying down the challenge to the government and all parties over the significant boost needed – there are some difficult decisions and the service can ill-afford cans to be kicked further down the road.
‘It is vital that the government makes the NHS a good workplace that will attract the best people. And fair pay is a fundamental part of this – otherwise we’ll see nurses continue to leave in their droves.’
Ms Cullen added that the funding for this expansion ‘must not come at the expense of frontline services’.
Additionally, the report’s authors claim the £2.4bn additional funding for training new staff outlined in the workforce plan has not considered the ‘much larger’ medium-term implications of such a ‘rapid’ staffing expansion.
With the number of staff in the NHS pledged to expand by 60% by 2036/37 the cost of additional inputs, staff retention, and expansion of the NHS estate will create hard choices for future funding decisions, the report added.
Max Warner, research economist at IFS and an author of the research, said: ‘We estimate that the plan might imply average real-terms funding growth of around 3.6% per year for the NHS in England.
‘That is by no means outlandish by historical standards, but would nonetheless require difficult fiscal decisions in the current climate of sluggish growth.’
Mr Warner notes that the staffing growth called for by the plan will only meet demand for services if staff productivity increases by 1.5-2% each year.
‘The risk of having a workforce plan but no similarly high-profile plan for capital, technology or management is that higher spending on staffing squeezes out other vital inputs, and makes those productivity gains all but impossible to achieve,’ he added.
Responding to the IFS’s findings, an NHS spokesperson said that the NHS Long Term Workforce Plan provides a ‘once in a generation opportunity to put staffing on sustainable footing’.
‘The number of people aged over 85 is estimated to grow 55% by 2037, as part of a continuing trend of population change which outstrips comparable countries, and without the action set out in the plan the vacancy gap could grow to up to 360,000 by 2037,’ the spokesperson added.
Likewise, a spokesperson for the Department of Health and Social Care, said the long-term plan was ‘both a plan for investment and a plan for reform’.
‘We are backing the plan with over £2.4 billion over the next five years. Decisions about spending review periods beyond this will be announced in the usual way, but this demonstrates our commitment to delivering the whole plan,’ they added.