An ambitious 10-year plan for the NHS unveiled by Theresa May relies upon recruiting thousands of nurses and doctors a year from overseas – a practice widely criticised for draining developing countries’ health services of vital qualified staff.
The prime minister revealed details of the blueprint, which details how the extra £20bn a year she announced last summer will deliver improvements in patient care across the beleaguered service, which has had to cope with years of real-terms cuts under austerity.
It includes targets to diagnose three-quarters of cancer cases early enough for successful treatment, more emergency patients to be treated and sent home on the same day, and a right for every patient to have online GP appointments via apps by 2024, among other initiatives.
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However, to fulfil these commitments, it makes clear a “significant uplift” in international recruitment is needed right away to fill the more than 100,000 vacancies that currently exist.
“This will mean a step change in the recruitment of international nurses to work in the NHS and we expect that over the next five years this will increase nurse supplies by several thousand each year,” the plan states.
The NHS is already recruiting thousands of GPs from overseas and the plan says it will expand foreign exchange schemes for doctors from developing countries and elsewhere to spend time in the NHS, as well as making it easier for trusts to recruit.
As well as attracting criticism for causing a “brain drain” in the countries from which staff are recruited, the strategy flies in the face of a government pledge to become “self sufficient” in staff made just two years ago.
The health service’s vision to transform out-of-hospital care, and specialities like cancer and maternity services, does include some measures to boost homegrown staff over the next decade.
A new online nursing degree will be launched as early as next year which will cost “substantially less” than the current £9,250 a year nursing degree in a bid to attract those put off after the government scrapped NHS bursaries.
However, nursing leaders warned the new recruitment plans could harm health services in developing countries.
“Overseas recruitment might be a short-term solution, but it will not be enough to solve the burgeoning workforce crisis that’s jeopardising safe patient care in England,” Dame Donna Kinnair, acting chief executive at the Royal College of Nursing, told The Independent.
“We need immediate investment in nurse education to grow the domestic workforce – it is neither sustainable nor ethical long term to rely on other countries to provide our nurses.”
She added that the RCN welcomes the ambitions of the plan, but is concerned an online degree is being seen as a “magic bullet” to the crisis while there was no money for current staff to specialise into new roles.
Among the ambitions for the next decade included in the plan are:
- Targets to diagnose 75 per cent of cancer cases early, before they have spread around the body
- Genetic testing for every child with cancer to help personalise their treatment
- Provisions to see the NHS take over key public health roles like tackling obesity, drinking and smoking
- New emergency treatment targets for mental health, including a 24-hour helpline available through NHS 111
- Asking the government to tear up reforms implemented by Conservative health secretary Andrew Lansley which force NHS providers to compete with private groups for contracts
Health chiefs argued that without a fix for the workforce crisis, these commitments – and an accompanying pledge to save 500,000 lives with prevention and better care – would be “fatally undermined”.
NHS figures show 111,000 full-time vacancies in the NHS in England, 41,000 of them nurses, and at the weekend health and social care secretary Matt Hancock was unable to explain how these would be filled.
Brexit has added to this crisis. Over the summer the prime minister belatedly committed to allowing EU citizens resident before 29 March to stay and NHS staff were given a two-week window to apply for settled status in December, before general applications opened.
This came after two years of “botched” negotiations, which have resulted in 3,000 fewer nurses from the EEA working in the NHS in 2018, and a collapse of new applicants.
While doctors and nurses are recognised as shortage roles and exempted from visa caps, there is still no clarity over how the proposed “low skilled” visa threshold on those earning less than £30,000 will affect EU applicants after 29 March.
The plan says part-time medical degrees and a shift to train more generalists and GPs will help the NHS attract more staff equipped to manage rising numbers of elderly patients with more than one condition. This is in addition to changes to make a 25 per cent expansion in the numbers of nursing and medical training places that the government has already announced.
However, given the length of time it takes to train new staff – three years for nurses and five for doctors – overseas recruits will undoubtedly be needed if the gaps are to be filled.
In addition to filling existing vacancies, more staff will need to be brought in if the NHS is to care for more patients at home and help them avoid A&E, as well as expanding neglected areas like mental health, experts say.
However, the detailed workforce plan which was due to be published alongside the long-term vision has now been delayed until later in 2019.
Reforms of flagship waiting time targets, which could see patients waiting longer at A&E for less urgent issues, have also been removed and social care reforms pledged in 2017 have still not materialised.
At a speech today at Alder Hey Hospital in Liverpool, NHS England chief executive Simon Stevens said the plan included immediate and longer-term ambitions.
“Some of the improvements that patients will see will happen quite quickly – new genetic tests for children with cancer this year, new options to see your GP online, radical reforms to avoid 30 million outpatient visits, guaranteed support for older people at home in the community,” he said.
“Some of these changes are going to take a bit longer,” he added, referring to goals to halve maternity deaths and diagnose more cancers at an early stage.
However Chris Hopson, chief executive of NHS Providers, which represents health service trusts, said he was worried by the lack of detail.
“It’s a major concern that we will have to wait longer to get the comprehensive plan that is needed here,” he said.
Liberal Democrat former health minister Norman Lamb also expressed scepticism that the plan would deliver everything it was advertising.
”Delivering this ambitious plan is likely to be fatally undermined by insufficient resources, a staffing crisis and a failure to address the disastrous situation with social care,” he said.