Wrangle over who pays for NHS workforce plans risks undermining care, Treasury told

‘If the assumption is that somehow individual employers can absorb these costs then that is just fantasy’

The government has still not said how it will pay for plans to boost the NHS workforce (PA)

A tussle between the Treasury, NHS England and the health department over how to pay for the government’s promises to increase the NHS workforce has sparked fears hospitals might be landed with the bill.

The lack of clarity over who is going to pay for plans to expand the numbers of nurses, doctors and other staff in the NHS has left at least £1.7 billion of funding in doubt.

In his budget at the end of October, Chancellor Rishi Sunak failed to outline any spending plans for Health Education England, the £5 billion body that trains nurses, doctors and clinical staff to work in the NHS.

Now NHS bosses have written to the Treasury warning that hospitals must not be left to shoulder the cost if money isn’t found.

Danny Mortimer, chief executive of NHS Employers and who speaks for hospitals on workforce issues, told The Independent: “The budget was oblique. It swerved the question of what the funding settlement was and we can't afford to do that.

“We have to hope that no one would consider reducing the budget for Health Education England. Because what they do is central to our ability to recruit and retain people over this next three to five years. To interfere with those budgets either passes cost on to trusts or frankly makes the NHS a less attractive place to work.”

He warned: “If the assumption is that somehow individual employers can absorb these costs then that is just fantasy. As we emerge from the pandemic and the priority is addressing the backlog they don't have that sort of headroom.”

Health Education England was given a one-off 14 per cent increase in spending in 2021-22 with £570 million to pay for government projects such as delivering 50,000 extra nurses, increases in GP numbers, as well as boosting staffing levels in other areas such as physiotherapy and mental health.

But there has been no agreement yet as to where the extra funding for HEE, which could be at least £1.7 billion, will come from. The Treasury has given NHS England an extra £6 billion and real-terms increases in spending of 3.8 per cent a year to 2025.

In a letter to the Chancellor, seen by The Independent, Mr Mortimer said this was an area of “unfinished business” adding there was “mounting concern amongst NHS leaders” about what he said was a “deliberately obtuse” budget for NHS workforce plans.

He added that while the government’s plans to boost medical school places, expanding degree nursing apprenticeships and recruiting more nurses was welcome it “now seems increasingly likely that the government is unwilling to properly pay for these steps and is expecting NHS budgets to support these significant and extensive interventions. This will lead to intolerable choices.”

“If we are forced to absorb the additional expenditure required for training and education budgets to help the NHS meet the government’s manifesto commitments on staffing levels, then something will have to give elsewhere and that inevitably means patient care will be affected.”

Health committee chair Jeremy Hunt put health secretary Sajid Javid under significant pressure over workforce planning during an evidence session this week.

Mr Hunt said on Wednesday that he was “still not convinced there is any kind of workforce plan to go alongside the big ambitions to reduce the backlog.”

He said there was no way to know if the NHS had the right numbers of staff if the government would not publish its internal projections or settle the question of funding for Health Education England.

Mr Hunt said his sense was that the Treasury was “blocking” the health secretary from making significant changes and he warned: “I remain convinced that staffing shortfalls are the biggest risk to patient safety at the moment.”

Mr Javid said an NHS workforce plan would be published in the spring and he was willing to consider publishing projections regularly.

Mr Hunt has indicated he will table an amendment to the Health and Care Bill going through Parliament to try and force that to be put in place.

Calum Pallister, director of finance at Health Education England said only that HEE’s budget was “still being discussed” but that the Department of Health and Social Care had indicated it grow year on year.

A spokesperson for the DHSC said: “The government is providing hundreds of millions of pounds in additional funding over the spending review period.

“This investment will contribute towards the training of some of the biggest undergraduate intakes of medical students and nurses, continuing to support a strong workforce and delivering the government’s existing commitments for 50,000 more nurses and 50 million more primary care appointments.”