RISHI SUNAK says it is “one of the most significant things” he will do as Britain’s prime minister. On June 30th his government published a long-term workforce plan for the National Health Service (NHS) in England. This is the first of its kind in the service’s 75-year history. It commits the government to some bold targets: doubling the number of places for students who learn medicine, before 2032; almost doubling the number of training places for nurses. It rightly focuses on the need to retain existing staff, and calls for reform of how staff train and work. It is welcome that an organisation with 1.4m staff, Europe’s biggest employer, at last has a plan. But when the NHS faces the biggest workforce crisis in its history, it is also not enough.

Staff shortages have plagued the NHS since it first opened its doors in 1948 (the anniversary falls on July 5th). Fixing the problems behind that is not easy, quick or cheap. For politicians preoccupied by five-year electoral cycles it is hard to make plans that bring benefits over decades. Thus workforce planning has routinely focused on meeting short-term needs, often in a haphazard way. Even when the Department of Health and Social Care is able to set priorities for what to focus on, it is up to the Treasury to decide whether—and how generously—to provide funds to achieve it.

The need to act, however, had become urgent. Already the NHS has a shortfall of 112,000 workers—which places enormous strain on existing, overworked nurses, doctors and others, and in turn pushes more of them to leave. Rates of staff sickness are historically high. The service is also enduring more strikes than at any time in its history—this week consultants became the latest to vote for industrial action, and will walk out in July. On June 30th radiographers also said that they would strike for higher pay. Shortages (plus the effects of covid-19, and more) are also a reason why waiting lists for treatment have grown enormous: patients are waiting for 7.4m procedures to be carried out, the biggest backlog ever.

The plan projects the staff shortfall will only grow worse in the next decade or so. By 2036-37, it suggests, the NHS will be short of between 260,000 and 360,000 staff. That’s because Britain’s population is all but certain to become bigger, older, fatter and sicker in the coming years.

What can be done about the shortfall? The NHS increasingly relies on agency workers, known as locum staff. But this is not sustainable. In 2021-22 it spent nearly £3bn ($4bn) on this alone. A more sustainable route is to recruit permanent workers internationally: countries such as the Philippines and Nigeria are becoming big suppliers to Britain, especially in the aftermath of Brexit (which has seen fewer Europeans available to work in the NHS). But there is growing global competition for medical staff, especially as populations of rich countries age.

Thus it is essential to train more Britons, too. The government says it will provide an extra £2.4bn to pay for extra education and training places over the next six years. To train one nurse today costs over £60,000—and typically around a quarter of trainees drop out of their courses. Some training may be shortened, and more apprenticeships are also proposed. A cap on medical places had previously meant that British students moved abroad, to study in places such as Ukraine and Georgia. At least some of those may now be able to train at home. The plan notes a 2% increase in medical graduates who were trained in Britain and joined the workforce since 2017. However that compared with a 121% rise in international ones. That funding, meanwhile, is likely to be locked in whoever wins the next election, expected next year, because the opposition Labour Party has promised similar plans.

Finding ways to better hold on to existing staff, far too many of whom are leaving, is even more important. Allowing more flexible working and finding ways to lift dismal morale would help enormously. Some of that is about getting leaders to listen more to junior staff. Small changes could also have a big impact. It’s not rocket science,” says Kate Jarman, a senior manager at Milton Keynes University Hospital and a co-founder of Flex NHS, a movement to promote flexible working. In Milton Keynes they provide free parking for staff, for example, which Ms Jarman reckons is a big boost to morale.

All of that should help to fill some of the expected shortfall in staff—but overall numbers are not the only concern. Staffing costs already consume two-thirds of hospitals’ budgets. Making the workers more productive, therefore, is another pressing need. Some of this is about making much better use of technology. In addition, resources are devoted to areas such as Accident and Emergency, when they would have greater impact if spent on early treatment or preventative care. The new plan does promise a 50% increase in the number of training places for general practitioners (GPs), or family doctors. But it says little about how overworked GPs will find time to supervise them.

The workforce plan, therefore, constitutes a small and welcome start in tackling an immense problem. Mr Sunak deserves some credit for that—but there’s a much greater set of tasks to complete ahead. ■