This blog has been kindly written for HEPI by Susanna Kalitowski, Head of Policy at the University Alliance.
The headlines have been dominated for weeks by grim stories detailing the extent of the NHS workforce crisis, which is deepening with the addition of widescale strikes. There are nowhere near enough staff with over 130,000 vacancies in England – including over 46,000 nursing posts. This is even though the Government is on target to meet its manifesto pledge of 50,000 more nurses. Demand for nurses is increasing more quickly than supply.
While Brexit and the COVID-19 pandemic have undoubtedly exacerbated the situation, the workforce crisis predates these. Back in 2017, a Lords Committee warned that the absence of long-term workforce planning was ‘the biggest internal threat to the sustainability of the NHS’. The King’s Fund says the crisis is the result of ‘a prolonged funding squeeze … combined with years of poor workforce planning, weak policy and fragmented responsibilities.’
The higher education sector – which it goes without saying trains most healthcare professionals – has all too often felt like a helpless bystander. Increasing capacity on healthcare courses requires long-term investment in new buildings, facilities and staff and years of preparation. Yet we have not had a national NHS workforce strategy since 2003. Despite having a world-leading higher education sector, the UK has relied on immigration to fill workforce gaps. This is no longer sustainable practically, politically or morally. The head of NHS England, Amanda Pritchard, has called for more homegrown doctors and nurses.
It therefore comes as something of a relief that the Government is set to publish a long-term workforce plan, and that this will include for the first time independently verified forecasts of the number of doctors, nurses and other professionals needed in five, ten and fifteen years’ time. This plan cannot be achieved without the full involvement of the higher education sector. Alliance Universities are some of the largest providers of healthcare training in the UK, training around 30 per cent of all nursing students in England and a considerable proportion of allied health professionals. They hope to collaborate and play a much more strategic role in workforce planning going forward, especially in relation to the development of new roles.
University Alliance has published a briefing, Delivering the Healthcare Workforce of the Future, which sets out four areas where universities, the NHS and government can work together to find solutions to the ongoing NHS workforce crisis.
- Involve the higher education sector in long-term NHS workforce planning: It seems self-evident, but universities and colleges have been an untapped resource for too long when it comes to ensuring we have the healthcare workforce we need. University Alliance would like to see universities established as anchor institutions across Integrated Care Systems (ICSs) and Integrated Care Boards (ICBs). We also recommend that the Department for Education and the Department for Health and Social Care convene a joint ministerial working group tasked with finding immediate and long-term solutions to meet NHS training and skills needs. There is a need for the two Departments to work more closely on the issue of the healthcare workforce.
- Reform placement tariffs for nursing students: A lack of additional clinical placements is the single biggest barrier to increasing nursing and allied healthcare course capacity. Currently placement providers such as hospitals, GP surgeries and care homes receive £5,000 per nursing student they offer placements to, compared with £30,000 for doctors. The low tariff means there is less incentive to take students on, particularly during a workforce crisis.
- Fully embrace simulation in nursing training: The last few years have witnessed a quiet technological revolution in healthcare education and training. New simulation units and virtual and augmented reality training suites enable students to undertake rare or risky procedures and hone everyday skills in safe but highly realistic environments, before using them on real patients. The burden on the NHS is reduced by cutting the number of hours of ‘live’ clinical placement needed. The Nursing and Midwifery Council (NMC) recently announced that 600 hours of nursing student placements could take place in simulated environments of approved providers. This was a welcome development, and simulated training should now be invested in for the long-term. We are calling on the Government to continue to provide capital funding for simulation through the Office for Students (OfS) and others, and a long-term guarantee from the NHS that universities will continue to receive a proportion of the tariff to provide simulated practice hours. This will support them to invest in the staff and equipment required to scale up their simulated training provision.
- Explore a new regulatory framework for nursing education. For many years the NMC has followed an approach, set out in EU law, which requires nursing pre-registration programmes to total 4,600 hours. Half of these (2,300) must be practice hours in a live clinical setting. Time spent in real-life environments is essential to put students’ learning into practice. However, the significant number of hours required places a strain on the NHS, which hosts the majority of clinical placements. Many countries take a different approach. For example, Australia stipulates 800 hours and Canada and most US states do not require a minimum number of hours at all, opting for a competency-based approach. Nursing training is becoming increasingly sophisticated and high-skilled – and we think moving towards a modern framework that keeps pace with these developments is sensible. Now that the UK has left the EU, we have the opportunity to design a new regulatory approach to nursing training with quality and efficiency at its heart, that emphasises proficiency rather than time served.
Although the NHS workforce is facing an unprecedented crisis, there is huge potential for the higher education sector to be more involved in finding solutions to longstanding issues. If they have as seat at the table, universities and colleges can do much more to help alleviate the strain on the healthcare service and deliver a workforce fit for the future of the NHS.