Why Universities are key to a healthy NHS

• This blog was kindly authored for HEPI by Jolanta Edwards, Director of Strategy at London Higher, and Susanna Kalitowski, Head of Policy at University Alliance.

This summer we have been commemorating 75 years of the NHS, the first universal health system in the world to be available to all, free at the point of delivery. Most Britons were born in an NHS hospital, and nearly everyone living in the UK has benefited at one time or another from the service, be that through A&E at a moment of crisis, a visit to a GP surgery or hospital for specific issues or check-ups, or – more recently – a lifesaving Covid vaccination. It is one of the institutions we treasure most as a nation.

However, the NHS is under pressure like never before in its history. Things have changed drastically since its inception, and in some cases in unforeseen ways. There are no easy or cheap fixes. At the heart of the crisis is a severe workforce shortage, with 112,000 vacancies in England, and a key challenge is the need to train more people more quickly to the same very high standard. The UK produces fewer health professionals per head than most of its OECD counterparts and around half of all new doctors and nurses joining the NHS have been educated abroad. The long-awaited publication of the NHS Long Term Workforce Plan – which heralded the “biggest workforce training expansion” in the history of NHS – was long overdue and frankly couldn’t come soon enough. 

Universities up and down the country are keen to work as closely as possible with the Government and NHS to deliver on the once-in-a-generation plan. All too often education providers are excluded from workforce planning at the national, regional, and local levels, yet they are uniquely placed to advise on both issues and solutions. Collectively, University Alliance and the London Higher Health and Medicine Groups educate 44% of nurses and midwives, 39% of all allied health professionals and 19% of doctors and dentists in England. The last three years have witnessed a steady expansion of our provision across the board, with a significant increase in nursing to help meet the Government’s 50% manifesto target.

Our universities are uniquely well placed to advise on how to roll out high-quality education and training at scale efficiently and effectively through the use of the latest technology, for example simulation units and virtual and augmented reality training suites. These exciting innovations enable students to practice rare or risky procedures, as well as everyday skills, in safe but highly realistic environments, before using them on real patients.

However, dangerous misconceptions around healthcare education abound: for example the assertion that nurses do not need degrees and that training has become less practical after moving from nursing schools into universities. What we expect from our nurses now has changed since the NHS was established, and nursing has become an increasingly sophisticated and highly-skilled profession. Today nurses can specialise in many areas from adult to child to mental health to intensive care. International evidence shows that patient outcomes are better and morbidity rates lower if nurses are trained to at least degree level and the WHO is calling for a bachelor’s degree to become the standard requirement for midwives and nurses globally. It was reassuring to see a commitment to graduate nursing in the Long Term Plan.

Nurses must spend half of their degree (2,300 hours) on placement, usually in a clinical setting such as a hospital or GP surgery, and the education they receive on university campuses is also largely practice-based, as well as theoretical. Nursing students learn practical, hands-on skills like defibrillation, managing beds and ward capacity, along with communication skills like discussing bereavement. A degree – coupled with placement training – provides today’s nurses with breadth, depth and understanding. However, this year we have seen a nearly 20% drop in the number of students applying to study nursing. Government, the NHS and universities must urgently work together to attract more students into the profession.

London Higher and University Alliance members are continually innovating the way they educate health professionals, for example through the creation of degree apprenticeships and new blended learning degrees in nursing and midwifery. The education and training they deliver is continually improved by their world-leading research, which directly informs lifesaving discoveries, treatments and services – most spectacularly illustrated by the rapid development and rollout of the Covid vaccines. The NHS has a symbiotic relationship with the research and innovation produced by the country’s universities. It is notable that the Executive Chair of Research England, Dame Jessica Corner, began her career as a nurse.

The NHS has enjoyed a glorious reign for 75 years, but public satisfaction with the service peaked in 2010 and has been decreasing ever since. Radical reform to its operating model is needed. We desperately require more doctors and nurses, but we also need to rethink healthcare roles. Inevitably, different skills will be required of the future workforce – such as a more sophisticated understanding of data and AI – and new roles will emerge. Universities have a wealth of expertise to offer the NHS in this space, much of it informed by their groundbreaking research and decades of experience of healthcare education and training. To ensure this is not lost, higher education providers should play a key role in the newly created Integrated Care Systems (ICSs) and Integrated Care Boards (ICBs).

In the short term, we need to accept that the problems faced by the NHS cannot be solved overnight. However, by bringing together universities with health policymakers, creative solutions to longstanding problems can surely be found.