A long-term workforce plan for the NHS – which the UK government promised four and a half years ago – has finally been unveiled. Its arrival, days before the NHS turns 75, is welcomed.
The ambitious plan sets out a 15-year strategy to address the increasing demand for healthcare and decreasing supply of healthcare professionals in England. An investment of more than £2.4 billion has been agreed to fund a 27% increase in training places by 2028-29. The total NHS workforce would grow from 1.4 million in 2021-22 to around 2.3 million in 2036-37.
This investment targets the current shortfall of NHS staff, which has around 150,000 vacancies. This shortfall is forcast to grow to 260,000–360,000 staff vacancies by 2036-37 without any intervention.
The main emphasis of the 151-page plan is on training and increasing the number of healthcare professionals – not only doctors and nurses, but also allied health professionals, such as physiotherapists, speech and language therapists and podiatrists, as well as pharmacists and healthcare scientists.
Existing apprenticeships for nurses and other healthcare professionals will be expanded, and a new apprenticeship scheme for doctors will be introduced to meet the required number of 12,000–15,000 medical school places by 2030-31.
New healthcare roles have been promised, including “enhanced practitioners”, who have specific knowledge and skills in a field of expertise, and the more senior “advanced practitioners”, who manage the whole episode of a patient’s care. These posts will combine with the more generalist roles that provide basic care across a range of patients and free up the time of those more specialist practitioners.
To mark the 75th anniversary of the launch of the NHS, we’ve commissioned a series of articles addressing the biggest challenges the service now faces. We want to understand not only what needs to change, but the knock-on effects on other parts of this extraordinarily complex health system.
Retention in the NHS is a considerable problem. The overall staff leaving rate increased from 9.6% in 2020 to 12.5% in 2022. The plan acknowledges the importance of retaining workers, offering them more flexibility, and improving the culture and leadership in the NHS. But details of how this will be achieved are limited in the current plan.
Reform and innovation are also part of the plan to improve productivity by including staff with a more varied mix of skills and expertise within multidisciplinary teams, combining generalists and specialists. For example, a dental practice might have only one dentist, but two dental therapists and two dental hygienists. The therapist and hygienist would do most of the basic dental care, with the dentist intervening when more specialist care is needed.
The plan also draws on the increased use of technological advances to enhance and transform healthcare, such as AI technology, which can decrease diagnostic screening times in radiology.
More detail needed
While the plan is certainly a positive step, it is only the first step in a longer trajectory, setting out clear markers for growth and improvement. Much more detail is needed on how the plan will be implemented and what measures will be used to judge its success.
The emphasis of the plan is on boosting the quantity of staff and services. However, aspects of quality of care, type and level of staffing required and overcoming obstacles to this expansion, need to be explored further, such as the feasibility of shortened medical degree programmes, medical apprenticeships and the student take-up of all the new university places.
The plan acknowledges that NHS staff are working in highly pressured environments and many are exhausted since the COVID pandemic. The recent nursing strikes are not only about pay but also poor working conditions and lack of support and leadership. To make this plan viable, a clearer blueprint on how to retain staff must be included.
Where will this expansion come from? Universities do not always fill their quota of places for some health courses, including nursing, midwifery and allied health professions. It is difficult to see where the students will come from to fill the government’s proposed 92% increase in adult nursing training places by 2031-32 if current places are not being filled.
During the pandemic, people saw the value of working in healthcare as they clapped weekly for those working in the NHS who they regarded as heroes. But this perception of feeling valued in society has not endured in the NHS workforce. More NHS staff are leaving – the overall number rising by more than 25% from 2019 to 2022.
Meanwhile, nurses, doctors and some allied health professionals are taking strike action. About 170,000 NHS workers left their jobs in 2022, more than 41,000 of whom were nurses, the highest rate for a decade.
Improving the culture, wellbeing and work environment of staff in the NHS will lead to people valuing NHS roles and seeing the opportunities they bring. This will encourage people into health and social care careers.
The availability of clinical placements during training is a major obstacle to this ambitious expansion plan, mainly due to the shortage of experienced staff to supervise students. All healthcare courses incorporate “practice-based hours” where students work in a variety of healthcare settings.
This shortage of experienced supervisory staff means that clinical placements are notoriously hard to find and universities are sometimes forced to cut target placement numbers, despite the need, because of a lack of capacity.
Partnership working is essential if the plan is to be successful. Close collaboration between training institutions and NHS trusts will ensure that the appropriate type and number of health courses are offered at the right time and with the right balance of skills.
A closer alliance between schools, colleges and universities will allow students to step on and step off at different points in their learning trajectory, depending on their abilities, experience and choice of occupation. Showcasing the benefits and opportunities of healthcare as an occupation both in primary and secondary school will lead to more people choosing to join the NHS and fill these newly released places.
If working conditions for NHS staff are improved, the current trend of people leaving can be reversed. This, in turn, can lead to a more positive image of working as a healthcare professional in the NHS.
And, combined with the development of more active and well-defined partnerships across education, health and social care, the hope is that more people will opt to enter the health and social care sector.
If all of the above issues are addressed, the ambitious expansion, retention and reform targets of the NHS long-term workforce plan are more likely to be achieved. And in 25 years, at the NHS’s 100th anniversary, the NHS workforce will hopefully meet the healthcare needs of the population.
Victoria Joffe is a professor of Speech and Language Therapy and Dean of the School of Health and Social Care, University of Essex. She has received research grants from the ESRC, The Nuffield Foundation and the NIHR.