Health and Social Care in the United Kingdom are amongst the world's largest employers with more than 3.2 million people being employed across both sectors. Despite considerable efforts, both sectors are experiencing huge workforce problems with around 9% of posts being vacant across the NHS and even more significant problems in social care where 152,000 posts are vacant, which is around 10.7% of the total workforce.
Against this backdrop, NHS England published its Long-Term Workforce Plan (LTWP) in 2023 setting out a wide range of interventions to address workforce supply, retention and transformation. At the first Working Well in Healthcare event, hosted by Northumbria University, Professor Mark Radford, Deputy Chief Nursing Officer for NHS England and the National Director for Education & Training and the LTWP outlined how the numbers, should the LTWP by achieved, were truly startling with a projected 10% of all adults in employment being in employment in the NHS by 2030. When social care is added in 20% of adults will work in health or social care by the end of the decade making this a project of biblical proportions.
Addressing workforce deficits is only part of the task. Many people refer to healthcare as being like a leaky bucket, with retention representing a huge problem. While most would assume that this would happen when professionals first qualify Professor Debbie Porteous, Emeritus Professor, outlined that the major pinch point for professionals within healthcare is actually at around two years post-registration with many people deciding to leave the sector after significant time within the profession. This combined with projected retirements and migration to other countries, especially Australia and New Zealand, have conspired to produce the perfect storm.
During the event, we explored a range of interventions which can address the retention of experienced staff. Professor Mark Radford referred to the ‘rookie effect’ which would be created if we lost experienced staff and replaced them with newly qualified practitioners overnight. The ‘rookie effect’ can affect safety and also place an increased burden on the new practitioners who feel less well supported. Initiatives like the Professional Nurse Advocate programme, the hot debrief and restorative supervision also assist in supporting staff alongside the use of emotional intelligence when deploying and potentially redeploying staff to different clinical areas.
The Long-Term Workforce Plan in England will require a change in mindset to ensure delivery. Many issues remain unresolved and with funding not arriving until 2025 for apprenticeships and other delivery, the plan is already on a slippery slope. Part of the challenge is ensuring sufficient placements and the event heard about the need to learn from other countries. Professor Laura Serrant urged everyone to look beyond the shores of this island. Just because we have always done it this way didoes not mean it is the most appropriate way. For example, many registered nurses worldwide are successfully educated on fewer practice hours than the UK currently requires. Yet, outcomes are the same or in some cases better in terms of safety and mortality.
One of the more significant burning issues is the fall in applicants for nursing, medicine and allied health courses. The numbers have reduced by 10% from 2022 for nursing with a 26% fall over the last two years. Whereas for medicine the fall has been less significant with just over 3,000 fewer applicants. The cost of living crisis has certainly impacted more mature students entering the professions. However, since the pandemic, industrial action across nursing and medicine has also projected a negative image of the professions. Professor Laura Serrant asked people to consider what they would do and contribute to supporting individuals to pursue these professions, highlighting that we are all responsible for promoting the range of exciting roles available in nursing and beyond. Similarly, Laura asked people to reflect on what their contribution would be to making society and healthcare more equitable. Training can only go so far and we all have to work out what our actions will be and how they will contribute.
There was evidence that everyone wanted to see the workforce issues resolved while at the same time being open about challenges and barriers in the spirit of seeking solutions. Professor Alison Machin, Chair of the Council of Deans for Health was clear about the need to ensure that we have a robust workforce of educators both within Universities and in clinical practice. At the same time encouraging the proliferation of apprenticeships will require a rethink of the regulatory and other burdens this places on a sector which is already highly regulated.
If the LTWP is a success the UK will become less reliant on internationally educated nurses over time. Professor Serrant believed that we will always have places for internationally educated nurses and that since its inception the NHS has always relied on overseas recruits. However, it is my belief that as we become less reliant it is imperative that we have a phased plan to reduce recruitment. Many countries work on oversupply so it is only fair that we signal less reliance. The starting point needs to be an end of recruitment from red list countries (countries where the ratio of nurses per 1,000 of the population is low).
One of the key messages from the event was that everyone from healthcare assistants to nationally policy leads has a part to play in ensuring we can effectively address the workforce issues and support, nurture and retain the current workforce. As Professor Serrant outlined ask yourself in the ‘eye of the storm’ while things are a bit quieter what you should do and be doing to safeguard the health of the nation both now and in the future.
The Working Well in Healthcare Event: The Changes, Challenges and Opportunities for Developing your Workforce was the first in a series of events aimed at fostering collaboration across the healthcare sector to overcome the challenges it faces. To register your interest for the next event please click here.
To find our more about the workforce development and training offering at Northumbria University click here.
Northumbria University is one of the largest centres for healthcare professional education in the North of England, offering a range of specialist degree and CPD programmes across many areas of nursing, midwifery, operating department practice, physiotherapy and occupational therapy.
The University is dedicated to delivering high quality learning and development opportunities through experiential teaching using simulation-based education and innovative virtual reality technology to enhance practical learning, much of which was showcased at the event. It also prioritises providing first-class pastoral support for students. More than 6,000 students have graduated from our Nursing, Midwifery and Health courses in the last four academic years, over 100 newly registered nurses have entered the regional workforce through our 18-month degree apprentice programme since 2020 and the University’s recent announcement about its new Centre for Health and Social Equity (CHASE) will further increase capacity for the University to train the workforce of the future.
CHASE, which will be a flagship centre of excellence for research and training to meet the needs of stakeholders and communities in Newcastle, across the region, nationally and beyond. The University is already proactively driving forward educational growth and system support focused on delivery of the NHS Long Term Workforce Plan through initiatives such as; increasing nursing and Advanced Health Practitioner (AHP) places; developing new apprenticeships and direct entry; working to improve the continuation and progression to employment; and working on Advanced Clinical Practitioner pathways and Primary Care programmes. One of the aims of CHASE is to further enhance this work.
John Unsworth has worked in Higher Education since 2007 and has held posts at the Higher Education Academy, University of Sunderland and at previously at Northumbria University. John’s research relates to patient safety and workforce development around competence.
John has a background in primary and community care having been a Nurse Director in a geographically large Primary Care Trust in England. From 2001 to 2007 John was professional lead for nursing, allied health and adult social care / social work within Northumberland NHS Care Trust. Until 2018 he was Board Nurse on NHS Northumberland Clinical Commissioning Group. During the pandemic he has worked for NHS Test and Trace and a Clinical Contact Caseworker and is now delivering Covid-19 vaccines in Primary Care.
He has also worked in consultancy and a number of specialist nursing roles over the past 30 years. In 2013 John was made a National Teaching Fellow in recognition of his work around simulation education and student assessment in 2013. He became a Principal Fellow of the Higher Education Academy in 2016. John has worked internationally to develop practice and higher education teachers in Thailand, China, Hungary, Ghana, Vietnam, Bahrain, Ukraine and in Grenada (West Indies).
John is a Fellow of the European Academy of Nursing Science and a Fellow of the Faculty of Nursing of the Royal College of Surgeons, Ireland.
John was awarded made an Officer of the Order of the British Empire (OBE) in the 2022 Queen's Birthday Honours list for services to community nursing and community nurse education.
John is a Global Nursing Leadership Institute Scholar with the International Council of Nurses and has a lead role in influencing UK policy as Chair of the Queen’s Nursing Institute.
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