Working
Well in Healthcare: The Changes, Challenges and Opportunities for Developing
your Workforce
Professor
Mark Radford CBE, Deputy Chief Nursing Officer for England and Director for the
Long Term Workforce Plan Delivery, keynote: NHS Long Term Workforce Plan
The NHS
Long Term Workforce Plan considers the challenges facing the workforce over the
next 15 years and sets out actions to address them. During his keynote
presentation at Northumbria University’s first Working Well in Healthcare
event, Professor Mark Radford discussed the long-term workforce plan, how and
why it was developed and the key areas of focus where it’s essential to take
action if the NHS is to have the workforce it needs for the future.
The NHS Long Term Workforce Plan sets out a big
strategic vision that reframes what we need from contemporary modern
healthcare, something that was significantly influenced by what we experienced
during the pandemic.
What we need
from healthcare now is fundamentally different to what we needed even five or
six years ago, and huge consideration needs to be given to key issues such as pandemic threats, issues around physical health, mental
health, social inclusion and health inequalities. Now, these issues have always
been there, that hasn’t changed, what has changed is our focus on addressing
and overcoming those issues which in practice means the way we approach
workforce development and service delivery is going to be very different going
forwards.
Equally,
medicine and clinical practice is changing all the time with the advent of new,
hugely beneficial technologies. Genomics as an example is going to be a really significant
area over the next ten years in relation to how we can and do deliver personalised
medicine, what we do in terms of surveillance and support for patients and how
we get care closer to where those who need it are. All of this relies on how we
develop, train, and grow our workforce over the next decade.
The
government has committed to £2.4 billion in funding for phase one to achieve the
aims of the long term workforce plan. This is in addition to the £5.5 billion
funding for education and training which is due to rise to £6.1 billion. It’s a significant investment
package that could really make a difference.
There
are three key focus areas for this funding, and they are retention, reform and
training.
The retention
of existing staff and talent withing the NHS is critical for two reasons. One, we've already trained those individuals and they
have a huge amount of experience that can really benefit the NHS and help us to
deliver our services more innovatively. The people who can help us reform how
we deliver patient care are the ones who are already working in the sector.
The
second reason is the ‘rookie factor’. As we grow significantly in terms of
undergraduate production, apprentices and so on, we're going to have a lot of
new people working in the service and those people need supervision, advice, guidance,
and development. Again, our existing staff are absolutely essential to
embedding new employees into the service and providing them with the support
network they need in their early years after registration.
The second
focus area is how we grow the workforce. We currently have around 1.4 million
people working in the NHS and by the end of the long term plan that will need
to be closer to 2.3 million. The
IFS estimate that this figure equates to approximately 9% of the entire adult
working age population within England and, if we add social care into that it’s
closer to 14% of that
population. What we’re talking about is actually quite biblical in scale.
To achieve this,
we’ll need to move from a 20,000 adult nursing intake nationally per annum to
around about 40,000. That’s double. We
need to achieve that by 2031,
so this is going to require a huge amount of work. We need to ensure that we've got the physical capacity, both in
terms of placements as well as spaces at universities, and that we have enough
people wanting to come in and join the profession. We need to understand
the market and the choices people are making, we need to make the profession as
attractive as possible, and we need to look at how people can access that
training.
Equally we also
need to think about the support workforce and how we attract and retain people
in those positions too. Not as a substitution but we need to move towards a
multi-professional practice model where we have interdisciplinary teams delivering
care in the safest and most efficient ways possible. By the end of this 2037 we’re looking to have 550,000 registered
nurses and roughly around 60,000 nurse associates to
support them.
So how are
we going to achieve this? We need to significantly expand domestic education, training,
and recruitment. We’re looking at expanding medical school places from around
7,500 to 15,000 and most importantly we need to look at widening access to
these careers. How can we ensure that those people who don’t necessarily have
the right chances have the right support to access the same opportunities?
For example,
let’s take Nursing Degree Apprenticeships. These are probably among the most
beneficial courses at our universities when it comes to providing training
opportunities to the most diverse range of people. These courses give those
access to the career who haven’t followed the traditional route into higher
education and that’s important. Now, I need to be really clear. This is not an
inferior product, it’s a degree in the same way as an undergraduate programme
is but it has different entry criteria. For example, it often appeals to those
who are above undergraduate age or who have previous experience within
healthcare as a support worker. Our aim here is to increase apprentice numbers
from about 7% of the workforce when qualified to 22%
and there will be significant funding available to support universities in the
delivery of this.
Undergraduate
training will remain fundamental, as will our postgraduate programmes that
allow post-degree training to move into the profession. All of this is not just isolated to nursing for example, we’ve
also just launched the first medical degree apprenticeship. This again is a
widening access opportunity. It's a six-year programme and participants come
out with the same medical degree, but as with the nursing degree
apprenticeships, their access point is often through T levels and Btec courses rather than A levels. A huge part of this is trying to improve the
opportunity and life chances for those who don't necessarily come through
traditional routes but who want to access what is a highly competitive course.
More opportunities mean more registered practitioners that can help us to build
our workforce.
There are
opportunities there, but we need to think about how we attract people and how
we maximise those opportunities. We also need to look at these courses and how
they’re delivered. Currently nursing degrees provide 2,300 hours of practice
learning which is a lot of experience but creates congestion around the
delivery of the rest of the curriculum. If we were
to reduce those numbers, it would actually provide greater flexibility in
practice learning, greater intensity of experience, but also importantly, allow
us to think about how we can deliver training through a combination of
simulation and practice-based learning within universities.
And
this is where we come to reform.
The reform angle is really important because it will undoubtedly help us to
attract more people, but it will also help us to retain those we have. As an example,
we will be significantly expanding advanced practice training and
opportunities. An advanced role or an enhanced role, for example district
nursing, requires additional training and it’s going to be important that throughout
the undergraduate curriculum we make these opportunities known to students.
We
need to get them to consider advanced practice roles as a career route and get
them thinking about how they can maximise their impact to patients through
these roles. Not only will this provide us with more nurses capable of
independent autonomous practice, but it will give people clear paths for
progression and provide rewarding and fulfilling careers, ultimately supporting
retention. This is all about looking at our current models and how we can adapt
them. What do we expect these professionals to be able to do and are we
currently giving them those skills in the best way possible?
All
three of these elements form one package that will help us achieve our aims but
it’s important to stress this isn’t just about getting more people in to do
things the way we’ve always done them. This is about taking a real, hard look
at our profession, how we train our future professionals, how we nurture and
retain our existing staff and how we widen access to diversify our workforce.