From education to employment

#Apprenticeships in the NHS – Miracle cure or bitter pill?

Denise Baker, Head of Pre-qualifying Healthcare and Apprenticeships at the University of Derby

The introduction of the Apprenticeship Levy will see around £200 million per year ring-fenced in the NHS for apprenticeships.

For those employers who are prepared for apprenticeship changes, this represents a welcome opportunity to set aside money for training and development.

Budgets for education are often the first to be squeezed when there is a financial deficit, so levy monies offer protected funding for the first time.

Previously, NHS training budgets were focused largely on the medical workforce, with nurses and allied health professionals coming second, and the smallest portion of training budget reserved for the largest sector of the workforce – lower grades without professional development obligations. Once their statutory training had been delivered every year, there was little left for anything else.

So here is an opportunity for healthcare employers to review their training priorities but will they take it?

We know how depleted the NHS workforce is. Although the media focuses on nurses and doctors, all professional groups are carrying vacancies.

One of the key challenges faced by employers is making the NHS an attractive career choice for school leavers and mature entrants. Unfortunately, it has bad press at the moment.

Apprenticeships offer a suitable career development opportunity for new recruits. For employers, there is the added bonus of employee loyalty and the potential for a less mobile workforce.

Recruit locally, offer a good career structure, retain staff – but the NHS needs to work on its sales pitch. Fortunately, many recruits feel drawn to caring roles, but with pay restraints, long hours and endless horror stories, it is easy to see why there can be a high staff turnover.

The use of intermediate and advanced apprenticeships has been steadily growing recently. The Francis Report into the shortcomings in Staffordshire highlighted many deficits and led to the introduction of the Care Certificate for workers in health and in social care.

For most NHS employers, the Care Certificate forms part of an extended induction for new workers and leads in to a level 2 qualification. For some NHS employers, this is the limit of training offered to support workers. This is partly to make sure that the skill mix in teams is appropriate – there is no need to have more advanced skills for every team member. Also, the more skilled your team are, the more you have to pay.

But now we have an unusual set of circumstances in healthcare. High vacancy levels mean that employers are open to exploring more innovative staffing solutions.

There is concern that the removal of the NHS bursary for pre-registration education will deter students from entering the professions. Workforce predictions suggest vacancy levels will continue to rise; the Apprenticeship Levy has been introduced.

Evidence suggests that NHS employers are actively looking for ways in which to spend their apprenticeship levy.

The current financial deficit in the healthcare system means employers are looking to achieve a good return on their obligatory investment. But there are challenges ahead.

Many employers find the challenge of 20 percent off the job training difficult to achieve, but when this means you are missing a person on the rota and your safe staffing levels need to be maintained, there is an obligation to provide backfill.

The NHS is also slow in providing blanket guidance on pay, terms and conditions with local practice differing across the country.

For the Nursing Associate Higher Apprenticeship however, there is a mandate to pay the apprentice on a Band 3 salary (c £16–19k p.a.) during training. A generous apprenticeship salary but a financial burden to the employer where apprentices need to spend approximately 40 percent of their time off the job to meet professional educational requirements.

The everyday challenges of staff workload mean that a good network of educators needs to be provided to offer support and training to apprentices, which means an additional financial burden to employers.

While the levy offers the potential for supporting ‘preparation for assessment’, there is little guidance on what can and cannot be funded or indeed, how that funding is accessed and audited.

If we add in any professional obligations necessary in degree apprenticeships (e.g. currently pre-registration nurses need to spend 40 percent of their time working with a named mentor), the intricacies of the apprenticeship mount up even more.

The speed at which apprenticeship standards are approved and ready for delivery is also creating problems, so the recent news that processes are to be quicker will be welcomed.

The NHS already makes good use of lower level apprenticeships in health and social care or administration, for example, but the lack of more ‘expensive’ apprenticeships which would use up the levy more quickly, mean that employers are struggling to spend it quickly enough.

There is a significant chance that NHS public funds will be swept aside in April 2019 as unspent levy – this may be one bad headline too far if next winter is as bad as this one.

There are more opportunities for NHS employers to utilise apprenticeships and fix some of the training gaps.

However, the lack of investment in training in the past means the supply pipeline of people ready to enter higher or degree apprenticeships is currently depleted and needs time to build up.

High vacancy levels in the NHS do offer some opportunity for funding apprentice salaries, but lack of guidance from the centre mean it is a competitive market and apprentices will be wise to shop around and get the best terms and conditions they can.

Whether the rhetoric will be able to match the reality is questionable, but the NHS is acknowledging that something has to change.

New roles or new routes to professional qualifications can all be supported by apprenticeships but perhaps the NHS is looking for more support to make them easier to afford and deliver.

We know that funding is tight in the NHS, and apprenticeships offer a supportive mechanism to deliver new training routes, but the conditions need to be right.

Miracle cure? No. Bitter pill? Hopefully not. Long term rehabilitation? Let’s hope so for all our sakes.

Denise Baker, Head of Pre-qualifying Healthcare and Apprenticeships at the University of Derby

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