Addressing a lost opportunity in the NHS workforce crisis: higher education’s future role in clinical placement management

The National Health Service is enjoying a unique moment in its 73 year-old history as its value is brought into sharp focus by the COVID pandemic. After months of weekly doorstep claps for NHS workers and NHS rainbows – a once ubiquitous sight on British streets – it is perhaps not surprising that healthcare has become a more visible and desirable career choice.

Applications to healthcare courses for the 2021/22 academic year have skyrocketed. Recently published UCAS figures have revealed that Nursing applications are up 21 per cent across the board, with increased demand from both 18 year-olds and mature students. They have also shot up for other allied health courses such as Midwifery and Physiotherapy. As the providers of training for a quarter of nurses in England and a significant proportion of allied health professionals, University Alliance universities will have a vital role to play in meeting this increased demand.

It is easy to forget that just prior to the pandemic, there was genuine concern that the Government would struggle to meet its high-profile 2019 manifesto commitment of 50,000 additional nurses. NHS hospitals, mental health services and community providers had long been reporting a shortage of more than 100,000 full-time staff, including 40,000 nurses. According to The King’s Fund, this workforce crisis was the result of:

“a prolonged funding squeeze combined with years of poor workforce planning, weak policy and fragmented responsibilities.”

The removal of the student nurse bursary in 2015 had led to 10,000 fewer people applying to nursing courses each year, with a particularly steep drop in mature students. A few months before the pandemic, the Government partially reintroduced bursaries for Nursing, Midwifery and some allied health courses, which has likely contributed to the growth in applications in 2020/21 and 2021/22.

Although thousands more people are keen to join the health service, the workforce crisis has not gone away. COVID has placed immense strain on the NHS and its people. Current staff are exhausted and morale is low – not helped by the protracted debate over pay. The retention problem is illustrated by the high-profile resignation of the nurse who cared for the Prime Minister while he was gravely ill with COVID, Jenny McGee, who contends that nurses are not getting ‘the respect and now pay’ they deserve.

As an essential pipeline for the healthcare workforce, University Alliance universities are doing their part to address shortages by expanding their provision as far as they can. With healthcare recently deemed a ‘strategically important subject’ by the Government, they are likely to face continued pressure to do so. However, every year, University Alliance universities are forced to turn away thousands of high-potential applicants. This is because health courses require lengthy clinical placements, particularly for nurses and midwives, who need 2,300 hours to be qualified. There are a finite number of placements – and nowhere near enough to satisfy the soaring demand we have witnessed this year. Some University Alliance members have reported 1,000 applications for 40 to 50 places on smaller courses such as paramedic science and radiography. Many healthcare courses are already full for September 2022.

The gap between supply and demand is particularly regrettable considering the now urgent need to upskill and reskill thousands of Britons and provide high quality jobs to ‘level up’ the parts of the country where these have been lacking in recent decades. For many years, the health service has relied on overseas professionals to fill crucial gaps and it will need to continue to do so to meet the 50,000 target. This is a lost opportunity.

The Government and Health Education England, the body responsible for healthcare education and training, have recognised the problem and invested millions of pounds to increase placement capacity. In addition, the Nursing and Midwifery Council has helpfully relaxed some of its requirements during COVID and is undertaking a much-needed review of programme length and use of technology and simulation which could create more placement capacity in the future.

This increased investment and regulatory flexibility has been utilised by University Alliance universities who have been able to draw on their cutting-edge facilities, including simulation units and virtual and augmented reality training suites, to enable the delivery of innovative virtual placements.

Several University Alliance members are also providing new blended learning degrees in nursing and midwifery. University Alliance universities have long worked with partners within the local communities to address capacity challenges and skills needs and are increasingly drawing on these partnerships to identify new types of placement providers beyond the NHS, for example, independent and private hospitals and care homes.

Despite this progress, several barriers remain in the way of creating a healthy supply of placements. One of the most prominent is a lack of placement supervisors. Finding the time to look after students on placement can be challenging for overstretched, overworked NHS staff grappling with a lengthy public health crisis. The fact that the tariff that placement providers receive for nursing and allied health students is a mere tenth of what they receive for trainee doctors is a further disincentive. To make matters worse, COVID has created a substantial backlog, as many placements had to be put on hold in the earlier stages of the pandemic.

What is needed is a long-term strategy to significantly increase placement capacity developed in partnership with higher education providers. The Health and Care Bill currently going through parliament will require each part of England to have an Integrated Care System responsible for bringing together local NHS and local government to deliver joined up care for its local population. This will include responsibility for health education – and there is an opportunity for a more joined up and strategic approach. Despite their civic role and existing partnerships across the health services, universities are not yet explicitly recognised by Integrated Care Systems with the recently published Integrated Care Systems design framework only refers (sparingly) to ‘education providers’. Going forward, universities and other higher education providers need a formal place in their local Integrated Care System – and a greater role in placement management to help ensure placement capacity can match demand.

This blog was kindly contributed by Susanna Kalitowski, Head of Policy, University Alliance. You can follow University Alliance on Twitter @UniAlliance.