This article is more than 4 years old

NHS shortages will continue unless we reimagine health education

The incoming Conservative government has promised to tackle shortages in the health workforce. Claire Warnes argues that a more thorough review of professional health education is needed
This article is more than 4 years old

Claire Warnes is Head of Education, Skills and Productivity at KPMG in the UK.

The education sector has the skills, experience and influence to be at the forefront of solving our health and care workforce crisis now and for the long term.

Of course, it’s not just about the NHS. While a majority of health and care staff work in the NHS, many don’t or also work for independent or local authority services.

The NHS in England has this year published an ambitious new long-term plan setting out how services will reform over the next ten years to meet the changing health needs of the population. Critically, however, the success of the plan depends on tackling the burgeoning workforce crisis in the NHS and the wider health and care sector.

Crisis in the health and care workforce

Different strategies and plans exist in Wales, Scotland and Northern Ireland, but there are common themes around workforce shortages that all four nations must tackle. The general election manifestos from all political parties offered varying degrees of relatively short term or volume-based focus on the health and care workforce crisis. That said, the NHS in England is about to publish its People Plan, which will hopefully offer a longer-term view.

For the public and politicians, the crisis is often one of pure numbers, with one in eleven NHS vacancies unfilled, a massive reduction in health care professionals (particularly nurses) from the EU registering in the UK, skills shortages in key areas and high staff turnover. In England, the interim NHS people plan set out some steps to begin to address these issues, including increasing nursing placements for undergraduate trainee nurses, raising the profile of health professions among young people and recruiting from abroad to address skills shortages in the short term. It also identified areas where there will need to be significant growth and change in the next ten years, including mental health nurses, staff in specialist diagnostic roles (for example radiographers), NHS workers engaged in multi-disciplinary primary care networks and working in local communities.

As we await the full NHS England People Plan, there are legitimate questions to be asked about whether the NHS has the capacity and bandwidth to convene the coalition of stakeholders necessary to put measures in place that can solve the health workforce crisis for the long term. Put simply, the NHS will always be obliged by circumstance to prioritise short-term measures to increase the flow of people into key shortage areas, rather than fundamentally reassessing and reforming the health and care education and training that underpins its success.

Likewise, politicians pursuing short-term gain are more likely to make splashy announcements about expanding routes into the health professions than to question whether those routes are producing the professionals with the skills to deliver what the four nations of the UK need from the NHS now and in the future.

So, how can health education providers take the lead in designing the future health and care workforce?

Perhaps education providers feel constrained by being answerable to a multitude of regulatory requirements from health and care regulators, the QAA and the OfS. This may be compounded by the challenging financial environment that many education providers can see ahead. This means there are few incentives for education providers to “rock the boat” and offer radical solutions to develop health education to service a much more agile and multi-professional health and care workforce. Yet health and care education providers, working with clinicians and regulators, are best-placed to re-design health and care education. They can help create greater flexibility across the system, while keeping education safe, high quality and focused on the development of reflective practitioners.

Health and care service models are changing. So, we can’t just expect to tweak existing education and training. Nor can we merely increase the flow into existing programmes to support these new models of care and adapt to technological-driven change in role.  Education providers, and particularly universities, are key to designing more agile, flexible learning for existing and new health and care professions.

What might reform involve?

Fundamentally, the current system of health professions is too rigid.

Health professionals are generally trained in one area in depth, such as pharmacy or paediatric nursing, with the expectation that they will stay in that field for the remainder of their career.

Often, career development means rising through the ranks – or leaving the profession entirely. Professions need boundaries for reasons of professional identity and standards. But, these boundaries could be far more porous, and education providers are well-placed to explore how safe, high quality inter-professional education could be introduced.

For example, that could be through thoughtful accreditation of prior learning and the use of a common baseline of professional skills for all health and care professionals. This would mean that health and care professionals, whose career aspirations or circumstances changed, could remain in the health and care workforce. It would also mean that the NHS could redeploy people in shortage areas rather than relying on recruiting new people into the NHS or importing expertise.

There are professional silos everywhere you look across health and care despite the fact that the majority of health and care pathways are (or should be) delivered by multi-professional teams. Silos in (some) universities with separate schools of nursing/midwifery, medicine and pharmacy. Silos in professional regulation and professional bodies. Silos in policymaking with heads of each profession. Good examples of collaboration within and across these silos of course take place, but these structural barriers cannot be ignored as a factor in why we find it hard to solve our health and care workforce challenges.

The emerging, more joined up, place-based workforce approaches, such as those being led by Integrated Care Systems in England, will need to bring education providers more fully into shaping and innovating the learning provision so that it directly addresses the future local workforce requirements.

Access to health and care education is also an issue. Traditionally, nursing pathways have appealed to mature learners, but the undergraduate degree is still structured around 18-21-year olds, and the change to nursing funding in England has led to a decline in applications since 2016. A nursing apprenticeship has been developed but it is subject to the peculiarities of the apprentice system (independent end-point assessment, for example), which creates disincentives for rapid scaling up. Earn while you learn should be embraced. Again, how this can be done safely and with the right balance of earning and learning is a question of pedagogy. For example, why should there not be a distinct system of apprenticeships designed and structured solely for the health and care workforce?

Education providers rightly have different strategic aims, different drivers around research and teaching and, therefore, attract different types of students. Yet, in health and care education, most providers are performing an important local civic duty in providing skilled professionals to join and re-join the health and care workforce.

It would be easy to focus on universities being at the heart of solving the workforce crisis. Yet, FE is key to providing skilled professionals other than those requiring graduate level qualifications and also key to offering progression routes for a much wider pool of people who want to work in roles across the health and care professional spectrum.

Schools too have an important role to play, not least in showcasing the breadth, value, and ideally the flexibility, of career pathways that make health and care one of the sectors to aspire to be part of.

Finally, as is well documented, the workforce crisis is not simply an issue of skills shortages and leaky pipelines. A recent survey of NHS staff found as many as 40 per cent of staff reporting they have been unwell due to work-related stress in the last 12 months. This is clearly, in part, due to overload caused by staff shortages, but also speaks to general working conditions, blame culture and limited time for staff to engage in service improvement.

Education providers can be at the forefront of inspiring the next and current generations of health and care professionals, and this includes embedding a greater breadth of skills into health and care education and training, such as leadership development, data-led decision-making, commercial negotiation and the deployment of artificial intelligence.

Education providers must lead the way in developing professional learning that enhances the skills learned through existing clinical programmes, whilst also stimulating the pipeline of new health and care professionals, such as the data scientists necessary for the UK to benefit from genomics and personalised medicine.

A coalition of the willing

None of this is a suggestion that education providers should act alone. In fact, there needs to be a coalition of influencers who, crucially, are enabled to deliberate independently of immediate political expediency.

The traditional configuration of roles in the health and care workforce – and the status, perceived value and associated remuneration of different roles – needs shaking up.

Education providers have the talent, the expertise and the energy to drive the creative thinking required and it’s urgent. It is time to convene a different, timebound workforce plan, and one that enables us all to think outside of the confines of current frameworks, funding envelopes and short-term priorities. It should draw on the expertise of the UK’s education system in providing high quality learning to enable health and care professionals to deliver high quality, safe care.

Education providers, particularly universities, offer the key to this radical thinking to address the workforce crisis and safeguard the NHS and wider health and care system for future generations.

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