Universities, the NHS, and health workforce transformation

Health education is a complex and shifting landscape – with enormous ambitions. Denise Baker and Susanna Kalitowski set out suggestions for better coordination

Denise Baker is Pro Vice-Chancellor at the University of Derby and Chair of the University Alliance Deans of Health Network

Susanna Kalitowski is Head of Policy at University Alliance

Working alongside the NHS requires universities to constantly be adapting.

The relationship between universities and the health and social care sector can be described as evolutionary. For decades, nurses were trained directly on wards, with schools of nursing traditionally hosted by individual hospitals.

Training began to move towards higher education in the mid-1990s, but it took until 2009 for a full degree (level 6) to be needed to enter the Nursing and Midwifery Council’s professional register. At that point, universities became reliant on the NHS to offer placements to their students, with local hospitals sometimes feeling that they had little control over the development of their future workforce. This was compounded by the huge expansion of student numbers in the 2010s.

In recent years, the dynamic has changed once more with the advent of new training routes such as degree apprenticeships, which give employers more choice over how staff are educated and require universities to develop different relationships – yet again – with their NHS partners.

Getting integrated

A further shift in the power balance between the NHS and higher education occurred in July 2022 when Integrated Care Systems (ICSs) replaced Clinical Commissioning Groups as the statutory bodies responsible for planning health and social care services, tackling health inequalities and enhancing productivity in the system. They bring together the NHS, local authority, voluntary and other partners in a quest to deliver “joined up thinking” and have two key components: an Integrated Care Board (ICB) and an Integrated Care Partnership (ICP).

With control of over £100bn for health and care services in their area, the membership of ICBs matters. Minimum expectations for ICBs are specified, but the finer details of how each is governed is left to the discretion of the 42 ICBs across England. There is no requirement for ICBs to include or even consult universities or other education providers.

ICBs had barely been established before more change came their way in April 2023 with the Hewitt Review scrutinising their management and leading to significant budgetary cuts. Add in the publication of the NHS Long Term Workforce Plan in July – with its objective to achieve the biggest workforce expansion in NHS history – and it begins to feel that we are stuck in an eternal loop of Tuckman’s storming, forming, and norming with universities unsure of their place in the ICB structure.

Are universities on board?

University Alliance has been at the centre of working with first Health Education England (HEE) and latterly NHS England (NHSE) to represent members’ views in this space. We are significant providers of health and social care pre-registration programmes, training one in three nurses in England. It is not uncommon for Alliance universities to span across three to six different ICSs. All 42 have developed plans around workforce, but there is a large variation in the extent to which they have been engaging with universities to do this.

In a small number of ICBs, university leaders sit directly on the ICB, enabling genuine partnership working with the ICB chair, CEO and chief people officer to co-create workforce solutions. More commonly, ICBs have sub-committees such as people boards that allow for engagement with stakeholders from HE, FE and schools, although it is often constrained to narrow issues such as human resources.

At the other end of the scale, there are ICBs in which there is limited understanding of universities’ role in the development and retention of the healthcare workforce, not to mention research, innovation or knowledge exchange opportunities. Universities are regarded as just another “workforce supplier” delivering regular outputs of different staff roles to meet the requirements of local and national employers.

But at a time when applications to nursing programmes are declining, even the trusted supplier role becomes less reliable and ICBs run the risk of not having the right staff with the right skills in the right place unless there is a joint effort to effect a change.

Coordinated delivery

Delivering an ambitious workforce plan in a financially challenging environment will require new creative ways of working – how can the existing workforce be reskilled, or services be reorganised? The renewed emphasis on prevention will necessitate new healthcare and non-healthcare roles.

To deliver on the plan’s promise, workforce planning at every level must involve universities and colleges much more actively and consistently than at present, and University Alliance is calling for universities to have a more visible and strategic role in ICSs and ICBs. Clear guidance about how they should work with education providers could facilitate this.

At that national level, we would also like to see the establishment of a cross-government health education task force to coordinate delivery of the workforce plan. Membership should include representatives from local and central government (including the Department for Education and the Department for Health and Social Care), NHSE, health regulators, professional bodies and higher education providers.

University Alliance will continue to engage with government and NHSE as the transformation continues. The current position is not the end of the line, just one station on a long and interesting journey. However, making sure the train pulls smoothly out of the station with the right passengers on board is critical.

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