We have the NHS workforce plan. What next?

The NHS Long-Term Workforce Plan will have to reckon with a chronic shortage of nurses – and a recent dip in nursing applicants. Beth Craigie and Rob Waterson think through how universities can contribute

Beth Craigie is the Public Affairs and Policy Manager at the University of East London.

Rob Waterson is Dean of the School of Health, Sport & Bioscience at the University of East London

The shortage of medical staff within the NHS is not a new issue.

Back in 2019 the Guardian reported that since the government removed the NHS bursary in 2017, 40,000 vacancies had been created in the NHS, with 10,000 fewer people a year applying for nursing degrees in England.

Nearly six years on – one Brexit and one pandemic later – this issue has now escalated into a crisis. A shortage of staff has led to intense pressure on services, which in turn has led to staff leaving the NHS at an alarming rate due to burn out and overworking.

Of course, this will come as little surprise to anyone who has followed the news in the past year. The once in a generation event that was the pandemic has fundamentally changed nursing – both as a profession and in the way we teach.

During the pandemic, years of understaffing compounded by extreme demand reached crisis point. In the years since, those events have shone an increasingly bright scrutinising light on a system on the brink. With much publicised strike action and discontent within the NHS workforce, it is therefore hardly surprising that across the board, universities have seen a dip in nursing application numbers during this year’s UCAS round.

Universities, on the whole, are the main means of training nursing staff and we know from data from our partner organisation Million Plus that it is modern universities, like the University of East London, that train a large proportion of our home nursing students. With the recent release of the NHS Long Term Workforce Plan, it is clear there is a role for universities to play in ensuring that we realise these ambitious, 15-year ambitions.

Virtually the real thing

However, I’m sure we’re not alone in stating that placement capacity remains an ongoing concern. Placement capacity has been a much bigger issue, especially in higher density areas such as London, since the pandemic.

Some universities are taking an innovative approach to reducing the capacity concerns by adapting their approach and incorporating simulation into teaching. Simulation not only prepares students to engage with emerging technologies as part of their development, but it also helps to ease the pressure on placements.

At the University of East London, we have invested heavily in online simulation technology and redeveloping The Hospital & Primary Care Training Hub to ensure it offers the very best learning environment for our students. Our Oxford Medical Simulation is available to all learners via an initial virtual placement and enables our students to go out into practice with a basic competence and confidence in their skills and ability. Early evaluations of the use of these virtual placements has led to increased confidence and lessened feelings of anxiety – which could have a positive impact on retention figures within nursing courses too.

The retention question

Whilst the adoption of these changes will have a significant impact on reducing the effects of the placement, recruitment and staffing deficit, universities must go further to ensure that we are supporting our nursing students from application to graduation. There has been a persistent challenge around completion, with around 25 per cent of nursing students leaving their courses each year – and this has been consistent since 2008.

If the past fifteen years have taught universities anything about teaching nursing, it is that we must address the reasons for students not completing the course. It will, no doubt, come as little surprise to many in the sector, and perhaps those outside the sector, that the overwhelming majority of individuals studying a nursing or allied health course at university are quite different from the average undergraduate student. Nursing applicants tend to be overwhelmingly female and are far more likely to be mature students upon entry and have dependents. At the University of East London, for example, our nursing demographic is 70 per cent GEM students (global ethnic majority), 88 per cent female and 88 per cent mature students.

Addressing the lack of continuation on nursing courses, by ensuring universities fully analyse available exit data and subsequently build their admissions strategies around that, would be one way that we could begin to tackle the issue. Universities should also put in measures to support our nursing students with flexible learning and generous financial support.

At the University of East London, we have put several measures in place to help progression – particularly during the cost-of-living crisis. These include an additional £1.5 million in bursary funding, an additional £1.2 million in hardship funding as well as adjusting the criteria so that the funding is open to more students, free car-parking spaces for students and staff, free weekly breakfasts, grocery vouchers, free essential products such as sanitary products, and a consolidated timetable to reduce the amount of time students are travelling onto campus. There are of course deeper and more complex problems, and measures like this represent just a start.

No silver bullet

Retention of the existing workforce and reducing the continuation gap are essential to provide the workforce for services that are currently commissioned, but also to ensure that the training posts in the Long-Term Workforce Plan can be realised.

There is no silver bullet to solving the crisis within the NHS, and it will certainly require input and collaboration between government, the NHS, the unions, and universities among others, to ensure we can meet the demands now, and in the future. But universities beginning to tackle the consistent completion gap within nursing will help alleviate the crisis mid and long term.

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