Following the plea from Simon Stevens to better support healthcare students, Danny Mortimer of NHS Employers considers the impact of education funding policy changes and identifies the priorities in supporting qualified staff to meet the needs of the long-term plan.

College students

Source: Kevin Dooley

The education landscape in the NHS has altered considerably for our key registered professions in the last three years. The removal of the bursary and introduction of the apprenticeship levy have created both opportunities and challenges in abundance.

But has the overall effect been a positive one on the NHS? And does it pave the way for our services to build and retain the numbers of talented staff we need – not only to support our current services, but to develop a health system that is fit for the future?

In his King’s Fund speech on 10 July, Simon Stevens emphasised that the current education system for registered professions is not delivering on the numbers we need. This helpfully reopens the debate about what must be done to attract talented students into healthcare undergraduate courses.

It also rightly highlights the incomplete investment in the NHS, and while the long-term plan funding included the most generous pay settlement in the public sector, it did not invest in supply.

The recent announcement from Health Education England of a £2m investment into the development of the learning disability nursing workforce through apprenticeship and postgraduate routes is of course welcome, but we have argued on behalf of our members for some time that the NHS must be backed to go further.

Decline in numbers

UCAS has reported a significant downturn in nursing applications since 2016, with student applications in England falling 29 per cent, while applications to learning disability nursing have halved. In an effort to address this decline, trusts have redoubled their efforts to increase student capacity and have scaled up the number of placements available by 7,000 in time for September 2019.

As a starting point, The King’s Fund, Health Foundation and Nuffield Trust’s Closing the Gap report suggests the introduction of £5,200 “cost of living” grants, in addition to the loan system

Meanwhile, the number of learning disability nurses registered in the health and social care system has shown a stark decline. Between September 2013 and September 2018, there has been a 9.53 per cent drop in learning disability nurses on the NMC register.

In comparison, there was a 2 per cent drop in adult nurses over the same period. The picture for mental health nursing is no better, with a reported decrease of 11 per cent since 2009.

Alternative pathways to nursing, such as the registered nursing apprenticeship, have sparked interest, but this has not translated to implementation at scale to help address our supply challenges. The refusal of the government to reform the apprenticeship levy means that there is a significant cost associated with this route.

While some trusts have bravely invested in this option, for others, this is just not viable in the context of wider financial pressures and choices.

A similar decline in applications to a number of key allied health professional roles has also been reported. While the remarkable growth in physiotherapy applications, places and courses looks likely to continue, therapeutic radiography and podiatry in particular report a marked decline in applications with courses starting to review their viability.

These are also key members of our teams, and central to the ambitions of the long-term plan.

What needs to be done? As a starting point, The King’s Fund, Health Foundation and Nuffield Trust’s Closing the Gap report suggests the introduction of £5,200 “cost of living” grants, in addition to the loan system.

They argue, rightly in my view, that this should be made available to all healthcare undergraduate students and that this should be the priority for the forthcoming spending review.

This type of payment recognises that healthcare students don’t have the same opportunities for term-time or holiday work as their peers. Their learning depends on clinical placements, which greatly restricts their ability to take up the kind of part-time or holiday jobs that many of us will have done to pay our way through university.

The risk, of course, is that this investment when it comes will also be incomplete, either because there is no money from the spending review, or there is very little compared to what is needed. The NHS may then have to make some difficult choices about where the new investment is best targeted.

The greatest areas of risk are clearly in mental health and learning disability nursing and in therapeutic radiography and podiatry: these may have to be places where we start to restore the investment in the supply of our workforce.

There is no one solution to the workforce challenges the NHS faces. The People Plan must identify and deliver the bundle of focused actions that can be taken by government, ALBs and employers to drag us out of where we are.

The NHS is already taking steps to improve its working environment, but our teams also must feel the benefit of the long-term plan, the investments in capital announced by Boris Johnson and the promise of social care funding reform.

The jobs we incentivise these students to take up must feel more doable and the demands placed on them must be more realistic. Investing in supply is essential.