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Working Well in Healthcare, Mark Radford Keynote Article

Working Well in Healthcare: The Changes, Challenges and Opportunities for Developing your Workforce

Professor Mark Radford CBE, Deputy Chief Nursing Officer for England and Director for the Long Term Workforce Plan Delivery, keynote: NHS Long Term Workforce Plan

The NHS Long Term Workforce Plan considers the challenges facing the workforce over the next 15 years and sets out actions to address them. During his keynote presentation at Northumbria University’s first Working Well in Healthcare event, Professor Mark Radford discussed the long-term workforce plan, how and why it was developed and the key areas of focus where it’s essential to take action if the NHS is to have the workforce it needs for the future.

The NHS Long Term Workforce Plan sets out a big strategic vision that reframes what we need from contemporary modern healthcare, something that was significantly influenced by what we experienced during the pandemic.

What we need from healthcare now is fundamentally different to what we needed even five or six years ago, and huge consideration needs to be given to key issues such as pandemic threats, issues around physical health, mental health, social inclusion and health inequalities. Now, these issues have always been there, that hasn’t changed, what has changed is our focus on addressing and overcoming those issues which in practice means the way we approach workforce development and service delivery is going to be very different going forwards.

Equally, medicine and clinical practice is changing all the time with the advent of new, hugely beneficial technologies. Genomics as an example is going to be a really significant area over the next ten years in relation to how we can and do deliver personalised medicine, what we do in terms of surveillance and support for patients and how we get care closer to where those who need it are. All of this relies on how we develop, train, and grow our workforce over the next decade.

The government has committed to £2.4 billion in funding for phase one to achieve the aims of the long term workforce plan. This is in addition to the £5.5 billion funding for education and training which is due to rise to £6.1 billion. It’s a significant investment package that could really make a difference.

There are three key focus areas for this funding, and they are retention, reform and training.

The retention of existing staff and talent withing the NHS is critical for two reasons. One, we've already trained those individuals and they have a huge amount of experience that can really benefit the NHS and help us to deliver our services more innovatively. The people who can help us reform how we deliver patient care are the ones who are already working in the sector.

The second reason is the ‘rookie factor’. As we grow significantly in terms of undergraduate production, apprentices and so on, we're going to have a lot of new people working in the service and those people need supervision, advice, guidance, and development. Again, our existing staff are absolutely essential to embedding new employees into the service and providing them with the support network they need in their early years after registration.

The second focus area is how we grow the workforce. We currently have around 1.4 million people working in the NHS and by the end of the long term plan that will need to be closer to 2.3 million. The IFS estimate that this figure equates to approximately 9% of the entire adult working age population within England and, if we add social care into that it’s closer to 14% of that population. What we’re talking about is actually quite biblical in scale.

To achieve this, we’ll need to move from a 20,000 adult nursing intake nationally per annum to around about 40,000. That’s double. We need to achieve that by 2031, so this is going to require a huge amount of work. We need to ensure that we've got the physical capacity, both in terms of placements as well as spaces at universities, and that we have enough people wanting to come in and join the profession. We need to understand the market and the choices people are making, we need to make the profession as attractive as possible, and we need to look at how people can access that training.

Equally we also need to think about the support workforce and how we attract and retain people in those positions too. Not as a substitution but we need to move towards a multi-professional practice model where we have interdisciplinary teams delivering care in the safest and most efficient ways possible. By the end of this 2037 we’re looking to have 550,000 registered nurses and roughly around 60,000 nurse associates to support them.

So how are we going to achieve this? We need to significantly expand domestic education, training, and recruitment. We’re looking at expanding medical school places from around 7,500 to 15,000 and most importantly we need to look at widening access to these careers. How can we ensure that those people who don’t necessarily have the right chances have the right support to access the same opportunities?

For example, let’s take Nursing Degree Apprenticeships. These are probably among the most beneficial courses at our universities when it comes to providing training opportunities to the most diverse range of people. These courses give those access to the career who haven’t followed the traditional route into higher education and that’s important. Now, I need to be really clear. This is not an inferior product, it’s a degree in the same way as an undergraduate programme is but it has different entry criteria. For example, it often appeals to those who are above undergraduate age or who have previous experience within healthcare as a support worker. Our aim here is to increase apprentice numbers from about 7% of the workforce when qualified to 22% and there will be significant funding available to support universities in the delivery of this.

Undergraduate training will remain fundamental, as will our postgraduate programmes that allow post-degree training to move into the profession. All of this is not just isolated to nursing for example, we’ve also just launched the first medical degree apprenticeship. This again is a widening access opportunity. It's a six-year programme and participants come out with the same medical degree, but as with the nursing degree apprenticeships, their access point is often through T levels and Btec courses rather than A levels. A huge part of this is trying to improve the opportunity and life chances for those who don't necessarily come through traditional routes but who want to access what is a highly competitive course. More opportunities mean more registered practitioners that can help us to build our workforce.

There are opportunities there, but we need to think about how we attract people and how we maximise those opportunities. We also need to look at these courses and how they’re delivered. Currently nursing degrees provide 2,300 hours of practice learning which is a lot of experience but creates congestion around the delivery of the rest of the curriculum. If we were to reduce those numbers, it would actually provide greater flexibility in practice learning, greater intensity of experience, but also importantly, allow us to think about how we can deliver training through a combination of simulation and practice-based learning within universities.

And this is where we come to reform. The reform angle is really important because it will undoubtedly help us to attract more people, but it will also help us to retain those we have. As an example, we will be significantly expanding advanced practice training and opportunities. An advanced role or an enhanced role, for example district nursing, requires additional training and it’s going to be important that throughout the undergraduate curriculum we make these opportunities known to students.

We need to get them to consider advanced practice roles as a career route and get them thinking about how they can maximise their impact to patients through these roles. Not only will this provide us with more nurses capable of independent autonomous practice, but it will give people clear paths for progression and provide rewarding and fulfilling careers, ultimately supporting retention. This is all about looking at our current models and how we can adapt them. What do we expect these professionals to be able to do and are we currently giving them those skills in the best way possible?

All three of these elements form one package that will help us achieve our aims but it’s important to stress this isn’t just about getting more people in to do things the way we’ve always done them. This is about taking a real, hard look at our profession, how we train our future professionals, how we nurture and retain our existing staff and how we widen access to diversify our workforce.


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