NHS workforce plan: what does it mean for nursing?
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NHS workforce plan: what does it mean for nursing?

Shruti Sheth Trivedi RCNi senior news reporter

Critics say the long-awaited plan lacks clarity on how extra nurses will be trained and paid for, as well as a strategy for retaining experienced staff. We look at the detail

The long-awaited NHS workforce plan, which has now been published, years after it was promised, has been met with scepticism over how its commitments will be delivered.

Nursing Standard. 38, 8, 8-11. doi: 10.7748/ns.38.8.8.s6

Published: 02 August 2023

We take a closer look at the hugely ambitious plan, unveiled recently by prime minister Rishi Sunak, and what it means for nurses and the profession over the coming years.

What is the NHS workforce plan?

The plan was commissioned by the government to address the chronic workforce crisis in the NHS in England. Promised around six years ago and initially due to be published in 2020, it was delayed due to the COVID-19 pandemic and finally published on 30 June.

The 151-page document, overseen by NHS England, sets out how many nurses and other healthcare staff will be needed in the health service in England in the next 15 years, backed by £2.4 billion in government funding for additional training places over the next five years.

What has the government pledged on nurse numbers?

With about 40,000 existing nurse vacancies in the NHS in England, the government has pledged to recruit up to 190,000 more nurses by 2037 to reinforce the current workforce, reduce over-reliance on international recruits, and cut spending on agency staff.

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The plan promises to create thousands more training places for nurses and nursing associates to help make this happen, and vows to ramp up nursing apprenticeships so students can ‘earn while they learn’.

The government says the plan will be reviewed and refreshed at least every two years to ensure it keeps pace with NHS staff and patient requirements.

The RCN and the Nursing and Midwifery Council (NMC) were among 66 organisations asked to provide evidence to inform the development of the plan.

Who is responsible for NHS workforce planning?

University of Southampton health services research chair Peter Griffiths claims that, even after the publication of the plan, it is not entirely clear who is responsible for workforce planning in the NHS.

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‘While we do have a long-term NHS workforce plan now, it is ironic that the ongoing function of “planning” doesn’t seem any clearer than it was before’

Peter Griffiths, pictured, University of Southampton health services research chair

‘The best answer I could give is “everyone and therefore no one”,’ Professor Griffiths told Nursing Standard.

‘Health Education England used to have some more or less clearly defined responsibilities and that has now been absorbed into NHS England, but the Department of Health and Social Care (DHSC) is also clearly in the game, as are the various iterations of regional bodies, such as integrated care systems.’

There have been numerous parliamentary committee reports ‘bemoaning’ a lack of joined-up workforce planning, he says.

‘While we do have a long-term NHS workforce plan now, it is ironic that the ongoing function of “planning” doesn’t seem any clearer than it was before,’ Professor Griffiths adds. ‘The plan seems to imply leadership from NHS England – although in very general terms and without clearly identifying functions or processes.’

A spokesperson for NHS England insisted it does have workforce/people teams that are responsible for workforce planning. It lists Navina Evans as its chief workforce, training and education officer.

The DHSC did not respond to a request for comment.

How does the government plan to achieve its aims for the NHS?

To reach its ambitious staffing targets, the government has promised a large increase in nursing training places. The plan says it aims to boost overall nurse education places to more than 53,800 by 2031-32 – an 80% increase (see table, page 10). This would include almost doubling the number of adult nurse places to nearly 38,000, a 92% rise.

The plan says that in the next five years, training places for mental health nursing will increase to 7,902, up 38% on 2022 numbers, and education places for learning disability nursing will rise 46% to 794. Further increases will follow by 2031-32, it says, with mental health nurse training places up by 93% on 2022 numbers to more than 11,000, and learning disability nursing places doubling to more than 1,000.

There is no increase planned in children’s nursing places, which are estimated to remain at around 3,800 by 2031-32. The government says its assessment shows there are currently sufficient numbers of training places to meet demand for children’s nursing, but this will be kept under review.

District nurse training places are intended to increase by 152% by 2031-32, to 1,787. These figures have been kept separate and are not included in the increases in overall nurse training places, but it is unclear why. They have been grouped with health visitor and qualified school nurse training plans.

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Picture credit: Daniel Mitchell

Expansion of apprenticeships

Alongside a dramatic increase in university places, the workforce plan also promises the biggest-ever expansion of NHS apprenticeships – particularly in nursing – to help cover workforce shortfalls. The boost in apprenticeship numbers is intended to help enable the increase in nurse training places and entice future nurses with the ability to earn while they learn.

The stated aim is to have 20% of registered nurses – or about 8,800 – qualifying through nursing apprenticeships by 2028-29, compared with 9% at present. This is broken down to represent 20% of adult nurses, 33% of learning disability nurses and 28% of mental health nurses. There is no planned increase for children’s nursing apprenticeships.

Further modelling in the plan indicates that by 2031-32 two in five learning disability nurses and almost one in three adult and mental health nurses could train via a degree-level apprenticeship route.

In a further bid to boost training numbers and get nurses into the workforce more quickly, the government has said it will work with the NMC on cutting the number of placement hours students need to qualify by more than 20%, from 2,300 to 1,800. It suggests this could reduce pressure on learners, while ‘significantly’ increasing placement capacity across the NHS.

But experts have warned that significant further work is needed to ensure these high training numbers are actually achievable.

British Association of Critical Care Nurses chair Nicki Credland said: ‘We need to think about how we attract the right people into the profession. Inadequate pay, a lack of bursary and poor working conditions are vital areas that need to be explored further, with transparency and integrity.

‘This all requires a huge financial investment, which has not been considered. Just saying we are going to increase numbers will not make it happen.’

Newman University head of adult nursing Kevin Crimmons told Nursing Standard clinical areas across most of the country had reached ‘saturation capacity’ for placements. He warned that unless the NMC reduces the 2,300 hours requirement, the system ‘would not cope’ with the large numbers of training places suggested.

‘It would appear the plan for increasing nursing numbers is contingent on the NMC regulating to reduce the placement hours requirement,’ he said. ‘It will take considerable time for the regulator to consult with stakeholders and revise the requirement.’

How many NHS nurses and nursing associates will be recruited and when?

Nurses

  • » The workforce plan for England pledges to recruit 170,000-190,000 more nurses by 2037

  • » The plan estimates this will take the overall number of nurses from nearly 350,000 at present to between 545,000 and 565,000 by 2036-37 – though in fact this total would be between 25,000 and 45,000 more nurses than would be reached with the 170,000-190,000 extra set out in the plan

Planned increase in nurse training places

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Nursing associates

  • » The plan pledges to increase training places for nursing associates (NAs) to 10,500 by 2031-32

  • » The government says it will work towards this by training 5,000 NAs a year in 2023-24 and 2024-25, increasing to 7,000 a year by 2028-29

  • » The plan estimates there will be more than 64,000 NAs working in the NHS by 2036-37, compared with 4,600 at present

Planned increase in nursing associates

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Source: NHS Long Term Workforce Plan tinyurl.com/NHS-long-term-workforce-plan

What is happening in Scotland, Wales and Northern Ireland?

The newly published plan only applies in England. Governments in Wales, Scotland and Northern Ireland are devolved, so decisions about health and care workforce planning are made individually.

A national workforce strategy for the NHS in Scotland was published in 2022, setting out the Scottish Government’s vision for the health and social care workforce in the country. It pledged to expand its NHS workforce by 1% – the equivalent of around 1,800 full-time posts – within five years. More than 4,000 nursing posts remain vacant in the country, according to RCN Scotland.

A similar plan was published by the NHS in Wales in February, in response to ‘significant additional demands’ on the workforce and to help ‘accelerate’ the country’s ten-year workforce strategy for health and social care, published in 2020.

Wales is the only UK nation not to publish data on nursing vacancies, but RCN Wales estimates the country currently has at least 3,000 registered nurse vacancies in the NHS.

Northern Ireland published its last workforce plan in 2018, setting out the government’s ambitions to 2026. Nothing more recent appears to have been published, most likely because the country does not currently have a functioning legislature. Latest data from the Northern Ireland Department of Health indicate there were more than 1,600 registered nurse vacancies in the health sector as of March 2023.

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The plan says district nurse training places will more than double

Picture credit: iStock

What has the reaction been?

While the workforce plan has been broadly welcomed for its pledge to increase the domestic workforce, health leaders and nurses alike have criticised it for lacking detail on how extra nurse training places will be delivered, and failing to properly address the retention of experienced staff.

Experts called for clarity on how much of the £2.4 billion of investment behind the plan will go towards the additional training numbers, as nursing students already struggle with self-funding their courses.

Questions have also arisen on where additional placement and clinical mentorship capacity to train new nurses and nurse apprentices would come from, with experienced nurses regularly leaving the NHS due to poor pay and burnout.

‘The NHS is haemorrhaging staff,’ Ms Credland says. ‘This reduces placement capacity and the ability to provide mentorship to existing students, let alone increased numbers. In addition, there does not appear to be any consideration given to the significant increase in staff required in higher education institutions to deliver the expert education required.’

Echoing these sentiments, RCN general secretary Pat Cullen said: ‘Targets alone will not deliver the staff that the NHS needs to be able to care for patients now. Nursing leaders would have wished to see greater reference to patient safety challenges and recognition of how current shortages are impacting staff and retention.

‘While expanding places is key, it requires the experienced nurses to support students. The responsibility to expand training must not fall on local health systems before central government addresses key issues like inadequate pay and funding.’

Some nurses also raised the point that student attrition rates were already high, with applications to nursing courses dropping in recent years.

Others questioned if paying an increasing number of nursing apprentices while nursing degree students continue on placements without pay was realistic.

There was also a startling omission of pay restoration in the plan, despite the NHS being plagued by strikes over poor pay and working conditions in recent months. Nurses suggest the government does not understand the issue of retention if it is not prepared to include increased pay in future workforce plans.

What about retention?

The plan mentions some retention strategies, such as improved flexible working options for those looking to retire and reforms to the NHS pension scheme so staff can partially retire or return to work and continue building their pension after retirement.

But these are already in place and the plan goes no further in addressing the worrying number of nurses leaving the profession before reaching retirement age.

It says: ‘With the support of their employers, this will enable a “decade of retirement” approach through which older staff can draw down their pension, work more flexibly and remain in the workforce longer.’

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Critics say the ambitious targets will rely on experienced staff training more students – but placement capacity is already overstretched

Picture credit: Barney Newman

‘This all requires a huge financial investment… Just saying we are going to increase numbers will not make it happen’

Nicki Credland, chair, British Association of Critical Care Nurses

There is also a commitment to ongoing national funding for continuing professional development (CPD) for nurses, and mention of improved childcare support announced by chancellor Jeremy Hunt in the spring budget. But it is lacking in detail on how these commitments would be implemented or how much they would cost.

The plan says CPD funding will be ‘kept under review’ to ensure any subsequent funding for it is in line with workforce growth and inflation.

NHS England chief executive Amanda Pritchard told the House of Commons Public Accounts Committee there were no ‘specific costs’ connected to the retention elements in the plan and confirmed that none of its £2.4 billion of investment would be put towards workforce retention.

Ms Pritchard said costs for elements such CPD were ‘not new money’ but re-confirmed, and that changes to pensions had not been costed in the plan as they were outside its scope.

What does the plan mean for those already in the workforce?

Since the plan’s main focus is on the long-term development of the workforce, nurses currently working in the health service will have to wait some years to see the results of the strategies outlined in it. Any changes to education will have to go through the NMC and could take several years.

It seems unlikely that the plan will have much positive impact on nurses’ working lives in the short term. If the ambitious targets are met, positive effects on the workforce will be evident in the next five to ten years, as new nurses qualify, but only if the government addresses the vast number of nurses leaving the profession as well.

As the plan does not outline exactly how the thousands of extra nursing places will be delivered, or include a strategy to retain experienced nurses, including pay restoration, it is difficult to see how it could improve nurses’ working conditions.

In the short term, the government claims it is already expanding the workforce, with almost 14,900 more nurses working in the NHS now than in 2022. The DHSC continues to insist it is on track to deliver 50,000 more nurses by 2024.

Find out more

NHS England (2023) NHS Long Term Workforce Plan

Can nursing degree apprenticeships help ease the staffing crisis? rcni.com/apprentice-increase

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