‘Tinkering won’t deliver the vast increase in student nurses required’

On 7 November 2023

On 25 October, the APPUG convened health and education leaders to examine the role of universities in the NHS Long Term Workforce Plan.

Following the reception, Professor Alistair Fitt, chair of Universities UK’s Health Education and Research Policy Network, and vice-chancellor of Oxford Brookes University wrote on op-ed originally published by Nursing Times.

For the first time in decades, the nation’s health and wellbeing is in reverse.

Rising numbers of patients with multiple conditions, an ageing population, long-term illness, and growth in mental health problems, are placing huge strain on healthcare.

At the same time, many challenges weigh on the NHS as it tries to recover from the Covid-19 pandemic.

Foremost is workforce; year on year the NHS is beset with critical staff shortages. In March 2023, there were at least 112,000 vacancies across the NHS workforce – a number that does not even account for soaring increases in agency staff.

There is a retention crisis, clinicians retiring early, moving abroad or leaving healthcare altogether while healthcare students are dropping out of university or quitting early in their careers, leaving the NHS understaffed and under strain.

We compensate by recruiting internationally, with only half the nurses, midwives, and nursing associates and two in five doctors registering in this country in the last year trained domestically.

Health service managers have little option but to plug gaps with temporary and overseas staff at huge expense to the UK taxpayer and, at times, impacting on the continuity of care and depriving other nations of staff.

Politically, there is widespread support for the biggest training expansion in NHS history through the Long-Term Workforce Plan.

It is a priority for Labour, and the UK Government has pledged £2.4bn over five years to fund additional education and training places. Universities helped shape this plan and we are working with NHS and government to deliver it.

Tinkering around the edges of the current system won’t deliver the vast increase in healthcare student numbers required.

To achieve real change, we need bold thinking, cultural and structural reforms, as well as more money, to transform the system so that it is truly geared up for learners.

What needs to change? Firstly, we must reverse the declining numbers applying to health courses, then we need the clinical teaching staff, facilities, and technology to teach them, as well as enough practice placements.

Finally, we need to prevent healthcare students dropping out of university or early in their careers because of cost-of-living pressures or mental health.

For too long, students and trainees have been undervalued by the health service. This must change if the NHS is to survive and thrive.

Success also depends on closer working at a national and local level between health and education leaders. Vice-chancellors are up for the challenge.

Today, we are building on discussions with NHS England by publishing a series of recommendations to improve healthcare education in England. Let me give you three examples.

Firstly, a new approach is needed to recruit and retain talent from a more diverse range of backgrounds.

We know that health students have been hit hard by the escalating cost of living. The recent announcement of additional government support does not go nearly far enough.

At my university, Oxford Brookes, we have high retention rates on our healthcare courses by offering intensive student support throughout our courses, and into careers. But there is retention issue elsewhere in the country.

The expansion of degree apprenticeships, allowing students to earn while they learn, could attract more students from different backgrounds and varied life experiences.

But government must tackle the regulatory and administrative burden making health apprenticeships so complex and difficult to run.

Secondly, there is an urgent need for the NHS to work more closely with universities on the rapid expansion of placements.

These are an essential part of most healthcare courses, and their limited availability restricts the number of healthcare students.

Diversifying placements in community settings such as care homes and schools, as well as increasing hospital placements, would grow numbers while familiarising students with different environments, experiences, and roles.

Thirdly, we need to make the most of robotics, artificial intelligence and immersive technology to transform training.

At Oxford Brookes University, new technology, funded through a £2m grant from the Office for Students, allows students to step into the virtual reality of hospitals, patients’ homes and GP surgeries, to gain invaluable experience of different care situations.

To make this type of technology more widely available requires investment at time when many university budgets are stretched by the drop, in real terms, in domestic teaching income.

The NHS, with its founding principles of free care for all, makes us proud to be British. With the right conditions, universities can help the NHS be in good shape for decades to come.