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The Ward Round: In search of bold policy

Published on: 5 Oct 2023

Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce.

Rishi Sunak hammered home the government’s expectations around the long-term workforce plan and NHS productivity in his Tory conference speech this week.

Although it wasn’t quite an ‘education, education ,education’ moment, not once but twice the prime minister emphasised how the plan would “drive up productivity” and “enable the NHS to work as productively as anywhere in the world” – a reminder of the challenging quid pro quo attached to its (five-year) investment.

According to the plan, the 2 per cent rise in productivity hinges on investment in estates and technology and, earlier in the conference, Steve Barclay announced a £30m cash injection to “speed up the adoption of tech in the NHS”.

Considering the overall NHS tech budget is around £2.5bn over the three years from 2022-2025, this is a drop in the ocean. As King’s Fund director of policy Sally Warren highlighted, productivity gains from technology and artificial intelligence rely on a workforce with the right skill set and time to “implement innovations”.

She also warned £30m “will not cut the mustard of what’s needed overall in terms of capital investment for buildings and equipment in the NHS – with the latest data showing that the maintenance backlog has reached over £10bn in 2021-22”.

The investment is welcome, of course. However, if the NHS is not given the tools it needs to hit the demanding 2 per cent labour productivity target set out in the plan, the impact of the forecast 300,000 extra clinicians will be all but cancelled out.

Poor pipelines

A common criticism of the workforce plan is its lack of detail around improving staff retention and reducing the attrition rate of clinical staff in training. The Nuffield Trust recently explored the latter point in a deep dive on strategies to improve the supply of clinical staff to the NHS.

“For too long, the domestic training pipeline for clinical careers has not been fit for purpose,” the authors argue, reporting that around one in five nurses, occupational therapists, physiotherapists, and radiographers have left NHS hospital and community settings within two years.

It also highlighted that a “notable proportion” of students drop out of their degree programme, with financial, academic, workload and placement factors all commonly cited.

The report acknowledges the long-term workforce plan sets out proposals that could decrease attrition rates, but warns any gains rely on “an already overstretched NHS implementing these policies well”.

In light of these findings, the Nuffield Trust calls for “bold policy making” and sets out a 10-point plan to increase applications to study, reduce attrition during training, and improve participation and retention in public services.

Among its recommendations is that the government should commission an independent review into degree-level apprenticeships – considering the “strong commitment” to them in the long-term plan and the poor data available – and evaluate models used in other countries to improve participation. For example, the Irish and Australian preceptorship model gives a period of structured support to newly qualified practitioners during the transition from student to clinical professional.

In its most radical proposal, the Nuffield Trust also says introducing student loan forgiveness is “a compelling policy” and would provide a “substantial financial incentive” for students to choose clinical education.

The report suggests there are other potential equality benefits, as nursing, midwifery and allied health professionals are disproportionately negatively affected by the loan repayment system and the burden of student debt puts people off applying for clinical higher education.

The Nuffield Trust predicts loan write-off would cost around £230m per year for nursing, midwifery and AHP graduates but adds this is less than the amount to be saved by the Treasury through the incoming changes to the student loan repayment scheme – and suggests it could be expanded to doctors at a cost of around £170m per year.

Considering the vast increase in training numbers and the fact “more investment from the public purse is at stake”, the Nuffield Trust is clear: plugging the gaps in the domestic pipeline is overdue, and essential.