Last week, NHS England published the long-awaited Long Term Workforce Plan, that had been due in the Spring of 2023. The plan is a significant step forward in reducing vacancies in the NHS and establishing a sustainable and robust workforce.
Though we welcome the plan, there are some key factors that have not been considered – here is our analysis of the plan.
International recruitment in the NHS
While we welcome the plan’s increased focus on training the next generation of UK-national clinicians, who will train them has yet to be considered. Students are already struggling to gain placements to complete their courses as services run on minimal staffing levels, and do not have the resource to dedicate to education. The chronic vacancies in Specialist and Consultant positions also hinder Junior Doctor’s abilities to progress.
We have long sung the praises of international recruitment – as well as providing an experienced workforce to begin tackling the mass vacancies the NHS faces across all specialties, international clinicians bring a wealth of knowledge and culture to the UK. The need for international recruits is increasing, as more and more clinicians leave the workforce to retire, move abroad themselves or leave healthcare entirely. It also allows services to move towards a more permanently contracted staff base, reducing bank and agency locum expenses – which hit record levels in recent years, with the Labour party finding the NHS spent over £3 billion on bank and agency staffing in 2022. The Long-Term Workforce Plan specifically refers to the need to reduce expenditure on temporary staffing, and international recruitment is an efficient way to do so.
As the plan details, the aging population in the UK is creating a higher demand on services, as patients’ needs are changing with increasing levels of multi-morbidity – leading to more complex care needs. The NHS needs a plan to not only fill its existing vacancies, but continually grow the workforce to ensure patients are able to access the care they need. International recruitment will play an essential part in this.
In addition to increasing retention, the Workforce Plan lays out targets for improving retention in the service. Following the 2022 NHS Staff Survey, in which 23.7% respondents reported that ‘they will probably look for a job at a new organisation in the next 12 months’, the service needs to prioritise retention. Recruitment is one element of this – with only 26.4% of respondents agreeing that there is enough staff in their organisation to do their job properly, and over 30% reporting feelings of burn out – the historic vacancies facing the service are severely impacting the working conditions of existing staff, which is in turn driving more people to leave the service.
Retention is key in driving recruitment, though it is not the only factor. The plan recognises and sets out steps to improve the culture within the NHS to improve retention. Managers and people professionals will have a continual role in driving an inclusive and values-driven culture that improves staff experience and thus retention. Career progression and training opportunities will also be key in improving retention.
With the most diverse NHS workforce in history – 25% of which now come from an ethnic minority background – the plan sets out to systematically improve retention and promotion processes, leadership diversity, disciplinary processes, governance and accountability, and training and education. This follows the equality, diversity and inclusion improvement plan set out by NHS England earlier this year.
In addition, there are notable reforms to pension structures, allowing retired staff to partially return to work or partially retire while continuing to build their pension. This is a significant step amidst the backdrop of the UK’s aging population.
Increasing routes into the NHS
One of the plan’s main focuses is the drive to increase routes into healthcare. The plan sets out to increase university places and apprenticeships for medical students. The plan also proposes reducing medical school by one year for doctors and by six months for nurses – though concerns have already been raised about the increased pressure this will put students under, and that key elements of medical training may have to be omitted from courses. It is hoped that this will materially reduce vacancies by 2028/9, as well as creating greater opportunity for people of all backgrounds, making the NHS a more inclusive place to work.
Though we welcome the increase in domestic training, it is crucial that the need for staffing does not detrimentally impact the quality of teaching, content of courses and the pressure students are under. Reducing nursing degrees by six months, for example, will require already stretched students to fit the 2,300 practice hours required to graduate into a shorter timeframe, risking students burning out and quitting before qualifying. Almost one quarter of students who began a nursing degree in 2019 did not complete it or did not complete it in the expected time – the plan does not take this level of attrition into account.
In addition, increasing the number of places available on university courses does not necessarily mean there will be an increase in those accepted onto courses – there is a difference between applicants and acceptances. There has also been a steady decline in the number of nurse course applications since 2017, with the anomaly of the increased applications during the pandemic. Even if there are more university places, there may not be the students to fill them. Incentives, such as the bursary for nursing students that was reintroduced in 2017, did not increase the number of nursing applicants the previous year, and with public perception of working in the NHS amidst the backdrop of the industrial action that has become a theme of 2023 at a low, it seems unlikely that there are enough students to fill courses.
There are also concerns that if universities are forced to fill their courses, they may have to lower their entry requirements or rely on clearing. Statistics from the 2018 application cycle, and seen as a general trend across several years, show that those who enter a nursing degree via ‘clearing’ – the system universities use to fill spare places on their courses after applicants have confirmed offers – are more likely to drop out without completing their studies.
Domestic training is a key element of building a stable and robust workforce – though international recruitment will continue to be necessary to achieving safe staffing levels. With historic vacancies, it will prove difficult to introduce apprenticeship schemes as already under-resourced departments will not be able to devote the necessary resource to training and education. By filling existing gaps, international recruitment will be pivotal in supporting the next generation of healthcare professionals.
The NHS needs to evolve to be ‘fit for the 21st century’ – this means deploying digital solutions where appropriate to streamline diagnostics, care delivery and administrative processes. AI is being trialled in diagnostic support and administrative automation, though it is expected its impacts could go far beyond this. The potential for digital solutions to increase efficiencies across care and administrative processes is huge. Digital will also play a big role in joining up care – making sure that up-to-date patient records are available at every touch point in their care journey. Enabling safer, and easier, sharing of clinical information will help ICS’s plan care needs accordingly, as well as ensuring patient care is delivered as efficiently as possible.
While the plan focuses on digital solutions for optimising clinical and administrative processes, digital solutions can also be used to assist in the retention and recruitment of new and existing staff. Retention is a huge focus of the plan, and is instrumental to the continued knowledge sharing, high clinical standards and capacity of the NHS. Retention, especially of overseas recruits, can prove a challenge. The journey to the NHS is often long and requires a lot of administration for both clinicians and their new employers, leading to some dropouts. Digital solutions can help clinicians make the journey to the NHS easily, while also reducing administrative burden on trust teams.
Overall, the Long Term Workforce Plan sets out an ambitious goal for a fully staffed, digitally enabled and fit for purpose service. It is clear that recruitment and retention are at the heart of delivering this – and international recruitment remains a key strategy in achieving this. What remains to be seen, however, is a clear action plan, key milestones, and a fully comprehensive funding plan. The plan also needs cross party agreement – with a general election due in the next 18 months, the plan could be in a precarious place should the opposition come into power.
If you are interested in learning more about our international recruitment model, or would like to discuss the plan further, please get in touch with us.