How much credit can a Government a year or so out from an election get for a plan to fix the NHS’s staff shortages in 15 years time? We will find out next year, one must suppose.
Rishi Sunak has hailed the unveiling of the NHS Long Term Workforce Plan as “one of the most significant announcements” in the Service’s history and perhaps it is. There is certainly some good stuff in it:
“The 15-year blueprint, devised by the NHS and backed by ministers, will involve doubling medical school places in England from 7,500 to 15,000 and investing an extra £1 billion in training medical professionals beyond the next election, according to reports.”
But it is funny how much of the proposal seems to be about trying to remedy an entirely self-inflicted wound: the drag that degrees put on recruiting medical staff.
Speaking to Laura Keunssberg on Sunday, the Prime Minister said the plan will “draw on the latest innovations and techniques to streamline the process from classroom to clinic.”
This matters because in itself, an expansion in training places won’t necessarily change the economic logic which drives foreign recruitment. As I wrote in a previous piece on nursing in December:
“Unfortunately, schooling is not the only bottleneck choking the supply of domestic nurses to the NHS. Once you graduate, you then need to get a training placement – and as the cost of these comes directly out of the NHS budget, they are inevitably in short supply.
“If your focus is on pounds and pence, as the Treasury’s is, this does make sense. Why invest scarce resources – and NHS resources are always scarce – in a British trainee, who will take many years to become a fully-trained part of the Service, when you can recruit a qualified nurse from the Philippines who can start at once?”
Presumably, a concomitant expansion in training places will be part of the plan – an all-too-rare example, on paper, of actually tackling the structural causes of the UK’s dependence on imported labour.
But remember that this is a nice idea projected over a decade and a half. It is easy to promise to do things in 15 years’ time. It is much harder, year on year, amidst mounting budget pressures, to resist the temptation to resort to the short-term fix – in this case, spending the money on fully-qualified nurses from overseas with lower wage expectations.
Moreover, why not be bolder? If the idea is to shift the Health Service towards in-work learning, it might need a stronger push. As the Sun on Sunday noted, in its article accompanying Steve Barclay’s op-ed, of the introduction of degree apprenticeships for nurses and doctors in 2016 and 2017:
“They let recruits earn while training and help plug vacancies in the NHS more quickly. While hugely popular with No 10, most nurses and doctors still come via the more expensive and slower university route.”
As I noted in the above-linked nursing piece, there is actually fierce debate about the value of the slower and more expensive university route – perhaps not surprising, given that nursing degrees don’t actually equip graduates to be practising nurses (hence each and every one needing a training contract).
Ann Bradshaw, a retired senior nurse and senior lecturer in adult nursing at Oxford Brookes, has written scathingly about the impact of the decision to turn nursing into an academic qualification (“motivated by a desire to increase the status of the profession – not to improve patient care”) on the NHS:
“This was calculated by the National Audit Office in 1992 as £580 million for extra staff to do work previously done by students (now supernumerary) and £207 million to support colleges introducing the new system.”
Isn’t there the shape of a solution there? A much more ambitious (perhaps wholesale, where possible) shift back into apprenticeships and in-work learning would make the student body available to the NHS much more swiftly and consistently, notwithstanding any other improvements.
It would also make it much easier to justify subsidising their training. At present, the sheer cost of medical training means that the state foots most of the bill, even with students paying fees. Yet there is nothing to guarantee that this investment sees a return to the nation: expensively-trained British medics can, and do, take up more attractive postings overseas.
(Such an approach would also show that the Government is serious about vocational learning; there is something rather half-hearted about touting apprenticeships that still need ‘degree’ tacked on.)
In his Sun on Sunday piece, the Health Secretary writes that: “Despite the huge scale of its workforce, I know there are problems with vacancies, workload, and we rely too much on recruiting people from abroad.” (It’s about one in six.)
A major expansion in school (and training) places is a good start towards solving that. If it happens.
But given the mounting pressures on the Service over the next couple of decades that he alludes to elsewhere, it is difficult to see from here how that ambition will withstand the inevitable budget pressure in the other direction; it will always be tempting to pay less for fully-qualified staff, and difficult if not impossible to match the attractive offers luring British medics to foreign postings.
A Long Term Workforce Plan is a nice idea. But British politics lives, year to year and spending round to spending round, in the short term.