Crucial details are missing from the NHS Long Term Workforce Plan around retention and pay for both nurses and doctors, health leaders have warned.
At a session of the UK Health and Social Care Committee held today, leading figures representing nurses, doctors and health trusts were asked their thoughts on the plan, which was – after much delay – final unveiled around two weeks ago.
“We have a workforce which is depleting”
Patricia Marquis
Patricia Marquis, England director for the Royal College of Nursing (RCN), attended representing the nursing profession, and told committee chair Steve Brine that pay “has to be there” in any plan for the future of the NHS workforce.
Ms Marquis said the plan was full of “good aspirations”, but that it was lacking detail, particularly around retention and how ambitious targets to increase student nurse numbers would be achieved.
The 151-page document NHS workforce plan, published on 30 June, laid out the current scale of the staffing challenge facing the health service, and proposals by NHS England and the government for addressing it.
Among the plan’s promises was £2.4bn towards healthcare education over the next five years and an almost doubling of nursing student places, across traditional degree and degree apprenticeship courses, by 2032.
More on the NHS workforce plan
A segment of the plan about retention also made pledges including improvements to flexible working and occupational wellbeing.
Mr Brine asked Ms Marquis what she made of the plan regarding retention.
She said the plan was trying to solve a retention crisis with recruitment, adding: “Pay has to be there.
“There are some good aspirations but they’re aspirations which have been around for a long time.
“What’s lacking is granular detail, a plan on retention is absent. There are some lofty aspirations.”
Ms Marquis referred to the promises around flexibility, particularly for new mothers, and said such discussions had been ongoing for over a decade.
The workforce plan has set a target of a 34% increase in nurse training by 2028-29, with 20% of these qualifying through apprenticeship routes.
By 2031-32, the plan is aiming for an 80% boost in student nurses overall (28% through apprenticeships), with a 92% increase in adult nurses as part of that.
The select committee asked Ms Marquis for her reflections on how realistic she saw these goals.
Ms Marquis said that increasing spaces for nurse training was one thing, but attracting enough applicants to fill the places was another.
“The plan doesn’t address this,” she said.
“We’ve been calling for the return of the bursary, and to improve the mechanisms in place to make nursing training more attractive.
“How we intend to double the places? There’s no evidence to demonstrate how.”
Ms Marquis explained that improving retention was essential, should the plan go ahead and successfully bring on board more students.
“If we did get an influx, we need more people already here to support them on placements,” she added.
“We had a student who pitched a tent outside a hospital because their placement was too far from their accommodation”
Alex Whitfield
“That’s a big issue. We don’t have, like doctors, a system of trainers, and we have a shortage of educators in the university sector.
“We have a workforce which is depleting which we’ll need to support all these students.”
She said she “absolutely welcomes” apprenticeship degrees to widen participation, but that the position of the RCN was that improving access to traditional degrees was crucial, too.
“We still fear a two-tier system approaching,” said Ms Marquis, who warned that an increase in apprenticeship degrees without further financial support on traditional degrees would create a divide.
As well as this, having trained via an apprenticeship herself, Ms Marquis aired worries about the pressures apprentices would face out in practice.
“I trained on an apprenticeship scheme, and I speak from personal experience about being put in positions way out of the scope of what I should have been doing, with the education and supervision I had,” she said.
“When we’re talking about such a significant increase in apprenticeships in the pipeline, this becomes a real, real worry for us.
“And there’s nothing in the plan about this, and it hardly even mentions the current concerns we have about patient safety.”
She reiterated her feeling that the retention section of the plan was too vague, and contained gaps.
Alex Whitfield, chief executive of Hampshire Hospitals NHS Trust, said that, in her area, applications for traditional nurse degrees was falling whereas “we’re over massively oversubscribed by people who want to do nursing apprenticeships”.
She agreed with the ambition of increasing capacity for nurse apprenticeships – on the condition it was supported by investment for trusts and providers.
Meanwhile, she said action was needed to improve support for student nurses on traditional programmes, citing concerns about attrition rates.
“We work with Winchester University and ask them why students drop out, and they say it’s often financial reasons and placements,” she said.
“We had a student who pitched a tent outside a hospital because their placement was too far from their accommodation.
“We’re trying to address this, but it’s really difficult.”
On apprenticeships, Ms Whitfield said that increasing capacity would require more money for trusts to use to cover gaps in rotas, allowing for staff to focus on training.
Investment for this was not mentioned in the workforce plan.
Representing doctors at the select committee were Professor Kamila Hawthorne, chair of the Royal College of General Practitioners (RCGP), Adam Kay, former NHS doctor and author of bestselling book This Is Going To Hurt, and Charlie Massey, chief executive of the General Medical Council (GMC).
Mr Kay echoed Ms Marquis’ disappointment about pay not getting enough attention in the plan.
“It’s borderline laughable that pay gets not a single sentence”
Adam Kay
He said: “When I left [medical practice] in 2010, I was earning a quarter more in real terms than staff are today.
“It’s not unreasonable for doctors now to want an equivalent to what I had back then.
“We have this big, long report, but [pay] is one reason people are leaving and it’s not mentioned.”
Reflecting the views of others, Mr Kay described the retention section of the plan as “achingly vague”, adding: “I don’t know what’s being proposed to retain all these doctors.
“The biggest thing I can see is this emeritus doctor scheme, that’s not retention, that’s resuscitation.
“What are we actually doing to keep the staff in? Wellbeing is big but so is pay.
“It’s borderline laughable that pay gets not a single sentence, it needs to be acknowledged. You can’t have two pages on AI and not a single sentence on pay.”
Professor Hawthorne said GPs had been looking forward to such a plan for 15-20 years, and that something to address retention in primary care was long overdue.
“What we don’t see enough on is retention,” said Professor Hawthorne.
“We’re losing them faster than we’re gaining; we lost 930 full time equivalent (FTE) last year.”
Select committee member Paulette Hamilton asked Ms Whitfield and Ms Marquis whether they agreed with her assessment that the workforce plan was a “missed opportunity” to incorporate social care.
Ms Whitfield said she “couldn’t agree more” that social care nurses, and other staff, should be included in future health workforce planning.
Ms Marquis added: “It’s a complete missed opportunity. We’ve waited a long time, and we know around a third to half of nurses in the UK work outside the NHS and this plan misses that entire workforce.
“What is missing, too, is accountability for the delivery of the plan more broadly.
“We have this national plan, but it’s not clear on who is responsible. It pushes much of it down to integrated care boards, which is probably good in most cases, but a lot of the things which the plan says needs to happen isn’t within their control.”