Equity, inclusion and wellbeing for the healthcare workforce of the future

It predicted that by 2036-37 the NHS will be left with a shortfall of between 260,000 and 360,000 staff.

The challenges and opportunities across the sector as a result of the NHS Long Term Workforce Plan, as well as the potential for increased equity in the workforce and the impact that could have on retention, were the key topics of discussion at Working Well in Healthcare: The Changes, Challenges and Opportunities for Developing your Workforce, an event held at Northumbria University on 18 April.

The scale of the workforce challenge

The scale of the healthcare workforce challenge, as set out by the NHS Long Term Workforce Plan, was made plain in a talk at the event by deputy chief nursing officer for England Professor Mark Radford, who is also national director of the NHS Long Term Workforce Plan delivery for NHS England.

“We’re going to have a lot of new people working in the service. And those people need supervision, advice, guidance and development”

Mark Radford

He said that to meet the estimated workforce requirements, necessitated by demographic change in the UK, the current figure of 1.4 million people working in the NHS in England would need to double over the course of the next 15 years to closer to 2.3 million. The Institute for Fiscal Studies estimate this will mean around 9% of the adult working age population in England working for the NHS, and when the adult social care workforce is factored in, this figure rises to 14%.

“So, the scale of this is really quite biblical,” Professor Radford said.

The number of registered nurses working in the NHS in England will need to grow from around 350,000 to over half a million. Many of these extra 200,000 registered nurses will be needed in primary care and community settings.

Professor Radford said that this growth would be funded by a “significant investment package”, including an additional £2.4bn that the government has committed to providing to fund the early stages of the plan, as well as £6.1bn already earmarked for healthcare training and education across the NHS.

Professor Radford made it clear that meeting the workforce targets would require significantly better staff retention across the NHS.

“The key issue, without a doubt, is obviously the retention of existing staff and talent within the NHS,” he said.

Experienced staff are going to be crucial to realising the long-term plan in two ways, he explained. First, because they are able to bring their experience when it comes to delivering health services in innovative ways and secondly because they can provide invaluable support when it comes to managing what Professor Radford called the “Rookie Factor”.

“We’re going to have a lot of new people working in the service. And those people need supervision, advice, guidance and development,” he explained.

In addition to the efforts to improve staff retention, he said that healthcare education and training within the UK would need to be significantly expanded to support the huge increase in workforce recruitment.

Under the NHS Long Term Workforce Plan the number of adult nurse training places will need to be increased by 2031-32 to a total of 58,000 nurse and midwife training places a year. And the number of medical school training places will have to be increased to 15,000 over the same period.

“That’s going to require a huge amount of work,” Professor Radford said, “to ensure the physical capacity – both for placements as well as at universities.”

He added that a second challenge around training and recruitment will be attracting enough people to do a healthcare degree.

The boost in applications to nursing and other healthcare training programmes that came about as a result of the Covid-19 pandemic has now normalised, with current levels of unique applicants only 2% higher than in 2019, Professor Radford said.

“We’ve got to really think about how do we attract people to universities? How do we ensure that those people who haven’t necessarily had the right chances before get the right support?” Professor Radford asked.

One way to bring more people into the healthcare workforce will be through reforms to degree programmes that will open them up to a wider range of applicants from more diverse backgrounds, Professor Radford said.

This will include an expansion of apprenticeship training programmes with the NHS Long Term Workforce Plan setting an ambition of 22% of all training for clinical staff to take place through apprenticeship routes by 2031-32, an increase from what is just 7% today.

The plan also includes the goal of training more NHS staff domestically so that reliance on international recruitment can be reduced.

“Both the NHS and social care have relied on internationally educated nurses for decades now,” Professor Radford said.

“We cannot carry on doing this. We should be developing meaningful careers for people here in the UK to come into our universities.”

He added that as the domestic supply increases, the reliance of the NHS and social care on internationally educated nurses will decrease, allowing the relationship between the NHS and the global nursing workforce to be “reset” so that there is a greater focus on international collaboration to address the global challenge of health inequalities.

“That reset relationship internationally is, for me, a really important part of what the Long Term Workforce Plan will do,” he said.

Professor Radford added that the poor experiences of a lot of internationally educated nurses within the health service also needed to be addressed, with statistics showing internationally educated nurses are more likely to suffer disciplinary and less likely to have career progression opportunities.

He said that this was an important “moral issue”.

“If we are going to continue to support these internationally educated nurses working here in the NHS we have to deal with and address some of the equity and diversity issues that exist,” Professor Radford said.

Workforce wellbeing – the significance of equity diversity and inclusion

Leadership, development and inclusive practice specialist Professor Laura Serrant was formerly the regional head of nursing and midwifery for NHS England’s Workforce Training and Education Directorate in the North East and Yorkshire region and is currently chair of Sheffield Children’s NHS Foundation Trust.

Laura Serrant

She said that many of the problems faced by internationally trained nurses stemmed from the tendency for them to be placed where there is greatest clinical need, without taking into account their experience and areas of specialty.

“These are really experienced people,” she said. “We need to think how we are placing them.”

In her keynote speech at the event, Professor Serrant said that a greater emphasis on equity and inclusion was needed to address the sorts of inequities, mentioned by Professor Radford, that are experienced by internationally educated nurses, as well as to improve the health and wellbeing of the healthcare workforce more generally.

“Belonging and inclusion in our education, our practice and policy is absolutely crucial for the survival of our profession,” she said.

She stressed that work towards improving equity, diversity and inclusion in the healthcare workforce should be considered an intrinsic part of healthcare quality, not just something extra that is “nice to have”.

“Without this we cannot safeguard our profession for the future because people won’t want to come. Because as we’re told from when we’re very young ‘don’t go where you’re not wanted’,” Professor Serrant said.

Professor Serrant also spoke about the importance of distinguishing between efforts made to promote equity and social justice versus those which are designed around the concept of equality.

She explained that while equality is about ensuring that everybody has the same going in, equity is about ensuring that everybody has a chance at the same outcome even if they start from different positions. Meanwhile social justice is looking at the root cause of inequities and attending to that.

“Ultimately what are we aiming for? I would say what we ultimately want is social justice,” Professor Serrant said.

“We have to think about impact, not just intentions,” she added.

“Whether we feel we belong is absolutely key to whether we stay,” Professor Serrant added. “That’s why it’s important that we optimise equity, inclusion and belonging, not just for ourselves but also for our professions,” she said.

In another keynote speech at the event, head of the Department of Nursing, Midwifery and Health at the University of Northumbria and chair of the Council of Deans of Health Professor Alison Machin agreed that fostering a sense of belonging was essential to the wellbeing of the healthcare workforce.

Professor Machin illustrated this with the findings of research she did more than 10 years ago looking at how health visitors’ sense of professional identity was affected in a time of significant policy change.

Her research showed that a strong sense of connection with others from the same professional group was fundamental to the sense of professional identity that healthcare staff need to thrive in new roles and situations.

What seemed to be important was that people from the same professional group had the opportunity to connect, talk about things and feel comfortable in their own professional role identity, Professor Machin explained.

Professor Machin said that this research finding was now more relevant than ever, with the current proliferation of new nursing roles and titles across the health services creating a sense of uncertainty around professional identity for some individuals.

In particular, she said. It was important for students doing clinical placements as transient team members to be made to feel that they belong.

“They need to feel not on their own, that they belong and are part of something,” she said.

“Having that strong sense of professional identity means people can go into an interprofessional multidisciplinary context and be confident about what their role is and what their contribution is,” she said.

Workforce training at the University of Northumbria

The department of Nursing Midwifery and Health is currently the largest at Northumbria University, with more than 600 nursing training places per year, as well as 189 allied health professional and 81 midwifery places.

John Unsworth

In addition to undergraduate courses, Northumbria also offers a number of alternative routes into nursing careers, such as degree apprenticeships.

Speaking about the programmes offered at Northumbria University, deputy pro vice chancellor for health and life sciences Professor John Unsworth said that the department had a “strong focus on widening participation” and was working to widen access to healthcare education to people from a more diverse set of backgrounds, for example through the development of a T-Level in health with a partner school in the North East.

“As a higher education institution, half of our students come from widening participation backgrounds,” he said. “We run a range of foundation programmes, which allow students to access higher education even though they might not have the formal qualifications that are usually needed to access it.”

He added that Northumbria University would also be playing its part to address the current and future workforce challenges, including by expanding the number of nursing and allied health professional training places by around 8% per year until 2030.

Northumbria University is also set to open a new education and research centre on its city campus in Newcastle. The Centre for Health and Social Equity (CHASE) will increase the capacity across a number of the university’s degree programmes, including nursing, healthcare, education and social work.

“CHASE will be a flagship centre for Northumbria University, which will bring together excellence in both research and education around health and social care, meeting the needs of multiple stakeholders and communities within the city,” Professor Unsworth said.

This hybrid event was designed specifically for senior leaders, HR and people workforce managers in the NHS, private and third sectors, in a bid to support and develop the next generation of nursing and healthcare professionals.

Through its continuing professional development (CPD) and workforce programmes, Northumbria University plays an important role in tackling workforce shortages and supporting NHS England to deliver on their plan.