‘Radical’ changes needed to meet NHS workforce plan

Nursing leaders have discussed how the “wonderful ambitions” of the NHS Long Term Workforce Plan can become a reality.

Professor Jane Ball, professor of nursing workforce policy at University of Southampton; Liz Fenton, deputy chief nurse at Health Education England; and Lisa Plotkin, head of policy and influence for the Florence Nightingale Foundation, spoke at the Nursing Times Workforce Summit 2023 about how to implement the plan in a way which best bolsters the nursing and midwifery workforce.

At the event, held today, the nursing leaders spoke about their views on the viability of the plan, which was released earlier this year.

"There’s need for massive expansion and it’s good to see that vision set out"

Jane Ball

Professor Ball said nursing needed a huge amount of expansion at all levels from what was currently a “very, very low baseline”, and said that student recruitment alone would not be enough.

According to data published in the workforce plan, the UK has (as of 2021, the most recently-available figures) around nine nurses per 1,000 people, compared to 15 in Ireland.

Professor Ball said this comparison showed the UK must “radically” expand the nursing workforce’s size.

“Nursing workforce planning has not traditionally been done very well in this country, and we bear the scars of that,” she said.

“There’s need for massive expansion and it’s good to see that vision set out [in the plan].

“For me, it’s symptomatic of not truly valuing nursing and the registered nursing workforce; when budgets were tight in 2010, we cut 10% of nursing places [on average across the UK’s regions].”

She said nurse shortages had, in the last 13 years, then been allowed to grow, and that the plan – if it is to succeed – must plug this gap with enormous investment in training more new nurses.

However, Professor Ball continued, how far the training investment will go will depend on whether commissioning matches the influx of newly graduated nursing students, and if capacity in universities can match the vision in the plan.

The professor of nursing said that “flooding the market” with trained nurses is just the beginning of what must be done to meet the ambitions of the long term plan.

She pointed to a previous plan to train more health visitors, which succeeded – but did not lead to all of them being employed.

“We must look at how we will ensure [the new nurses] are employed,” she said.

“How does this supply vision translate into the raising of staffing levels in each and every NHS organisation?

“[We must ensure] trusts have the resources to increase the number of posts, and actually increase staffing on the ground.”

The plan also contained targets for a huge increase in clinical support workers, such as healthcare assistants and nursing associates.

While supportive of this, Professor Ball said she was “concerned” about how this increase would be approached – adding that there was “no substitute for registered nurses”.

She said: “We cannot substitute but very much welcome an augmentation of the workforce; registered nurses need good support.

"But that support must be looked after well. And at the moment, [there are] big inconsistencies with how the support workforce are trained, what knowledge and skills they have and how fairly they are paid."

Meanwhile, Ms Fenton described the UK Government’s 50,000 new nurses by 2024 target – which has broadly been met – as a “good foundation” on which to begin implementing the “much more ambitious” goals of the long term plan.

She said that, in her view, one way to help meet the high recruitment targets for universities would be to recapture the positive public view that nursing held during the height of Covid-19.

“We all saw the growth in [university] applicants over the pandemic when there were positive role models of our professions in the media,” said Ms Fenton.

Referring to the potential for more positive media around the profession, she added: “We can think about what can an individual can put into the NHS, but [also] really promote what the NHS can do for you.”

Ms Plotkin said her organisation had received the plan well, but that it was a missed opportunity for the NHS to lay out a strategy to better retain internationally educated nurses.

The plan focuses on the domestic nursing workforce supply, but, Ms Plotkin pointed out, still forecasted high levels of international recruitment until 2030 at the earliest.

“We need to do something to address the high attrition rate among our internationally educated colleagues,” she said.

“It is our plea to integrated care boards to prioritise this.”

She added that the ambitious goals surrounding nurse and midwife numbers would require the “recruitment drive of a lifetime”, and that FNF would like reassurance that standards would not drop.

Ms Plotkin also mentioned the need to ensure the digital aspirations of the plan were built with nursing in mind.

“There is a huge sense of optimism [about the plan], but a real plea to please unite and focus on the areas we can make tangible progress on now,” she added.

“I’m really glad it can be iterated in two years’ time, so some of the challenges that we talked about today we can get right in the next version.”