Have your say on building the NHS workforce

Health Education England is consulting on draft proposals to cope with increasing demand and a ‘significant shortfall’ in staff.

Health Education England is consulting on draft proposals to cope with increasing demand and a ‘significant shortfall’ in staff.

Picture: Getty


Nurse leaders are being asked to help shape the latest strategy for recruiting, training and supporting the health service workforce in England as the NHS approaches enters its eighth decade.

Health Education England (HEE) is promising a workforce strategy, the first in more than 25 years, and expects to publish it in the summer to coincide with the 70th anniversary of the foundation of the NHS.

It has published a draft version, Facing the Facts, Shaping the Future, and is now seeking feedback on its proposals by 23 March 2018. To take part in the consultation, go here.

The formulation of the strategy comes as the health service battles to recruit and retain staff, particularly nurses.


number of nursing and midwifery vacancies in the health service

Source: HEE

HEE says the draft takes ‘an uncompromising’ view of the scale of the clinical and non-clinical challenges across all parts of the workforce. It states that, while the NHS is employing more staff now than at any time in its history, it cannot keep up with increasing demand as the population expands and grows older.

The draft review acknowledges there is a ‘significant shortfall’ in staff, pointing out there are about 36,000 vacancies in nursing and midwifery. It also highlights well documented retention problems and notes that 8.7% of the workforce left NHS employment last year for reasons other than retirement.

HEE chief executive Ian Cumming says the strategy must be a watershed in how the NHS is managed. ‘Continuing with a business as usual approach is no longer sustainable. There needs to be a major shift in the ways we plan in order to make sure we can meet the health needs of the country’s population.’

The strategy puts forward a range of solutions, initiatives and calls to action under six over-arching principles:

  • Securing the right supply of staff.
  • Investing in training and education.
  • Developing career pathways.
  • Improving access for people of all backgrounds.
  • Intertwining financial and workforce planning.
  • Making the NHS a model employer.

Retention support

For nurses, the draft strategy sets out a number of steps. These include the expansion of the return-to-practice scheme, which has seen 2,500 nurses complete refresher training since it was launched in 2014. The goal is to have 1,000 joining up each year from now on.

Meanwhile, efforts will be made to encourage European nationals to remain in the NHS by ensuring a streamlined, user-friendly service for obtaining settled status. Under the Brexit deal agreed in December, this system will allow those who have been resident in the UK for five years or more to continue to work and live here.

Coupled with these two initiatives is the on-going retention support programme being delivered by NHS Improvement across acute and mental health trusts. This includes bespoke support and retention masterclasses for directors of nursing and human resources.


proportion of nurses left the NHS last year for reasons other than retirement

Source: HEE

HEE says discussions are also under way about running a national recruitment campaign similar to those in the past for teachers and members of the armed forces.

This campaign is intended to complement moves under way to increase the number of training places by 25%­ and the number of routes into nursing through the apprenticeships and nursing associate schemes.

For nurses working at a senior level, HEE says it will explore introducing a suite of national post-graduate standards in research, education, clinical practice and leadership to go alongside the national advance clinical practice framework that has been drawn up.

The draft strategy states that together these steps should create a ‘careers not jobs’ culture that will help ensure that people are attracted to nursing and stay in the profession over the next decade. This will be critical, HEE says, because, unless rising demand is curbed, the clinical workforce will have to grow by 190,000 by 2027.

Long-term view

NHS Providers chief executive Chris Hopson says the draft is a ‘sensible and constructive start’.

‘This is the first time the NHS has taken such a long-term view. It’s one that’s definitely needed.’ But he fears there are ‘significant omissions’ that need to be addressed. These  include a clearer commitment to overseas staff, which will be essential if gaps in the workforce are to be avoided short term.

RCN chief executive and general secretary Janet Davies says the jury is still out about how effective the measures to boost the number of domestic training places will be. She points out that student numbers are ‘not increasing’ after the removal of nurse bursaries, and that there is still a ‘workforce crisis’ despite the efforts being made.

‘It is the single most important issue facing health and social care today,’ she says.


Number of extra clinical posts needed by 2027 unless rising demand is curbed

Source: HEE

RCN nurses in management and leadership forum chair Sally Bassett agrees that problems remain, pointing out that pay is a ‘crucial issue’.

Ministers have announced the pay cap is to be lifted but staff are still waiting for news of what the rise should be. But Ms Bassett says that, despite the problems, there is still much that nurse leaders can do individually. Indeed, this is recognised by the draft strategy, which lists the most important principles needed to create the right working environment: from good line management to the importance of flexibility (see panel below).

‘A strategy alone cannot address all the issues,’ says Ms Bassett. ‘As individual leaders, managers and colleagues, we can influence the workplace experience through the way we choose to behave, respond and interact with each other and in doing so set the tone and standard of the type of professional environment in which we want to do our job and train the future workforce.’

How to create the right working environment

The draft strategy makes it clear that individual leaders have a crucial role in creating the right environment for staff. It lists five principles in particular:

  • People naturally like working in teams, but must know their place in them.
  • There needs to be good line management, clear objectives and a shared sense of purpose.
  • The working environment must be clean, modern and equipped for safe and effective care.
  • Staff must have support to look after their own mental and physical health, while being protected from violence, bulling and harassment.
  • People value the flexibility to manage 'work-life balance', not having to make choices between professional and personal commitments.

To help develop leadership skills, the strategy says NHS Improvement and the Leadership Academy will work together to deliver support for ‘the next generation of nurse directors’.

NHS Improvement executive director of nursing Ruth May says making sure the health service is a good place to work is essential. ‘Patients deserve good quality, reliable care that meets their needs, and the best way of achieving this is via the service’s talented and dedicated staff. Locally and nationally we have to make it easier for our staff to want to do this for the long term.’

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