A “once in a generation” NHS recruitment plan requiring an extra 50,000 clinical training places in less than a decade risks being derailed by difficulties in finding enough applicants and a shrinking number of staff to teach them.
A new analysis seen by the Observer reveals the sheer scale of the proposed increase in NHS staff implied by the government’s long-awaited workforce plan, unveiled at the start of the summer and given a broad welcome across the NHS.
The proportion of first-year higher education students in England training to be NHS clinical professionals would need to increase by 50%according to said the Health Foundation thinktank.
Such students represent one in nine of all first years at university, but that number would need to rise to one in six by 2031-32 - increasing from 76,300 to 125,700 places.
The new analysis states that it will require a massive and rapid increase in applicants, housing, training staff and training placements to accommodate them all. However, it notes that the number of 18 to 24 year olds is also projected to grow, which should help boost recruitment.
While there is strong backing for the plan, NHS and university insiders are all concerned that the pressures on the NHS, as well as the conditions for staff, will make it very hard to attract the necessary numbers.
The latest round of strikes by junior doctors, a four-day walkout, continues this weekend.
There are also concerns that the workforce needed to actually train the students is on course to shrink.
Under the plan, nursing and midwifery training intakes would increase by about 32,000 by 2031-32. However, official figures from June show a 16% drop in nursing applicants.
Pat Cullen, the general secretary of the Royal College of Nursing, said ministers had to “show the next generation that being a nurse is worth it” to make the plan work.
“Simply too many are put off joining a great profession because they will be saddled with high student debt and offered a low salary – not just once qualified but in return for years of service too,” she said.
“Nursing staff received real-terms pay cuts for over a decade and there are now record unfilled nurse jobs. The plan will not work – improving care by boosting staffing levels - if we do not urgently see proper funding and greater clarity on how they intend to make laudable aims a reality.”
Saffron Cordery, deputy chief executive of NHS Providers, which represents health service trusts In England, said it was still unclear where the extra capacity would come from and that the departure of existing staff remained a problem.
“The lack of detail on retention is also worrying due to the high turnover of existing staff, including senior colleagues who teach and supervise trainees,” she said. “Trust leaders are very concerned about the lack of clarity on how this plan will be funded. There isn’t much allocated for many of its ambitions, while a lot of the funding that is referenced is pre-existing.”
Dr Katie Petty-Saphon, chief executive of the Medical Schools Council, also called for clarity on funding and raised concerns about the size of the clinical teaching workforce.
James Hallwood, head of policy at the Council of Deans of Health, said that challenges had already emerged in retaining some students as a result of rising living costs: “Challenges in student recruitment – and retention, especially during a cost of living crisis – will need to be addressed as a priority.”
John de Pury, assistant director of policy at Universities UK, said attracting enough applicants would be a challenge. “At the moment, we’ve had two years of dips in applications to [nursing, midwifery and allied health professions] courses,” he said. “We can still recruit enough for current numbers, but can we recruit for the expansion?”
Nihar Shembavnekar, an economist at the Health Foundation’s Real Centre who conducted the analysis, said the plan was “rightly ambitious’, but its main implications now needed to be hammered out. “Boosting healthcare training places is vital to address chronic staff shortages and meet the future needs of the NHS, but it is just as crucial to improve staff retention,” he said.
A Department of Health and Social Care spokesperson said the “first ever” NHS long term workforce plan demonstrated “our commitment to support and grow the workforce and is backed by over £2.4bn over the next five years to fund additional education and training places, including doubling the number of medical school places”.
They added: “Healthcare courses were in high demand during the pandemic and while this has rebalanced, we are still seeing strong demand, with the latest applicant numbers for nursing and midwifery courses still 12% higher than in 2019, and thousands more applicants to study medicine than there are places available.
“There are record numbers of staff working in the NHS to help train students, with almost 6,000 more doctors and over 15,200 more nurses than last year.”