The NHS is facing an unprecedented workforce challenge. Demand is rising at the same time as jobs are becoming harder to fill. It’s estimated the health service – the country’s biggest employer – will need to expand from providing jobs for one in 17 people to employing one in 11 by 2036/37 to keep up with demand.
As well as tackling retention rates – 11.2% of hospital and community health staff left in the year to June 2023 – NHS leaders will also need to consider how to build the talent pipeline. News that applications to study nursing have fallen 26% over the past two years, for example, recently prompted the head of the Royal College of Nursing to write to the health secretary, warning of the “direct threat to the sustainability of the NHS”.
“It’s easy to look at the immediate issues in the NHS, such as how much we’re paying NHS staff. But we need to be thinking about where we’re going to recruit our students from,” says Prof Liz Mossop, vice-chancellor of Sheffield Hallam University. “There has been a drop in healthcare applications across the board for universities. Nurses and other healthcare students now have to pay their own tuition fees, which is very challenging for them, particularly with the cost of living crisis. We used to see lots more mature applicants to nursing, but of course they’re no longer getting a bursary to support them through their studies.”
The expansion of degree apprenticeships in healthcare is providing some hope. Apprentice students can earn while they learn, and have their university fees covered by their employer (paid for via the apprenticeship levy). They play a key part in the government’s NHS Long Term Workforce Plan, across disciplines such as nursing, allied health professionals, and other clinical staff. Overall, the government aims for more than one in five (22%) of clinical staff to be trained via apprenticeship pathways by 2031/32.
Sheffield Hallam is home to the National Centre of Excellence for Degree Apprenticeships, supporting close to 3,000 degree apprentices across a variety of sectors and roles. Mossop says apprenticeships have a noticeable benefit in terms of boosting the diversity of those going into further education. Almost half (45%) of the university’s students on degree apprenticeships come from disadvantaged backgrounds, and there’s a higher proportion of mature learners compared with a traditional degree. “They’re very attractive to people who come to education a bit later,” she says. The university recently received a £460,000 grant from the Office for Students to invest in new apprenticeship standards, and will launch a new course in nursing later this year.
Lucy Ashmore is currently in her second year of a degree apprenticeship in medical ultrasound. She spent most of her professional life working part-time at a nursery, supporting children with special educational needs. There wasn’t much career progression but the hours meant she could pick up her daughter and three stepchildren from school. When they got a bit older, she realised she wanted to really focus on her career. “I started looking for jobs in hospitals because I’d always wanted to be a nurse – I ended up as a radiology assistant at the George Eliot hospital NHS trust in Warwickshire and loved it.”
She thought she’d hit an impasse when considering her career options within ultrasound. The traditional route is an undergraduate radiology degree then specialising in ultrasound if there’s space on the training course, she says. “That could take five or six years. I loved ultrasound but was 48 at the time.” When the trust announced it was starting a three-year degree apprenticeship, she jumped at the chance. “I was over the moon when I was accepted.”
Ashmore now works 37.5 hours a week over four days at the hospital and spends the fifth day studying. Online learning is complemented by face-to-face time at the university, where there are simulated wards and exercises in virtual reality (VR) to give students practical experience in a safe environment. There’s a dummy called Eve, for example, that can be adjusted for different scenarios, such as gallstones or pregnancy.
“You need to be able to practise constantly,” says Ashmore. “With VR you can take organs out of the body or move them out of the way. You can see where the muscles and ligaments are, all in 3D. It helps build up that spatial awareness.”
Ashmore’s supervisor and the AHP practice educator for radiology at the hospital, Rebecca Magrath, says degree apprenticeships have really helped the trust recruit and retain staff. “We had some good support workers who were interested in furthering their careers but were having to leave the trust to fulfil those aspirations,” she says. “Now they can see there are opportunities within the department. And when we go out to recruit for the support workforce, we are inundated. People can see there are opportunities within radiology and we’re tapping into a whole different workforce pool.”
As the Department of Health and NHS England debate how to solve the health service’s workforce challenges, Mossop would like to see the expertise of universities tapped into more. “Regionally, we’re working really hard and really collaboratively to tackle the pipeline and the challenges we have with recruitment and retention here, but nationally that picture doesn’t feel as joined up as we’d like to see. Universities are a really important part of this discussion.”
For Ashmore, doing a degree apprenticeship has given her a second chance at building a fulfilling career in healthcare. “If I’d known I wanted to do this 18 years ago, I might have done [an undergraduate degree]. But to be in the position where I can still earn a proper wage and support my family, while bettering myself and getting a career in something I love, is just brilliant.”
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