Seventy-five years ago, the establishment of the NHS was a historic achievement, representing a commitment to the health and wellbeing of millions. Initially, the service grappled with training a workforce to address health issues arising from war, poverty and diseases such as tuberculosis. Since then the population's needs have evolved, in part due to medical advancements, which have raised life expectancy by 13 years since 1948.
Today, the NHS in England has experienced immense growth, employing numerous doctors, nurses, therapists and scientists. This expansion has enabled the NHS to offer diverse care. However, there are now 112 000 job vacancies in the NHS (NHS England, 2023).
Challenges
The dedication of the NHS workforce was especially evident during the COVID-19 crisis. Yet, from 2008 to 2018, challenges such as insufficient funding, suboptimal planning, and fragmented policy-making led to chronic staffing issues, a primary hindrance to improving the NHS's service delivery (The King's Fund, 2022).
The nursing workforce crisis poses challenges for nursing professionals and potentially compromises patient safety. A recent study by the International Council of Nurses (2022) indicated that an additional 13 million nurses might be needed in the upcoming decade, which is nearly half of the current global workforce of 28 million. The Nursing and Midwifery Council's leavers' survey (2020) revealed that 21 800 nurses, midwives, and nursing associates exited the register between July 2019 and June 2020. Among the reasons cited for leaving were retirement (51.6%), inadequate staffing levels (10.8%), overwhelming pressure, stress, and deteriorating mental health (22.7%), and a negative workplace culture (18.1%). Furthermore, a report by Kline and Lewis (2018) approximated the financial burden of bullying and harassment on the NHS in England to be about £2.281 billion annually (including sickness absence, employee turnover, sickness presenteeism, legal disputes and industrial relations expenses).
According to the Royal College of Nursing employment survey (2021), a significant 57% of participants indicated they were either considering or were in the process of leaving their positions. Among those considering a departure, 47% felt that they couldn't provide patients with the quality of care they deemed appropriate, further underlining the growing concerns in the nursing sector.
Plans for change
Emphasising these challenges and advocating for secure staffing and equitable compensation is of paramount importance. Yet, this advocacy should be conducted in tandem with initiatives to enhance the workplace environment. Collaborative efforts across various sectors and settings are crucial to reinforce the health and wellbeing of staff. Such endeavours not only ensure staff wellbeing but also contribute to enhanced patient safety, quality of care, and a reduction in associated costs. To address this, NHS England (2023) has set out a strategy aiming to reduce staff shortages. A primary objective is to significantly increase student admissions to clinical training. This strategic shift prompts essential questions about the future of England's health and care sectors.
Current data from The Health Foundation (2023) shows that 1 in 9 university entrants selects an NHS clinical profession. If the NHS's goals are achieved, this figure could rise to 1 in 6 students by 2031/32. Achieving this would require significant expansion from both the NHS and universities, including the need for experienced educators. Key questions arise: how will this initiative be funded, what is the implementation timeline, and how will collaboration between the NHS and educational institutions evolve? Furthermore, the strategy's success isn't solely about creating training positions, it is also about making them attractive. As an illustration, sectors such as nursing and midwifery anticipate a considerable growth, with student numbers expected to increase significantly by 2031/32 (The Health Foundation, 2023). Medical schools also have ambitions to double their intake by the decade's end.
For academic and NHS institutions, the tasks are diverse. Apart from recruiting skilled educators, it's imperative to foster rigorous training environments for practical learning. Sufficient funding is essential, and there's a need for measures to retain staff in the long run.
A holistic approach
From its inception, the NHS has continually strived to adapt and innovate. However, the road ahead demands not only the expansion of the workforce but also a holistic approach that highlights the wellbeing of its professionals, ensures adequate funding, and fosters a positive working environment. As the NHS in England embarks on this new chapter, it is essential for all stakeholders to collaborate effectively to recognise the vision of a robust, resilient and responsive NHS for the future.