The NHS long-term plan begins to recognise that in return for the extra resources it receives from the public it has a wider responsibility to English society. For example, though it self-evidently has a role in health (and not just healthcare) it doesn’t have sole responsibility for it. Equally the plan begins to recognise that since the NHS now spends such a significant proportion of all public expenditure, it must play a bigger role in developing the whole economy.
Today I want to explore what that responsibility is in terms of the labour market and employment. (There is after all a crisis in the NHS of not enough people wanting to work in it – so the labour market matters a lot to us).
I spent most of the 1970s in Coventry and whilst there were severe economic problems for the car industry from the middle of that decade, it was always thought of as a car town. (In the early 1980s, as that industry disappeared, the Specials renamed as Ghost Town).
Whilst then (as now) I held no remit for the car industry, what interested me was the depth and breadth of the relationship that the car industry had with the whole population and potential labour market of the city. They recognised that to guarantee a continual supply of staff, they needed to have a strong relationship with schools, further education, sport and cultural life. This involved building systematic relationships through many and frequent discussions with young men and women to create the ladders of opportunity that linked community to the factories. Time, money and effort were put into creating sufficient numbers of people with the relevant skills needed in the workforce because they realised that, if just for a couple of years, this relationship didn’t work the industry would be in a very bad way. For the car industry labour was not an abstract part of production that you only considered when you advertised for staff.
It’s not that they never suffered from occasional shortages of skilled labour, but they understood that if they didn’t take significant responsibility for creating it advertising would not, of itself, produce the necessary talent.
Given that the NHS has a much bigger presence in society than even the car industry did in Coventry, (and Brexit looks to be diminishing the car industry with speed) and given how much public money the NHS spends, it’s a pity that it doesn’t show both the same responsivity (and self-interest) to create its own labour force.
To provide its skilled clinical staff the NHS expects people to turn up at universities in the right numbers and go on to work in the NHS. In the last few years about 50% of 18-year olds get A levels and go to university. The long-term plan makes it clear that it wants a higher proportion of these to go – for example – into clinical training. The plan points out that there are thousands of applicants every year who attain the A levels standards required for these courses but, because of competition for places, don’t find one. Given this shortage of numbers the argument is that course numbers should be increased.
But this only speaks to the 50% of the current younger generation who pass A levels. Given the shortage of staff, it seems positively contrary to address that problem by only talking to 50% of the young – and at the same time not address the 75% of the older population without A levels.
If we really need staff – what about looking at most of the population?
The long-term plan starts to address this by pledging an increase in Nurse Associates and talking about NHS apprenticeships. In amongst the rest of the plan these are good initiatives, but they are not given the central weight they need to make a significant difference to the NHS staffing crisis. Most of the time and effort still goes on recruiting from the minority of the population that have obtained A levels.
We have known for decades that this particular form of selection works better at denying numbers of people the opportunity to work in the NHS than at creating a ladder of opportunity for them to do so.
In fact for the majority of those seeking trained work, the NHS builds better barriers than ladders. The thing about a ladder is that to work It needs,
- to reach down to the ground where the people who need the opportunities are and,
- to have rungs spaced in such a way that people can climb up it.
What pass for ladders of opportunity for getting the majority of the population into trained work in the NHS currently have neither of these characteristics.
Instead what they look like is a couple of poles coming out of the clouds very distant from where most people live. Way up high between these poles – barely perceptible – are a few misaligned rungs that are too far apart to climb.
It could be different. Every Further Education college could have a course that if you passed would be the equivalent of 2 A levels and get you into nursing. Pass the local access course and you are guaranteed a place in nurse training.
Equally the proposed distance learning course for nurse training could – within the time of the long-term plan – be scheduled to become the orthodox way of becoming a trained nurse.
If we really recognised that there was a crisis in the workforce of the NHS, we would enlist the help of the whole population to solve it, not just the few who do well at school between the ages of 16 and 18..