Diminishing the impact of skills shortages (2)

Increasing the pool of skilled labour – challenging the class barriers created by education.

In this week’s posts about the shortage of skilled labour in the NHS, I have reached the stage of suggesting ways in which we can improve the situation. Yesterday I looked at how we could value the staff we have a bit more highly and through that hold on to them. Today I want to talk about increasing the pool of people in English society from which we draw skilled labour.

What do I mean by that?

Well hundreds of thousands of people work in the NHS.  They work for an institution that has equal access for all at the core of its being. People who work for the NHS range from unskilled staff to very highly skilled staff. Given that equality is a major feature of the whole organisation, how many people going through it move from unskilled to highly skilled. How many cleaners become senior doctors?

I would be surprised if there were five.

And yet we have a shortage of skilled staff. And we are looking for skilled staff all over the world.

Why not look for skilled staff among the large pool of unskilled staff in the NHS itself? Pushing this idea even further, why don’t we look for skilled staff in the pool of unskilled people that exist across our society?

This task is a bit hard because to succeed we need to counter a whole class view and experience of education. This view dictates that your ability to do white collar skilled jobs such as clinical staff are in some way fully formed by the age of 14. Your GCSEs define your A levels and your A levels define the skill level you can achieve.

So one of the main reasons that there are skill shortages in the NHS is that the pool from which nurses and doctors are drawn is not the whole of society but only that part of it that obtains good A levels.

A levels recreate generation after generation of inequality. Yet the NHS has the notion of equal access to services running through its veins.

Time to practice a bit more equality that we preach.

How could this be done?

Coincidentally, educational qualifications outside of A levels are called ‘vocational’ and clinicians often refer to their work as being a ‘vocation’. It would be interesting to know how many doctors obtain vocational qualifications, rather than A levels, to enter training for their chosen vocation.

Vocational education in England has never reached the levels required for it to play a fuller part in any ladder of opportunity. The NHS needs this to change now.

Occasionally the NHS talks about a ladder of opportunity from the bottom to the top. But the reality is that the bottom of our ladder has a large number of rungs missing and it never really reaches to the bottom.

However, within the NHS a start has been made. Up until recently getting into nursing education hit the A level barrier. Very many people felt that that this gap in the ladder placed opportunity beyond them. However the new nursing associate role provides a new rung in the ladder. To become a nursing associate you need GCSEs or equivalence and these equivalences come from a variety of the devalued vocational sector. People can now access nursing associate training – which in turn opens up the opportunity to enter training for fully qualified nursing – through gaining vocational qualifications. This creates a much bigger pool from which to draw talent.

In 2016 1000 nursing associate training places were created and students will qualify at the end of their course in January. 8000 people from inside the NHS applied for these 1000 places.

Give people a chance to get on the ladder and they will take it.

Over the next couple of years the numbers of nurse associates will expand and if the NHS has any sense at all there should be 20000 a year training as nurse associates within a very few years. This will, for the first time, provide within the NHS a sturdy ladder to allow progression from semi-skilled NHS staff to fully skilled clinical staff.

By creating a real ladder and doing it at scale the NHS can begin to solve its skill shortages from within its own staff.

But it needs to go further.

It needs to create rungs in the ladder for the millions of people outside the organisation who would like to become skilled NHS members of staff. This could start with NHS apprentices. A few years ago the government created an apprenticeship levy for large organisations. All large organisations had to put a sum of money into a national fund for apprenticeship training. Then, if they created apprenticeships themselves, they could use the money they had put in to train apprentices in their own organisation. If they didn’t use their bit of the fund, it could be spent by the Government to create apprenticeships.

This levy cost the NHS £200 million. To use up this money they need to create 27,500 apprenticeships. If it were to do this, it would be building another rung further down the ladder to develop a skilled workforce and potentially more skilled clinicians.

If it doesn’t, it loses the money.

To find new entrants to become nursing associates and new routes to create skilled clinicians the NHS will have to turn its attention away from higher education and invest time, effort and money in further education. Not as a ‘nice to have’ add on, but as the only way to widen and deepen the pool from which skilled staff are drawn.

Skilled staff shortages are real. We need to ‘get real’ to solve the problem.