Where should we look for the people we need to run #FutureNHS? – Right here? Right now? *

The NHS could begin by helping many more staff feel that they could learn, improve their skills, and gain more qualifications (and fill vacancies!) where they work.

The core theme of these posts is to explore ways in which the group of employers, called the NHS, can work better with staff to not only retain them, but improve their welfare. And part of my answer this week is – by offering them the opportunity to learn and obtain qualifications at work and support them while they do.

I started this sequence by talking about how today’s young professionals wish to work to live. They expect to be much more in control of their work patterns and want their employers to facilitate this.

In this series of posts, I want to talk about improving other working relationships, with different staff and in a different way.

Today the NHS spends a lot of its resources searching the world for qualified staff.

I mentioned in previous posts my own recent experience of hospital care where qualified staff have come from all over the world to care for me. When I came round from my 10-hour cancer operation in 2022, the 1 to 1 nursing I received duringr those recovery hours in the critical care ward were provided by a nurse from the Philippines. Because of her I recovered well and, as I did, kept asking her, as the anaesthesia left me, why she had come all this way to care for me. (She insisted it was only 3 stops on the train…). On this ward, where every decision was pretty important, there were 12 nurses (9 from the Philippines, 3 from Thailand).

For which I, and millions of other patients, are extremely grateful. (And, as any of my readers who have been in a similar position will know, that word ‘gratitude’ inadequately expresses the magnitude of what you feel!)  BUT should this be a now continuous 80 yearlong strategy for obtaining qualified staff from abroad? Most of us would say we have to find another way. And sometime soon we will have to as more and more qualified staff will stay in their own nations.

This post argues that we should gain more of our qualified staff from inside the NHS (as well as from other local people).

Today I’m suggesting employers have two problems with the same solution.

    1. How do we create a better relationship between employer and employee?
    2. How do we employ more clinically qualified staff?

And the answer could be, why not offer staff the opportunity of obtaining those qualifications?

For decades we have come to believe that the only national pathway to NHS clinical qualifications comes through 18-year-olds getting ‘A’ levels and going to University.

This is a very limited way of obtaining qualified staff offering little to the many existing NHS staff without ‘A’ levels. The NHS might talk about building a ‘ladder of opportunity’ for staff, but the mainstream of our qualifications system has become ossified around ‘A’ levels, full time university education, and student loans.

I know, I know, there have been a few apprenticeships for a little while now. But now, in 2024, it’s time to make them the mainstream method of learning and qualifications (This will take a little while with medicine but let’s get started with other clinicians).

NHS institutions like using the analogy of a ladder. They talk about there being a ‘ladder of opportunity’ on offer for people to climb up from unqualified to qualified.

For most of the people we want to climb that ladder, what they see are two poles coming down out of a cloud. They hear a voice from on high calling this a ladder, but they can see and feel no rungs. The rungs may well start up in the clouds. But they are out of reach (and sight).

What needs to happen now is the creation of real, sturdy rungs on which people can test their own weight to pull themselves up those first few rungs and, when they can, climb a little higher.

For those returning to education and qualifications, those first few rungs are very difficult. It’s scary leaving the ground and you are unsure if you can make it. What if when you get a few rungs up – they just stop?  This all takes a lot of trust. And it’s trust your employer can help with.

Why didn’t these same people take these opportunities before, at earlier stages in their life? Many NHS employees have a wide variety (in fact a world-sized variety) of reasons for not having done so. Those who have gone through an education system in Britain will have had their opportunities restricted by experiences at school. It’s true that the opportunities were there for some, but only if you were up to taking them at exactly the right age. If you want to use education to get on when you’re aged 13-16 it could work.

If at that age you’re among those that believe – that becoming a nurse, for example, is completely beyond you – the current opportunity structure at school doesn’t work.

If you get aspirational when you’re 18 or 19 then, by and large, education as a means to fulfilling that aspiration has, for the moment, gone. Millions of people are in this category and some of them work in the NHS.

Then there are those whose education took place in another country. Take, for example, a woman who grew up in Afghanistan. If she was lucky then her school and culture encouraged aspiration. If not, there would have been little educational drive to become a nurse.

She too could be working for the NHS.

So, to cut to the chase. The NHS loves to see itself as an institution based upon equal access for all. It’s certainly better at this than many other health services. What might it achieve if, as a set of employers, the NHS took that equal access seriously by developing opportunities for qualifications for its employees.

“You’ve been working for us as a kitchen assistant for 4 years. Would you like to work for us in the clinical side. Here are the routes through apprenticeships to becoming a nurse associate”.

And in primary care. “You have been working as a health trainer for 4 years. Have you thought about becoming a nurse associate and our practice nurse”.

Those conversations only make sense if the employer (backed up by the ICB) has a set of relationships with education providers and an apprenticeship levy to make the offer real. But a caring employer would do that.

Equally it needs an employer who recognises that at the moment they really need qualified staff, and that they are spending scarce resources getting staff from other countries.

This is in the interests of both the staff and the employer.

In the next couple of days, it is rumoured that the Government will make some announcements about how it wll implement its long-term workforce plan.  We can hope that some reforms and money will be outlined to meet its planned aim to increase the number of nurse apprenticeships.

I’ll examine those in a post later in the week.

Then it will be up to the NHS employers to create the reform

(*with acknowledgements to Fatboy Slim)