The recently published NHS Long Term Workforce Plan (NHS England, 2023) coincides with the 75th anniversary of the creation of the NHS, and heralds a seminal plan to increase staffing levels to match the changing demographics of patients and health needs. The plan is viewed by the Government as ambitious, bold and an opportunity to redress the shortcomings of the current NHS service provision to improve patient care at the point of need. This plan not only sets the biggest recruitment drive ever seen across the NHS (NHS England, 2023), but heralds ongoing future strategic workforce planning to avoid the NHS being in its current predicament. The workforce plan has three main pillars:Train, Retain and Reform, which form the basis for a pragmatic drive locally and nationally for the short and medium term to address current workforce challenges.
The Plan makes significant pledges; for example, it aims to increase the number of GP speciality training places to 6000 by 2031/32, and 500 of those places will be available by 2025/26 (NHS Enlgand, 2023). Adult nursing training places will increase to nearly 38000 by 2031/32, of which 8000 more nurses will start training by 2028/29 (NHS Enlgand, 2023).
Nursing Associates (NA) training places will increase to 10500 by 2031/32. The target is to train 5000 NAs by 2023/24. The Plan intends to train 1300 Physician Associates (PAs) by 2024/25, and they will be expected to work in primary care and mental health services (NHS England, 2023).
Allied Health Professionals (AHP) training places will increase to 17000 by 2028/29. The Plan will see training places for clinical psychology and child/adolescent psychotherapy increase by 26% by 2031/32. The target is to train 1000 of each group per year, up to 2028/29. Pharmacists’ training places will be expanded by 29% to reach 4300 by 2028/29. Although the number of pharmacy technicians are set to increase in future years, there is no specific figures given.
Training places for dentists will increase by 40% to more than 1100 by 2031/32. This increase is supported by another increase of 500 in dental therapists and hygiene professionals by the same year. This translates to an increase of 28% by 2028/29. These three groups are seen to work closely together to improve dental health of the nation.
There is a pledge to expand advanced practice training by 46% to ensure 5000 clinicians commence training pathways each year, and universities like the author’s will continue to train these practitioners. This translates to 3000 clinicians starting their advanced practice training pathways in both 2023/24 and 2024/25. To achieve this target by 2023/24, which is now quite tight, training institutions and NHS Trusts need to rapidly agree and identify those clinicians they deem suitable to train.
There is a pledge to continue funding shortened midwifery courses for registered nurses in both 2023/24 and 2024/25 to quickly boost qualified midwifery numbers. There is also agreement to complete the planned increase in medical speciality training places by September 2024 to more than 2000 over 3 years. There will be 1000 additional speciality training places for areas of greatest needs/shortages, such as mental health, cancer and diagnostic services and elective recovery. Public health, maternity services, acute and urgent care are also included in this group. It is not clear whether the 1000 places are for each area or spread across all these areas, with the latter being a missed opportunity to properly staff these specialties.
Finally, there is a pledge to increase training places for healthcare scientists by 13% to more than 850 places by 2028/29. The target is to have 1000 training places by 2031/32, an increase of more than 30% compared to current levels.
The success of any ambitious plan such as this depends on how it is translated and implemented into reality. It is important to acknowledge that such increase in training places also requires a review of the numbers of qualified staff/teachers who will train all these professionals. Most of the skills and clinical based training require those in training to go on placements, and such places need a review to make sure they too can meet the increased demand.
It is clear from the list of ambitious targets within the Workforce Plan that palliative and end-of-life care are a huge omission, considering that people are now living longer, and will require enhanced quality of life and a dignified death. However, the only hope palliative care has is to appeal to the 92% increase in adult nursing places and persuade/attract qualified nurses to specialise into palliative care provision. Considering that most palliative care services are charitable with only 38% government funding, the Workforce Plan has missed an opportunity to redress the balance and pledge additional funding for this specialty. The way we care for the dying reflects on the compassion of our society.