5,000 extra trainee nurses places: What does Jeremy Hunt’s pledge really mean?

Jeremy Hunt’s announcement of 5,000 more nurses has perhaps been greeted with some scepticism – another government revised announcement or an empty promise? There is no doubt some confusion about what is happening and how, but the pace of development in health education at the moment is incredible. Government policy, vision by professional bodies and regulators, and a willingness to work in different ways by employers and education providers have all contributed to a growing revolution in workforce development in England, which may go some way to achieving the government’s targets.

Funding for nursing students

The removal of the bursary for pre-registration health programmes has been heavily debated over the last year, with predictions of reduced numbers in training. That hasn’t been the case at the University of Derby. We have seen increased numbers of adult and mental health nurses joining the programme this September, which had been possible because of strong working relationships with local employers. There has been nervousness around the introduction of student loans, but closer inspection reveals more money being available to students while training than under the bursary scheme. Even more encouraging, we seem to have recruited our usual mix of mature as well as younger students, but this traditional training model will be only one of the ways the nursing workforce will be developed going forwards.

The role of nursing associates

The introduction of the nursing associate role earlier this year has offered new opportunities for support workers to develop their skills. The high number of vacancies in the NHS is challenging and the traditional three years of training required to become a nurse means that there isn’t a quick fix to this. The nursing associate follows an apprenticeship model (and is set to be an apprenticeship before the end of the year) and offers a robust training programme over a two-year period. The nursing associate role is designed to complement the nursing role, not replace it, and will bring a higher level of knowledge and skills to the workforce. They are not ‘untrained’ as some suggest – the apprenticeship model is designed to offer training both on and off the job. Nursing associates will need to demonstrate both practical skills as wells as completing a two-year qualification at university, ultimately achieving registration with the Nursing and Midwifery Council.

Nursing and the Apprenticeship Levy

The introduction of the Apprenticeship Levy in April 2017 has, undoubtedly, encouraged employers to consider how apprenticeships can be used to develop employees. While apprenticeships have been used for many years, policy changes and introduction of the Institute for Apprenticeships has seen new apprenticeships being established with more to come. The nursing degree apprenticeship was approved in May 2017 and the first degree apprentices started in the East of England in September. More will follow and Derby hopes to offer the nursing apprenticeship from March 2018. Again, this is not an easier or less robust alternative, it is just an alternative. Apprentices will still need to meet all of the requirements laid down by the Nursing and Midwifery Council, they will still need to pass a university degree, but they will be able to work alongside their training and earn a salary.

The aspiration is that the apprenticeship routes for nursing associates and nursing will allow employees to develop their skills and gain a university qualification without having to leave their job – the ‘earn while you learn’ model. The two-year nursing associate training could be followed by an additional 18–24 months of nurse training leading to registered nurse status. There are an enormous number of skilled and knowledgeable support workers in healthcare who, given the right opportunities, will be able to deliver even better care to patients. But there is a cost associated with this. Employers will need to provide a salary while nursing associates and nurses complete their apprenticeships, perhaps for four years, and this needs to be balanced against the wider needs of their organisations.

The government’s message of more training places and ‘earn while you learn’ is very attractive for those seeking a career in healthcare, but places in apprenticeships and at universities will still have to be earned by applicants. The apprenticeship routes will offer real alternatives for learners, employers and educators. Importantly, this is available to employers outside the NHS in a way that the previous commissioning method wasn’t, and so independent healthcare providers can also develop their own workforce. It is not just the NHS that needs more nurses and allied health professionals – many are employed by private healthcare providers and this route offers them the opportunity to invest in workforce development not previously seen.

So, will we see 5,000 more nurses in training?

It’s hard to say. We will see more innovation, we will see new roles developing, we will see more apprenticeships and real opportunities for both NHS and independent healthcare providers to develop their workforce. In Derby and across the East Midlands, we have been working with employers to make sure that we have a range of innovative alternatives for those seeking to enter a career in healthcare, those wanting to return to their career and those wanting to develop their career further. Healthcare needs to change to reflect the changing needs of the population which means that the workforce needs to change too. We can’t fix it overnight but we can be ready to offer the alternatives that Hunt suggests and work with employers, regulators and policymakers to make sure we do all we can to help.