Our initial thoughts…
It has been announced that record numbers of doctors, nurses and other healthcare staff including dietitians will be trained in England as part of the first ever Long Term Workforce Plan published by the NHS and backed by the Government.
The NHS Long Term Workforce Plan sets out how the NHS will address existing vacancies and meet the challenges of a growing and ageing population by recruiting and retaining hundreds of thousands more staff over 15 years and working in new ways.
The NHS plan, which has been described as a once in a generation opportunity to put staffing on a sustainable footing and improve patient care, focusses on retaining existing talent and making the best use of new technology alongside the biggest recruitment drive in health service history to address the gap.
It was commissioned and accepted by the Government, which has backed the plan with over £2.4 billion to fund additional education and training places over five years on top of existing funding commitments.
Upon reading the Plan Liz Stockley, BDA CEO says: “We’re glad to see that a Long Term Workforce Plan has been developed and by its very creation there is an acknowledgement that work needs to be done to protect and plan for the future NHS workforce. The Plan certainly has the right overall message - train, retain and reform and it’s great that the NHS will be fully resourced when it comes to the medical model. It’s also positive to see the government supporting it.
“We are excited at the prospect of increased support for the development of the dietetic workforce with increased funding for apprenticeships and advanced practice. We are particularly pleased at the inclusion of reducing the lag in the process for achieving independent prescribing and the commitment to supporting professional development in the workplace in line with the demand of our Trade Union.
“However, what we aren’t seeing is innovation and it definitely doesn’t go far enough for our members and other Allied Health Professionals. Dietetics doesn’t feature highly despite a focus on prevention, which is something dietitians are well placed to support. Given this is a 10-15 year plan there is a risk that dietetics will be left behind. We need to ensure this is not the case and we are willing to work with Government to build on the plan to realise our aspirations. Implementation will require careful scrutiny, therefore it is vital that there is real commitment to close working with the NHS Staff Council and the Social Partnership Forum.
“And of course, none of this is achievable without adequate funding. There is a commitment for 5 of the 15 year plan, so we need assurances for the long term.”
So, what are some of the key things to be aware of?
You can read the full NHS Long Term Workforce Plan here but to summarise here are our initial thoughts on what this means for the dietetic profession.
Please note the Plan is for England only but we hope devolved nations will also benefit in the long term.
Training
The Plan sets out to increase domestic education and training, increase apprenticeships and alternative routes, as well as introduce new roles.
The focus is largely on increasing the numbers of doctors and nurses. The overall increase in the workforce is estimated at 2.6-2.9% which could potentially be good news for our dietetic departments as at least teams will be more fully resourced. An additional 60-74,000 AHPs are due to be recruited, something we very much welcome, despite the fact that AHP’s will become a smaller percentage of the overall workforce once the increases in doctors and nurses are taken into account. It is vital that recruitment should be high on the agenda but the skill mix needs careful consideration and multi-disciplinary teams should be the norm and should therefore be appropriately resourced.
We’re pleased to see recognition of the valuable role support workers play in the NHS workforce by addressing their short fall, with 210-240,000 due to be recruited.
We will also see an increase in AHP education, with training places due to increase by 25% or 18,800 places by 2031/32. This increase will focus on both apprenticeships and undergraduate courses. By 2031/32 25-50% of dietitians will enter the workforce through the apprenticeship route. We absolutely welcome and fully support the development of apprenticeships and the widening participation elements and continued diversification of our workforce that this offers. However, we need to make sure that traditional HEI routes with practice-based learning (PBL) are not negatively impacted by growth in this area. PBL is needed for all learners.
Interestingly medical degrees are due to be shortened to 4 years, which we feel will undoubtedly impact on the already limited nutritional training that doctors receive. Dietitians must therefore be recognised and deferred to as the experts in the area of nutrition, supporting the case for more dietitians in all areas working closer with medical professionals.
Retention
Staffing shortfalls have been an issue since the foundation of the NHS and vacancies now stand at 112,000. The growing and ageing population, coupled with new treatments and therapies, means that without action, the gap could grow up to 360,000 by 2037.
It is suggested that a renewed focus on retention, with better opportunities for career development, improved flexible working options, alongside government reforms to the pension scheme, could mean that up to 130,000 staff stay working in NHS settings longer.
The plan anticipates an improvement of 15% in the rate of people leaving the NHS.
It highlights better support for staff health and wellbeing and good leadership, increasing flexibility for staff and for prospective retirees. Cultural change is a priority and tackling bullying and discrimination is key to retention and career progression and importantly the patient experience.
We welcome the ongoing commitment to CPD funding for AHPs, but the NHS needs to make sure it reaches staff at an individual level to support their career progression. It’s also essential that the underlying infrastructure is in situ to support this expansion, for example having the time to do it, supporting learners on PBL, preceptorship etc.
We already offer great learning and development opportunities, that we are constantly developing to meet the needs of our members, which can be found in our Learning Zone. There is potential for building these resources into clinical pathways.
NHS organisations are requested to review the NHS Health and Wellbeing Framework and the National Standards for Healthcare Food and Drink to ensure that all staff are working within an environment that supports their health and wellbeing. We welcome this and stand ready to expand our existing partnership with the NHS delivering successful, tailored interventions for staff wellbeing on how food and drink choices (and availability) can help them feel and function well at work.
And yet, when it comes to retention, the elephant in the room is pay. Without addressing pay across the NHS then achieving better recruitment and retention will be hindered.
Reform (working and training differently)
One area we have concerns about is the plan to increase productivity by 2% through operational excellence, reduced admin, technological advancements (including AI), and better infrastructure. Whilst all of this will no doubt help, the workforce is already exhausted. Recent figures from the BDA Safe Staffing Survey found that 77% stated that they suffered work related stress due to an excessive workload. Of those who were stressed around 23% suffered episodic and 58% chronic stress. Of the group who suffered from work related stress, 56% reported that it had made them unwell at some point in time.
It will be interesting to see how investment in new technology will help to close the gap and free up staff to focus on using their expertise to help patients and to see how AI will help support staff further too.
We welcome the NHS’ commitment to Advance Practice Pathways, going up to 6,300 clinicians by 2031/32. Our workforce is well positioned, capable and already demonstrating excellent work in these areas.
We’re pleased to see they are seeking to grow the number of ARRS roles in general practice by around 15,000 by 2036/37 but we want to see more detail and to see that this is for all professions, including dietitians.
The NHS’ commitment to Preceptorship is welcome, although only briefly mentioned for other roles. Preceptorship is just as important for AHPs as it is for doctors and nurses.
AHPs can and do play a significant role in preventing ill-health but their current involvement is not reaching its full potential. The Plan doesn’t acknowledge the diverse skill sets dietitians have in supporting people to manage complex conditions and in their prevention. They can support early interventions and prevention in a range of long-term conditions/significant areas including cardiovascular health, malnutrition, frailty, obesity treatment and prevention, diabetes etc. allowing for early dietary and wellbeing interventions before costly prescriptions.
We’re encouraged to read that prevention is recognised as vital in addressing demand but this must be delivered by a cross-government approach to tackle the growing inequalities in health.
