Reductions in training

shutterstock_168769247 (1)

Training is incredibly important in the NHS. The NHS needs to train new staff and it needs to keep its current staff up-to-date with changes in practice and innovations. Since the decision by the last coalition Government to scrap bursaries for trainee nurses and midwives, there have been widespread impacts across the service. Applications in 2020 for clinical medicine courses increased, however the issues surrounding completion, recruitment and retainment remain pertinent. 

Nurse training places cut

In a March 2016 report the independent Migration Advisory Committee stated that the nationwide shortage of nurses has been driven by a desire from the government to save money. It revealed that Health Education England would have commissioned 3,000 extra nurse training places for 2016-17, but that financial cuts in November’s spending review meant it commissioned only 331 extra places.

In 2019, universities claimed they had warned government ministers of the threat of a staffing crisis unless more nurses were trained. They say the crisis began in 2011 when health authorities slashed the number of nursing degree places they would fund. Universities warned at this time but the then health minister claimed fewer nurse trainees were needed. What a disastrous error, in the aim of saving money, this has proven to be.

Cuts to nursing bursaries

In 2016 the previous Government announced that bursaries for perspective nurses and midwives would be replaced with loans. Since then there have been steep declines in the number of applications for nursing courses. UCAS figures for the first wave of applicants hoping to start in 2018 sees a 13% drop from the previous year. With nursing students now facing up to £60,000 in debt this is no surprise.

The latest Conservative government has since restored elements of the bursary and subsequently the number of applicants has begun to rise once more. Despite this, the previous actions to remove the bursary and reduce nursing places commissioned have had significant impacts which will even current increases struggle to counteract. Future projections suggest there could be a gap of 100,000 full-time equivalent staff by 2028/29.

After the 2019 election, the Conservatives introduced a £5,000 grant to nursing students to try to bolster applications. It is unclear just how much effect this will have in the coming years. However, recruiting new nursing students will not alone solve the crisis as there needs to be sufficient nurses to train and supervise the students.

The July 2022 report from the Parliamentary Health and Social Care committee noted that many health care assistants would be excellent nurses but are unable to afford the training because of the lack of bursaries and the affordability of hospital-based childcare.

Inadequate funding for student doctors

The NHS is reported to be short of around 12,000 doctors, but students are being put off or not completing their training due to the massive debt incurred. The financial cost also means that students are working second jobs whilst studying leading to burn-out and poor mental health.

In August 2022, the BMA reported that medical students are having to stop spending on essentials such as food, clothing and heating because of “astronomical” debts, a “broken” student finance system and a spiralling cost of living crisis.

Six in 10 UK medical students report cutting or ceasing spending on necessities, according to a BMA survey. Many are questioning their decision to go into medicine and some are considering quitting before they qualify.

More than half (53.6%) of UK medical students say they have to work during term time to pay their bills, feed themselves and keep themselves warm, the survey found, with 73.1% of those saying this adversely affects their studying.

The BMA said the student finance system is broke and in urgent need of reform.

Omolara Akinnawonu, a co-chair of the BMA medical students committee, said:

With the NHS facing an unprecedented workforce crisis, and short of more than 8,000 doctors in England alone, the government must urgently review the funding for medical students and provide the support that is needed, or risk losing talented future doctors even as it invests the funding needed to train them.”


Midwife training reduced

The lack of adequate numbers of fully skilled staff is leading to the remaining workforce being unable to keep up with training important for refreshing their skills and adding new ones.

A survey by baby loss charity Sands published in June 2022 found that most midwives across 117 UK health Trusts and Boards are expected to undertake bereavement care training in their own time.

Only 49% of NHS Trusts and Boards surveyed by Sands provided bereavement care training to staff and only 12% of those who did allowed for that training to happen during working hours.

It is not just bereavement training that is not being undertaken, midwives should be attending a number of courses to refresh and update their skills, but this can not happen if there are not sufficient staff.

RCM’s Chief Executive Gill Walton said:

What we are seeing far too often is many midwives and maternity support workers (MSWs) booked to attend vital training across a range of areas, including safety, are having to postpone. Because of understaffing, they have no choice but to stay on shift to plug the staffing gaps and to care for women and their babies. In the long run this can have serious implications for the quality and safety of care if training is not kept up to date. It’s a vicious circle. so many reports say midwives need more training, but we aren’t given enough midwives to enable this to happen proficiently.

In 2019, 56% of HOMs say they do not have the capacity in their units to take on extra student placements, despite the need for more midwives.

Increasing workloads leading to burnout

In a 2018 GMC annual survey of doctors in training it discovered that almost quarter of all doctors in training and fifth of trainers feel burnt out because of long, intense working hours and heavy workloads. Growing workloads and thin workforces have stunted learning opportunities for young doctors as well. Around a third of doctors in training and trainers said that training opportunities are lost to rota gaps.

The July 2022 report from the Parliamentary Health and Social Care committee noted that the Medical Schools Council and the Academy of Medical
Royal Colleges should be allowed to increase the number of medical school places in the UK from around 9,500 per year to 14,500.

Working conditions put off students

Moreover, despite the positive increases in numbers entering training courses there remains the issue of recruiting these students into the NHS. According to one survey completed by young people who had considered nursing, reasons cited for opting against the career was the working hours and pressure of the job. The Covid-19 pandemic and pressure associated within the workforce has led to extraordinary levels of burnout. This could have a significant impact on the future recruitment of students.

Too few training places

The July 2022 report from the Parliamentary Health and Social Care committee noted that the Medical Schools Council and the Academy of Medical Royal Colleges should be allowed to increase the number of medical school places in the UK from around 9,500 per year to 14,500.