Policy Adviser, Horia Teodorescu looks at the data on the health workforce pipeline, exploring what is required for a future sustainable NHS workforce.
The government’s 10-Year Health Plan is expected this summer. For the NHS, it represents a major opportunity to build a health service fit for the future. Successful delivery of the plan will drive growth and prosperity by ensuring access to high-quality healthcare, which is key for individual well-being, increasing productivity and reducing economic inactivity. Universities, as civic institutions, are critical partners to the ambitions of the plan. Outside of their critical research and innovation in the health sphere, universities stand ready to further strengthen their partnerships with the NHS to deliver the workforce pipeline that the future health sector depend upon.
In 2022-23 alone, the higher education (HE) sector’s first-year intake across all health courses was 76,300 students, amounting to one in nine of all first-years. However, we need to go even further. Back in 2023, the Health Foundation estimated that, in order for the NHS workforce to grow in line with the country’s needs, the proportion of first-year higher education students in England training to be NHS clinical professionals would need to increase by 50%, to one in six (125,700 students) in 2031–32.
Such a systemic shift requires a long-term strategic ambition that sets out the direction of travel and offers confidence to universities as they consider expansion to support the NHS. The Long-Term Workforce Plan (LTWP) published in 2023 aimed to do just this, and while there was room for improvement in its design, both operationally and strategically, there remains significant value in the 10-year Health Plan preserving a workforce growth plan that defines milestones and addresses key challenges that universities and the NHS face in this area. This includes placement capacity, student interest in healthcare careers and burdensome regulatory processes.
Figure 1 - UUK analysis of HESA data, first-year, first-degree, England institutions only
Universities are anchor institutions and key partners to both the NHS and local communities. They train the country’s future health workforce and also provide key skills needed to support the NHS across key areas such as engineering, construction, AI & digital and management. Universities also drive innovation that delivers productivity gains, including via commercialised research and reimagining teaching practices to respond organically to local and national health needs, like simulators or virtual wards. Universities work closely with Integrated Care Boards (ICB) and trusts across all these vital areas and are ready to deepen their cooperation, including on clinical placement capacity.
The latest data from the Higher Education Statistics Agency (HESA) and the Department for Education (DfE) reveal the key role of universities and other higher education industries in sustaining and growing the health workforce pipeline. As student demand for health courses picked up during the pandemic – in part due to health workers inspiring prospective applicants during the crisis – universities expanded provision across both traditional degrees (Figure 1 – 21% growth across Medicine & Dentistry, Allied health and Nursing & Midwifery from 2018-19 to 2021-22) and alternative routes such as degree apprenticeships (Figure 2 – starts at Levels 6 and 7 for Health, Public Services and Care standards increased more than six-fold between 2018/19 and 2022/23). More recently, undergraduate applications have seen a minor decline as the pandemic effect has disappeared (Figure 3) – this illustrates long-term challenges around securing a sustainable pipeline into health careers.
Figure 2 - Apprenticeship starts in Health, Public Services and Care, Levels 6 and 7
Figure 3 - UCAS applications trends, Main Scheme Applications only, UK wide, UK and International applicants, 2018/19 = baseline
Universities play a key role in addressing cold spots in healthcare provision, rising to the challenge of meeting local or regional workforce needs. For instance, in September 2024, the University of Portsmouth launched the first branch medicine course in the UK, in collaboration with King’s College London (KCL). The 54 new students are the first in the UK to study medicine in a branch of an established medical school, making use of donated funded places from KCL. This branching model illustrates how innovative HE collaboration can help address workforce gaps in areas such as South of England, where there is a severe shortage of general practitioners.
Universities are ready to work with the government and the NHS to respond to future workforce needs, but we must also collectively address challenges which span both the demand (student interest) and the supply (provider and clinical capacity) sides of the pipeline.
Universities are ready to work with the government and the NHS to respond to future workforce needs, but we must also collectively address challenges which span both the demand and the supply sides of the pipeline.
Nursing and midwifery face particular recruitment challenges following a peak in interest during Covid. Between 2021 and 2024, nursing applications went down by 26%, while midwifery went down by 38%. In our response to the NHS 10 Year Plan consultation, we called for concerted action by government, the health service and the HE sector to boost demand for courses leading to these careers. This includes having robust information, advice and guidance for school leavers and adults, as well as a public campaign to attract people into the profession. We also need diverse entry routes - to strengthen and widen the NHS recruitment pool, the government should ensure there is sustainable funding for higher and degree level apprenticeships and that learners across all ages can access these routes.
Student demand for medicine and dentistry remains strong. However, it is important to consider the financial implications of clinical expansion in these areas, including the high-cost element of the Strategic Priorities Grant and the cost of growing placement capacity. While the recently published grant letter to the OfS provides a cash protection to high-cost subject funding in 2025-26, in the long term, sustained investment will be needed to support and expand provision. The government should support deeper cooperation between the health and education sectors to ensure that university provision planning can address national and local health needs in a financially sustainable way.
The government should support deeper cooperation between the health and education sectors to ensure that university provision planning can address national and local health needs in a financially sustainable way.
Across all provision pathways, there is a particularly strong need to further enhance local partnerships, including between universities and ICBs. With proposed changes to ICBs, universities may need to build new relationships, particularly at the regional level. There is an opportunity to share effective practice and develop solutions tailored to different contexts, including the use of appropriate funding levers, innovation in teaching methods and improved data intelligence.
An effective workforce will be essential to the successful realisation of the three strategic shifts that the NHS will need to undergo as identified in the Darzi report: from analogue to digital, from caring in hospitals to caring in communities and from treating sickness to preventing it.
Securing this workforce will require both a sustainable education pipeline and the upskilling and retention of the existing health workforce. Universities are ready to strengthen their existing partnerships with the NHS to deliver these objectives and help build a health service that will enable individual wellbeing and economic growth.
