The government will ramp up recruitment of nurse consultants, develop advanced practice and clinical research roles, and grow nursing apprenticeships by the thousands, according to the 10 Year Health Plan.
The major policy document, titled Fit for the future: 10 Year Health Plan for England and published earlier today, set out a range of ambitious proposals to reform the nursing workforce.
“It is good to see some deeper thought given to nursing as a safety critical profession that needs investment and development”
Alison Leary
It said these reforms would be key to delivering the government’s three big shifts for the NHS: moving care from hospital to the community, shifting services from analogue to digital and moving from sickness to prevention.
Nursing Times has unpacked and analysed the key nursing pledges in the workforce chapter of the 10 Year Health Plan.
First, the policy document set out that, over the next 10 years, training and development of nurses would be improved.
It noted that, over the last few decades, the range of clinical tasks undertaken by nurses had increased to include prescribing, some diagnosis and assessment, management of complex wounds and administration of intravenous therapies.
Nursing had evolved into a more autonomous role, with advanced nurse practitioners providing clinical leadership across the multi-disciplinary team, it said.
As such, the plan promised to develop advanced practice models for nurses and midwives “that are aligned to the delivery of the three shifts”.
It said these models would reflect “their essential leadership roles in a range of settings, including community and public health services”. However, it did not provide any further detail at this stage.
Alongside this, the plan said the government would work with the Nursing and Midwifery Council (NMC) to ensure that its advanced practice regulation was “introduced as quickly as possible”.
Earlier this year, the regulator published a new definition of advanced practice, as well as setting out for the first time the expectations for nurses working at this level.
The next stages of work in the NMC’s plan for regulating advanced practice include producing standards of education and proficiency, but this is not expected until 2027-28.
Similarly, the NHS 10-year plan highlighted how nurse consultants and consultant midwives would be involved in the government’s new ‘neighbourhood health services’.
These neighbourhood services, to be introduced across England, are set to bring diagnostics, mental health, post-op, rehab and nursing under one roof, and be open at evenings and weekends.
The plan said: “Nurse consultants and consultant midwives will play a vital role in the neighbourhood health service, providing advanced clinical care and system leadership, driving improvements in care quality, and advancing professional practice.
“We will increase the number of nurse consultants, particularly in neighbourhood settings,” it stated.
The plan said it would introduce neighbourhood nursing and midwifery leads who will act across multiple neighbourhoods “to coordinate local strategy, convene partners and represent the community’s voice”.
Examples of how nurses might lead in the neighbourhood health service include providing genomic counselling and support.
Under this new workforce model, the plan said staff must be “freed up to shape the future”.
Changes include reforms to skill mix and training to “allow more clinical tasks to be performed by nurses” which it said would “liberate” doctors to work to the top of their license.
Responding to this, Professor Alison Leary, leading nursing workforce academic, said: “The view of healthcare simply as delegable technical tasks is extremely concerning.
“Although there is a lot of positive support for nursing, we see it devalued significantly along with [allied health professionals] in this plan as a group who can simply take on some of the work of doctors.”
Further detail on how nurses and midwives can be supported throughout their careers, including progressing to advanced practice and consultant roles, will be set out separately in the chief nursing officer’s forthcoming strategy. It is not known when this is due to be published.
Government to publish new 10 Year Workforce Plan
Given the pledges in the 10 Year Health Plan, the government said it would need a “very different kind of workforce strategy”.
It noted that the first ever iteration of the NHS Long Term Workforce Plan, published in 2023, “did little more than extrapolate from past trends into the future”.
The document had promised a substantial increase in nursing staff, aiming to add 170,000 more nurses by 2036-37.
“This future is a fiction, and we reject it,” the 10 Year Health Plan said.
“Later this year, we will publish a 10 Year Workforce Plan that takes a decidedly different approach.”
The new iteration of the workforce plan will instead use the 10 Year Plan to ask what workforce is needed and where they should be deployed.
The document said: “Overall, while there will be fewer staff in the NHS in 2035 than projected by the 2023 workforce plan, those staff will be better treated, have better training, more exciting roles and real hope for the future – and so they will each achieve much more.”
Meanwhile, the 10-year plan also highlighted the need to support more students to sign up to and complete nursing courses.
It comes as applications to nursing courses have dramatically dropped in the last few years – with latest data showing that applications had fallen by over a third (34%) since 2021.
In addition, 11% of nurses and midwives also do not complete their courses, the plan noted.
It stated that, in response to these trends, education providers and employers would now be required to “urgently address attrition rates”.
It said that reducing the leaver rate of student nurses and midwives by one percentage point would result in the equivalent of an additional 300 nurses and midwives joining the register each year.
Increasing the domestic supply of the workforce is central to the government’s ambitions set out today.
The 10 Year Health plan promised to “reorientate the focus of NHS recruitment away from its dependency on international recruitment” to ensure sustainability in an era of global healthcare workforce shortages.
It pledged to reduce international recruitment to less than 10% by 2035.
This comes as earlier his week the International Council of Nurses branded international recruitment practices by wealthy countries as a “great global rip-off”.
Latest data from the NMC showed that overseas nurse recruitment had dropped by a third in the last year.
Similarly, the plan said it would recruit more domestically-trained nurses “from the communities they serve” by creating 2,000 more nursing apprenticeships over the next three years.
Areas with the greatest need would be prioritised, according to the plan, thought it did not identify which areas they might be.
These pledges come as health and social care secretary, Wes Streeting, this week trailed a range of policies designed to appeal to student nurses and nursing educators.
Among the promises were helping nursing students overcome financial obstacles to learning, supporting students to start work more quickly after finishing their degrees and speeding up expense payments.
The Royal College of Nursing (RCN) has described these changes as “modest” and argued that more was needed to boost student and nurse staffing levels.
Meanwhile, the 10 Year Plan pledges to develop skills in research and innovation by opening more research opportunities for nurses and midwives.
It said the nursing and midwifery role in research was “already expanding”, with 13% of National Institute for Health and Care Research (NIHR) money now going to studies where nurses are the lead researchers.
The document said it now wanted to “go further” and the NIHR Academy would support more dedicated funding opportunities for nurses and midwives across both its programme and fellowship funding.
Similarly, the plan promised to “reverse the decline in clinical academic roles” through a new collaboration between government and major charity funders.
This collaboration will allegedly fund a year-on-year increase in clinical academic roles over the next five years.
Responding to the overarching nursing workforce announcements, Professor Leary said: “It is good to see some deeper thought given to nursing as a safety critical profession that needs investment and development.
“But the implementation of bolder policy such as moving care to the community when the community workforce, [for example] district nurses, have been depleted is of real concern.”
More on the 10 Year Health Plan
