Private sector pulls its weight
More than 15,000 medical professionals were trained in independent healthcare settings in the 2022-23 financial year – despite under half of provider respondents reporting not having received any funding to support training. Now the private sector needs to do even more, says David Hare.
When the Elective Recovery Taskforce was convened in December 2022, its challenge was quite clear: better utilising the independent sector – and patient choice – to help reduce NHS waiting lists.
At that point, two years since the end of the National Hospitals Contract, three things had become very clear.
First, the full, efficient utilisation of independent sector capacity is essential to reducing NHS waiting lists.
Second, dealing with workforce challenges is going to be a major factor in sustaining the elective recovery over the next decade.
Third, with ever growing numbers of patients turning to private care, the contribution of private providers to training the next generation of clinicians was going to come under close scrutiny.
One of the actions that the Independent Healthcare Providers Network (IHPN) took away from the taskforce was the creation of a baseline dataset on clinical training in the independent sector.
Little data
Remarkably – considering its importance – there is very little routine data collected and published on clinical training within the NHS, let alone outside of it.
Conversations around training have always presented a challenge for the private sector. Anecdotally, we know that some really great work on developing the clinical workorce takes place in the sector, but, a few case studies aside, it has historically been hard to refute accusations of the sector taking staff from the NHS and not giving back to the ecosystem through training in return.
Our new report, In Train, demonstrates for the first time that this view couldn’t be further from the truth.
Based on a survey of IHPN members who, between them, account for more than 90% of NHS activity delivered in the independent sector in addition to their private work, we can now confidently tell the story of training in the sector. And on the whole, it is a fantastically positive story.
In the last financial year, the sector supported more than 15,000 learners, including by delivering more than 11,000 placements for trainee clinical staff.
We think that is a really strong number – IHPN membership employs about 80,000 clinical staff – and is a clear sign of the importance that independent providers place on training the future workforce.
The nursing workforce is clearly an area of real focus and success. The sector delivered more than 5,000 nursing placements in 2022-23 and supported more than 300 graduate nurse training programmes.
Overall, there is one nurse in training in the sector for every four nurses employed by independent providers – a really significant contribution to the health sector’s training delivery.
Success repeated
This success is repeated among radiographers, physiotherapists and other allied health practitioners, with 6,000 placements combined over these roles and more than 1,000 graduate training programmes.
We have identified some challenges, of course. The IHPN and our members are working hard to ensure that more junior doctors can access placements within the sector.
This has always been a challenge due to often highly-specialised nature of independent providers’ delivery models – and because of accreditation on training and access to learning support.
But during the Covid-era National Hospitals Contract, the sector was able to support several thousand doctors with their training and we think there is scope to vastly expand the number of junior doctors who can receive part of their training in the sector again going forwards.
Role of apprenticeships
Another interesting aspect that the report highlights is the increasing role of apprenticeships in training the future healthcare workforce.
NHS England’s Long-Term Workforce Plan focuses on apprenticeships as a key means to develop a sustainable workforce pipeline. And the independent sector is already taking a lead here – some 1,045 clinical apprentices were employed in the sector last year, with many providers already having plans in place to expand their apprenticeship offer.
Still, the report does flag some of the barriers to improving the training offer. Despite the overall use of apprenticeships closely mirroring that within the NHS, only half of independent providers currently make use of apprenticeships.
There are several reasons for this – access to academic capacity and support for upskilling in maths and English have been raised before.
Different settings
Perhaps of greater interest though is the challenges faced in non-traditional healthcare settings.
It’s very easy to train a new clinician in a large hospital, where they have access to multiple specialties and a wide range of procedures all in one location. It becomes a much greater challenge in community settings or in a sector where many providers deliver care in a single specialty.
Some providers told us that they have explored offering degree-level apprenticeships for nurses, but, because of the nature of their work, would be unable to offer exposure to the full range of areas needed to satisfy the NHS Knowledge and Skills Framework.
Clearly this is an area for future improvement. One suggestion is a greater focus on passporting within training – allowing training placements to take place across multiple providers, sharing support infrastructure where appropriate.
This would, of course, represent a major change from how things have worked in the past. But as care delivery models evolve, it is likely that exploring these different models of training will benefit NHS providers as well as support more learning in the independent sector.
NHS can learn
We also think there are many areas of training where the NHS can learn from independent sector innovation.
Our report shares several fantastic examples – whether it be members partnering with universities to deliver foundation degrees on radiotherapy or developing their own training programmes to enable staff without any prior clinical experience to develop a career in healthcare as scrub technicians or clinic and theatre assistants.
IHPN and the sector as a whole are committed to a sustainable healthcare workforce. Indeed, the future of the sector depends on it.
So, over the next 12 months, we are going to be working closely with NHS England and the Department of Health and Social Care with a focus on identifying and resolving barriers to the sector delivering even more training, so that the great work that we see across the country can be allowed to grow and develop.
David Hare (right) is chief executive of the Independent Healthcare Providers Network (IHPN)